Redefining Pain Management 2

On Tuesday, April 24 House Bill 1 was signed into law by Governor Beshear creating stricter regulations on the practice of pain management. Whereas time will determine the effects of the bill, the need for public attention and re-evaluation of pain management is great. Forty years ago, one of the greatest fears to becoming ill was not death but rather the pain of disease. From the scarcity of pain treatments arose a global initiative shedding more light on quality of life and pain control. Gradually that pendulum began swinging in the opposite direction, and today it is clear the pendulum may have swung too far.

In 1986, the World Health Organization (WHO) published its now famous protocol on pain management commonly referred to as the “Pain Control Ladder.”

At the time of publication, the average US opiate consumption was 30 mg of Morphine Equivalents per person per year; in 2009 it exceeded 725 mg, over a 20-fold increase. Whereas the WHO ladder was initially developed for malignant pain, such as cancer, it gradually found use in non-malignant conditions with ever-expanding indications.

All too often, patients with treatable causes of pain such as joint, back, or neck pain are sustained for years on escalating doses of opiates while ignoring other more sustainable treatments. In doing so, the injury progressively evolves and the pain medication loses its effect. Among those with pain conditions are also patients who have inadvertently become tolerant of or even dependent on opiates. Unfortunately, there has been a national scourge of “pill-mills” and healthcare providers masquerading as pain specialists. Whether unethical or simply poorly trained, these individuals have misrepresented and stigmatized the noble purpose of controlling and rehabilitating pain.

Kentucky has the 5th highest rate of opiate abuse in the nation and rates 6^th in opiate overdoses according to the CDC. The overdose rate has nearly quadrupled in the past decade and prescription drug abuse now exceeds the abuse rates of illegal substances such as cocaine and heroin. Aside from the societal costs, non-medical use of pain medication costs the national healthcare system $72.5 billion.

House Bill 1 is intended to curb this trend by targeting sham pain clinics, but the public also needs better understanding of legitimate pain management so as to discriminate between those committed to healing and those with less-noble intentions. Legitimate pain clinics do not simply write for narcotics, but rather seek the reason for pain and address the underlying causes. Ignoring the cause and solely treating the symptoms can eventually lead to further degeneration and disability. Physicians formally trained in pain management spend over 5 years in residency and fellowship after medical school learning how to comprehensively address pain in a safe and sustainable manner.

If necessary at all, opiates are only a means to an end and not the sustaining force of therapy. Pain is a symptom, not the disease. So, just as how a broken bone needs mending and rehabilitation, not just pain treatment, most injuries warrant more than just symptomatic pain control. Other modalities like behavioral modification, focal nerve blocks, non-invasive procedures, and rehabilitation exercise are needed to treat the source of pain and prevent its relapse.

Our bodies are incredibly resilient and have an amazing capacity to heal. The public needs a greater understanding of pain management. There is a substantial difference between clinics that promote addiction by simply dispensing narcotics and those that really help by treating the underlying cause of pain. As a community, we need to support professional centers who want to help us live healthier lives while seeking sustainable solutions to the opiate abuse problem that plagues the state.