In the city where I live, there’s a huge crisis/controversy at the moment involving homelessness coupled with drug – specifically heroin – addiction. I’ve also seen a lot of national news stories lately dealing with the growing heroin problem. There is an odd mixture of censure and compassion in these reports; camera shots lingering lovingly on images of heroin needles, reporters looking grave as they agree that the problem rests, in part, in the over-prescription of opioids and their subsequent abuse, and that something should definitely be done to help addicts and to limit the availability of these medications. Cue a shot of a pharmacist’s hand briskly counting out pills.
I know that, as a society, we tend to look for the easiest solution to complex problems, and it is easier to talk about pain medication than dive into the greater swamp of addiction, poverty, the need for mental health care, family trauma, and the fact we pander to pharmaceutical companies. But let’s at least include the voice of those of us who actually need these meds. They never seem to ask an actual chronic pain sufferer to come on to talk about the situation from our point of view. There might be a tiny mention of how many chronic pain sufferers there are (studies show that chronic pain affects more than 70 million Americans and costs more than $100 billion a year) or how studies show that chronic pain isn’t even helped by opioids, but that’s about it.
Legislators don’t seem to be aware of our point of view, either, since they are passing laws to restrict access to opioids; laws that – quite frankly – don’t do anything but make our lives a little harder and the shaming a little stronger. I’m not meaning to get up on my soapbox (I would need too much help) but this is definitely a more complex issue than how it is being presented, and not all the sides are being heard from. (As I write this, I am starting to see the chronic pain bloggers firing up and posting about this topic on the Internet, which is great as it gets another side out there.)
Why are there no news programs on people who really need opioids and are suffering due to the actions of abusers? And why is everyone so complacent and judgmental about it being a problem, without thinking about other solutions; like encouraging drug companies to study pain and make something new? Our society appears to prefer preventing one addict from being formed than treating a hundred suffering. In part, this is because of a misunderstanding about the difference between addiction and dependence. Those who take opioids become physically dependent on them, and can suffer withdrawal-like symptoms upon stopping, but symptoms decrease through dose-tapering. Addicts are unable to taper drug usage because they experience overwhelming craving for the drug. The rate of addiction for chronic pain patients with no history of addiction is extremely low. I, in fact, have gone through detox while switching from one pain medication to another and it was a painful, deeply uncomfortable – and yet successful – process. A few more news reports about this might help.
The other main problem is that pain, in general, is so poorly understood, researched and funded, that few doctors specialize in it. I’ve been in pain for years and I’ve only just started reading about it. Did you know that as recently as the fifties, doctors thought that children didn’t suffer pain, so they were not given medications during surgeries or for injuries? Pain is complex and subjective; being able to actually track it in the brain is a recent development. It can be incredibly difficult to describe pain to physicians, and prove that it’s not “in your head.” There are even different kinds of pain, something the average person might not know. I, personally, describe different pain in words like; “hot,” “pulsing,” “tooth-achey,” “sharp,” “dull,” “sore,” and, “gritchy.” (Hard to explain that last one, but I bet you pain sufferers know what I’m talking about.)
Pain is a natural and necessary response mechanism of the body that, if prolonged, can become an actual disease on its own, not just a symptom. Given enough time, pain can rewire the central nervous system, causing pathological changes to the brain and spinal cord. Eventually, the body is unable to return to normal functioning. The longer that pain pathways relay their messages, the more pathways are created and the more efficient those pathways become. Someone who suffers pain long enough will be more sensitive to future pain; even if it’s not extreme, it will register as high pain. Our nervous systems are complex things and apparently when they get ramped up for action, they don’t easily slow down.
In The Pain Chronicles (a must-read!), Melanie Thernstrom http://melaniethernstrom.com/ quotes a survey where chronic pain patients said that their pain was, “a normal part of their medical condition and something with which they must live. One third of the patients said that their pain’s severity was sometimes so bad they want to die.” Why do we think this is something that people want to experience, just to get pain meds? Because I’ll tell you, if I were to take a poll of chronic pain sufferers/opioid users, I’m pretty sure it would skew heavily in one direction: the direction of, “You can take this s*&t because we don’t want to! The addicts can have it.”
Because the studies are right – to a degree – opioids don’t take care of all the pain; nothing does. There’s always a faint pain echo under the chemical scrim; chemicals we’re not too happy to have swirling around in our systems, either! We don’t need meds for fun or recreation, and we are not addicts. I feel for families who have been hurt by addiction but we have a voice, too! We would prefer not to be in pain at all, but until that’s possible, why are we punishing legitimate users? Why isn’t anyone creating a better option in their multi-billion-dollar labs, instead of just talking about the abusers, or removing the only option we do have? Because the problem of pain isn’t going away, and it’s not just “in our heads”… it is in every part of our lives.