Thursday, July 3, 2014

The Many Faces of Pain

Pain comes to all of us during our lives. Whether it is physical pain brought on by an injury or an illness or emotional pain stemming from loss, stage of life difficulties or other psychological struggles. Everyone will feel its searing sting, but how we deal with it is not only an individual decision, but a legal one as well.

Considering the two types of pain brought on by a diagnosis of cancer or other illness which may mean and end to our lives, we see that it can be both physical and, surely, psychological pain. Who can effectively tackle the diagnosis that tells them that they have a few months or years to live? I'm not saying that all cancers are terminal, but all of them carry with them both components. The physical pain can be managed, and I find that word "managed" a bit annoying, with a variety of legal, prescription medications.

The psychological pain of such a diagnosis can also be death by suicide. This despite the use of prescription medication and psychotherapy which may include group and family therapy. While the psychotherapy can lift some of the burden from all involved, it may not be adequate to handle the physical pain. We do know that physical pain is exacerbated by stress and it is here that the therapy helps, but there's still a need for more and that comes in the form of substances.

What substances should we be using to alleviate the pain of individuals? I am not speaking specifically about medical pain but psychological pain as well. Not all psychological pain, in my opinion, is effectively ameliorated by therapy and there should be no stigma regarding substance use. We are, unfortunately, a nation which has placed legal restrictions on pain relief and we have labeled those who seek non-prescription relief as criminals or "addicts."

 If we truly applied the term addict to people using an incredible variety of prescription medications would the stigma still exist? Should we call everyone with disabling physical pain who take something like Oxycontin an addict because they take it every day and there's no indication they will ever cease using it? Anyone taking marijuana for pain relief of any type, whether it be physical or psychological pain, is also an addict? Should we strictly limit the use of this herb in any context in the belief that it's a "gateway drug?" Think about it. Do you know that there are still, I believe, chapters of AA that do not allow any use of any psychotropic meds and in some instances, of which I've been made aware, they don't even allow the use of aspirin. Aspirin? Are they for real? On what would these experts base that? Beats me.

Psychological pain can be so disabling that it is a recognized reason to receive disability payments. Of course, you get an appropriate diagnosis because psychological pain is never measured as it would be for physical pain. But it is no less painfull and disabling and it leads people to seek out help wherever they can find it. Should we condemn them for this?

Pain is pain and our aim should be its alleviation, not its stigmatization for using substances for everything but the most limited of illnesses. It is an illness and, frankly, we still don't know what causes this pain we call depression, anxiety and panic. It may be caused by genetics, injury, virus, immune system insufficiency, birth problems and even neural development. Who will set themself up as the "decider" of what is ok and should be treated (and in fact determine the only appropriate treatment) and who is to be shamed, arrested and allowed to suffer? Suffering helps no one.  It can lead to desperation and, too often, suicide. Better to let someone kill themself than for them to use something to help them get through the day?

Sure, you could say I'm advocating something like the illegal underground of substance distribution outside the legal constraints of pain relief.  But I'm not. I suppose, then, I may be in the company of a number of European countries and States in the US that have seen no reason to panic and reason, instead, to help. But not all states make marijuana, specifically, readily available to pain patients and they may not take these marijuana products out of the state where they purchased it. So, we're thinking marijuana drug mules here?

Have you heard of the new move to "underprescription" of sleeping medications for the elderly especially? The elderly, according to geriatric medicine specialists, suffer from sleep disruption several times during the night. As one physician put it, "It's part of aging." Lovely. In order to get a night's sleep without interruption, many elderly persons receive sleep medications but the move now is to take them off these medications because "they really don't need them." Excuse me, but if you're over 80 and living in a nursing home or at home under difficult circumstances, aren't you entitled to a full night's sleep? The elderly also suffer more physical pain because of numerous medical illnesses which disrupt sleep. Oh, but you don't need more than six hours of sleep so why should you get more? Oh, or maybe, you're addicted and we have to stop that at any cost even though you may only have about 10 more years or less to live. Will you begin selling your illicit meds to street dealers and become a drug dealer or "drug seeking" patient? Heaven forbid.

Heroin was seen as an excellent substance to control cancer pain, but it was an illegal drug even for terminal cancer patients. In Europe, they began using it in hospice programs and the relief was not only immediate, but manageable. In the US, heroin meant drug dealers and street corner transactions, the emergence of drug lords and the use of military-grade weapons.  Our fear of something that could have been used in a productive way turned it into a multi-billion dollar underground economy that has decimated whole areas of countries like Mexico and Colombia.  The curious thing about heroin is that we have provided financial support to countries that grow opium poppies, the main source of producing heroin after a bit of manipulation.

Should persons with intractible back pain be subjected to useless injections that, in the past, have been found not only to not be helpful but contaminated.? When the MDs offering these shots know they work perhaps half the time and can cause very serious problems should they continue using them? Ah, yes, at least 50% of the people will get relief. But here's another curious problem. The FDA sent out an advisory to these docs about the use of the meds and which ones were to be discontinued.  Someone did a follow-up and found that the docs were disregarding the advisory. And the reason would be...? Get a shot from a doc ("effectiveness and safety of epidural administration of corticosteroids have not been established") and suffer a stroke or death but don't use anything else like marijuana? Correct me if I'm wrong, but I haven't heard of any adults dying from eating a marijuana brownie. Have you?

Pain relief in any form or in limited forms? Pain is disabiling and we should be looking for better ways to treat it, not limit things that can do a very good job while maintaining that person in their lives in meaningful ways.

Do you still subscribe to the mentality that produced "Reefer Madness?" We're not talking roofies here.