Thursday, August 13, 2015

It's Not About the Meds, It's About the Pain

We are a nation in pain.  

According to the National Health Interview Survey conducted by the Centers for Disease Control and Prevention here in Atlanta, more than 25 million of us experience pain on a daily basis for a minimum of 90 days. That's 11.2% of adults in this country.  And a full 126 million adults (that's nearly 56% of us) reported some type of pain in the 90 days leading up to the interview.  

We try to fix it with drugs.  

Once upon a time, acetaminophen was a wonder drug.  And then we realized it carries significant risk of liver damage at high doses and with long term use.  At one point we thought ibuprofen was the answer.  And then we learned that heart attack and stroke risk significantly increase with its use.  At one point (hard as it is to believe), we thought opioids were the long-sought-after solution to the problem of pain.  That's led to the largest man-made epidemic in history: thousands of overdose deaths per year, more Americans addicted to pain meds, entire generations disappearing from some towns, and a lot of other scary statistics and awful outcomes.

And when those don't work, we pin our hopes to potential future drugs.  

Researchers at Memorial Sloan Kettering Cancer Center are working on an investigational compound, IBNtxA.  It's an opioid derivative that appears to provide the analgesic effects of an opioid without the risk of respiratory suppression or the "high" that comes with typical opioid use.  While this is great news for cancer patients (where pain medication is not only useful, but critical to compassionate treatment... which is why Sloan Kettering is working on it), it begs the question: what side effects and unintended consequences will result from the long term use of IBNtxA?  And to what extent are the psychotropic effects of our current opioids the real drivers of use (vs. their perceived analgesic effect)?  We have no idea, but history tells us we should proceed cautiously.

So what do we do?  

We have to find ways to manage the vast majority of chronic pain without pharmacological assistance.  Should some people with chronic pain be allowed to benefit from sustained use of medication therapy?  Absolutely.  But too many millions of patients are relying on dangerous and ineffective medications to manage an underlying issue that is only partially explained by biological factors, completely ignoring the social and psychological barriers to recovery.

Our pain, collectively and individually, is here to stay until we start thinking less about the pain and more about the person.  

On Twitter @PRIUM1


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