The Problem With Pain Pills: A Letter to Mr. Barry Meier and The New York Times
Recently, a piece on opioid medication and chronic pain was published on the New York Times Well blog. The article, entitled The Problem With Pain Pills, focuses on author Barry Meier’s ‘expertise’ re: problems associated with pain killers. Barry Meier is the author of e-book A World of Hurt: Fixing Pain Medicine’s Biggest Mistake, which explores long term consequences of prescription pain medication, including addiction, death, additional health issues, and how pain killers often do not work for many patients.
However, Barry Meier is not a pain specialist.
In fact, he is not even a doctor.
He is a New York Times reporter. And here is what he had to say about opioid usage and “why doctors and patients resist giving them up” while talking to New York Times Well Blogger, Tara Parker-Pope.
Before I dive in, please go and read the article for yourself. I urge you to leave a comment with your thoughts or send the New York Times, Tara Parker-Pope, and Mr. Barry Meier your thoughts.
We’ve seen this before. The fear-inducing vocabulary surrounding any conversation of pain management when it involves pain killers, and of course, vast generalizations of patient groups and chronic pain as a whole. That pain killers work for some patients is rarely discussed at length, if at all.
While Mr. Meier briefly (and I mean very briefly) acknowledges that “they work well for some patients,” he is quick to discuss the side effects that come with opioid medication.
And he is right about one thing: these medications come with risks and side effects that should not be taken lightly…which is exactly why having a specialist overseeing your pain management care is vital. But where is the discussion about responsible medication use and physician oversight? Nowhere to be found in this article.
Speaking of risks, I’d like to point out that many drugs come with the risk of tolerance. Not just opioids. Tolerance is not addiction. I’d also like to point out that the side effect of fatigue is minimal compared to the fatigue many patients experience as a direct result of severe, systemic pain.
We keep having the same conversations about how opioids have risks, how they can be (or are) dangerous, how they are used incorrectly or irresponsibly, how they are abused, the list goes on and on.
But we aren’t talking about comprehensive pain management. We throw the concept out there without including medication as a part of a comprehensive pain treatment model. We aren’t talking about how to use medication as a part of a comprehensive model. We aren’t talking about patient responsibility. We aren’t talking about treating chronic pain without fear being a part of the discussion— no, I don’t mean risk assessment, I mean fear. We aren’t talking about how to use these medications responsibly. We aren’t reading about stories of people whose lives have been improved by pain medications (and commentary about how they are used responsibly) and we are not hearing from ePatients in the public media.
When asked if doctors are questioning the use of opioid medications, Meier explains that "there is probably a real shift going on in the medical community” re: pain killer usage, and goes on to quote a “leading expert” (who remains unnamed) on this shift: "we thought the big problem with these drugs is addiction. Now we realize the problem is with patients who take them and basically opt out of life.”
That, my friends, is a word for word quote. Opt out of life.
While I do not doubt that some patients with some forms of chronic pain do indeed opt out of life, I’m going to go out on a limb here and say that for many of us, pain medication allows us to OPT FOR LIFE.
So what is a patient with chronic pain to do? Here is what Barry Meier suggests as an “antidote to dependence on these drugs:”
There are plenty of data suggesting that a multidisciplinary approach to chronic pain works as effectively as high-dose opioid treatment. Patients experiencing chronic pain for whatever cause will be put through a program where they receive intensive physical therapy, behavioral counseling, intensive psychological counseling.
One of the problems with chronic pain – there’s a lot of catastrophizing around it. People think this is the way it’s going to be for the rest of their life, and that they are trapped in this horrible pain and it’s only going to get worse. There is tremendous anxiety associated with that. They not only end up taking pain drugs and strong narcotics, but they take a lot of anti-anxiety medications as well.
Catastrophizing, ah. Spoken like someone who has never experienced a day of chronic, systemic pain. To touch on it adequately, I’d need a separate blog post. Who is catastrophizing here, exactly? Is it all chronic pain patients, or is it this author?
I’d be here all day if I tried to explain the kind of pain I experience on a daily basis or explain to you how many times I was told I was catastrophizing or had my pain invalidated by someone who couldn’t fathom that I functioned in spite of my pain (in part thanks to pain killers).
I would be here all day if I tried to explain how tears in the rheumatologist’s office are not always indicative of a mood-instability problem, but of a pain problem— one that is FREQUENTLY under-treated.
To stigmatize all chronic pain patients as catastrophizing people and suggest assigning a one-fits-all program for “whatever cause” a patient might be facing instead of a tailored approach for individual patients is downright ludicrous. It reminds me of when we stigmatized women as “hysterical,” surely we remember that generalization in regards to chronic pain.
With all this talk about how exercise, physical therapy, and different treatment modalities need to be utilized, Meier fails to take into account that chronic pain often keeps patients from doing these very activities that he suggests will resolve chronic pain.
It took me three years of medication (both immunosuppressants and pain medications) and multiple surgeries to get me to a point where I can now get on a treadmill, take a walk around the block, and do physical therapy twice a week.
I take 10mg of oxycodone on a full stomach before I get on the treadmill. I patch myself up with lidocaine patches. On good days, I don’t take pain meds. On okay-days, I take tramadol or ibuprofen if my pain is low enough. On bad days, I take oxycodone. Without it, I could not achieve my exercise goals— the pain is excruciating.
I take supplements and eat foods known to decrease inflammation. I learned healthy coping skills and meditate. I use ice and heat. I use non narcotic medications. I have tried acupuncture and I use a TENS unit. I used methadone under the supervision of a doctor after a surgery that got me the nickname the ‘woman cut in half’ and stopped it once I healed. I have had spinal epidural injections and I will be pursuing nerve blocks next. Yet here I am, Mr. Meier, still using pain medication as one of many tools in my pain management toolbox. I am not addicted. I am not dependent. I have not increased my dose nor have I developed opioid induced hyperalgesia. Psychological and/or behavioural counseling will not cure my pain and neither will physical therapy.
I am not alone. I am not rare. Mr. Meier, I urge you to go look at the hash tag #motionislotion on Twitter and see the many chronic disease patients using exercise to help chronic pain. I’d bet a good 2/3rds of them if not more are also using opioid pain medications.
Mr. Meier fails to take into account the patients— real people with real conditions— that rely on these medications. We are not all work injury cases. We don’t all have slipped discs. Many of us are chronic disease patients, with everything from vasculitis to cancer to ulcerated colons to trigeminal neuralgia to hypermobile joints that dislocate themselves. Many of us went from having active lifestyles to having a disease (or multiple) turn our lives upside down, and yet we still keep on going, rebuilding a life with chronic pain.
Most of us have incurable conditions. Many of us do not ever reach remission; many of our conditions were not identified early enough, some of us have diseases that are difficult to treat or entirely resistant to treatment, while others build up antibodies to the few therapies out there.
A fellow pain management and chronic disease patient Hannah Baartmans says it best: pain management is a lifelong process.
We are not a small number. We are millions of chronic pain patients with chronic diseases. We are runners, we are walkers— some of us wheelers. We are students, we are teachers. We are paramedics and we are stay at home parents. We are people, sometimes disabled yet still productive citizens, that opt to live the best life possible while coexisting with pain the likes of which I susepct you, Mr. Meier, do not have any experience with.
We don’t opt out of life. What we opt out of is being left out of the pain pill discussion. What we opt out of is being discriminated against at the pharmacy when we fill one prescription a year for pain medication— the same pharmacy where we fill Methotrexate and have paperwork on file verifying our conditions. What we opt out of is being treated like criminals for wanting to treat our pain. What we opt out of is the red tape that makes our rheumatologists and other specialists afraid of using these pills at all. What we opt out of is the red tape that makes getting medication difficult for patients with documented systemic diseases, even when we follow the rules.
We do not deserve the stigma that comes along with using pain killers; we are not addicts or “druggies.” We do not deserve the discrimination that comes from doctors, pharmacists, or “experts” like yourself that certainly seem to have no first-hand experience in treating chronic pain.
We deserve better advocacy, comprehensive pain management without fear and stigma,
we deserve to be a part of the conversation, and a part of the solution to the pill problem in this country.
Tara Parker-Pope, I do hope you follow up with discussion and commentary from an ePatient advocate (and if you are not familiar with ePatient advocates, check out Stanford Medicine X) or someone not ignorant on the subject of pain management. This article is not only insulting to patients and doctors, but it is filled with misinformation. Next time you want to make such statements, consult a pain specialist. Preferably one that went to medical school and has experienced chronic pain.
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