There is still hope for chronic pain patients
Re: “Restricting opioids caused my husband’s death,” by Meredith Lawrence, July 25.
It was with great sadness that I read the guest column in The Tennessean by Meredith Lawrence, whose husband ended his life after his doctor dramatically reduced his pain prescription.
I myself am a board certified pain specialist in the Middle Tennessee area and have practiced pain management for 22 years. I spend every day “down in the trenches” taking care of all kinds of pain patients with the majority being injured workers in the worker’s compensation system.
I fight the battles every day trying to provide safe and cautious management with and without opioids, trying very hard to carefully select the appropriate patients for whom “narcotics” are medically indicated.
It is very hard to make that decision sometimes as pain is so “subjective” and difficult to measure. I believe it comes down to deciding simply if the benefits outweigh the risks, no matter whether we are prescribing opioids medication, ordering invasive injections, writing anti-inflammatories or recommending surgery.
We also cannot forget to address the very prevalent emotional issues of chronic pain. It takes a lot of time and effort to make these decisions. There are definitely certain patients who deserve opioids as there are no other alternatives. But in reality, there are other alternatives in many of these cases.
Sometimes addiction management is the answer. But the health care provider must take the time to discuss, educate and consider such options and avoid the temptation to quickly write the pain pill and get out of the room.
I have been shocked to see how well many of my patients have done by slowly weaning down the narcotic and gradually transitioning to other treatments — good manual physical therapy, acupuncture, cognitive behavior therapy with a psychologist, yoga, health nutrition/anti-inflammatory diets, weight loss with gym memberships, essential oils and supplements, and other treatments.
Patients are not addicted many times to these drugs, but are simply very psychologically dependent and fearful that there are no other options. I have many patients who come off the multiple pain pills, muscle relaxers, nerve pain medications, and sleeping pills and come back and say, “I still hurt, but I feel so much better. Now what can we do?”
However, we must get insurance companies to pay for these alternatives and we must have access to these options in the smaller communities. We must try to prevent many patients from going down the “road of no return” of opioids in the future. The new laws for acute usage of opioids will help this greatly. But we must still use our training to choose the patients for whom opioids are appropriate to maintain quality of life and function without excessive risks. As one author said in a pain journal, “We must never lose our professional compassion for those in chronic pain ... We just have to be smarter in the management of their pain.”
So, in the genuinely heartfelt opinion article of Meredith Lawrence, when she said, “What are the other options for these 45,000 patients (without pain medication)?” I want to say there are options and hope is not lost.
But we as physicians must help patients through this crisis. We all have to work together to achieve this goal.
Jeffrey E. Hazlewood, M.D. is board certified in physical medicine and rehabilitation and pain management.