The bandwagon has been making the rounds noisily, with trumpets and tubas, raising consciousness about the Opioid Crisis. It's just my nature; I tend to take bandwagons with a grain of salt. Not to mention pendulums swinging. Don't get me wrong, the Opioid Crisis is real, and I'm glad it's getting attention. However my fear is that pain sufferers, particularly those with severe or chronic pain, are going to be thrown under the bandwagon.
This article https://www.vox.com/science-and-health/2017/8/3/16079772/opioid-epidemic-drug-overdoses states that "... the problem in part on the opioid epidemic began in the 1990s, when doctors became increasingly
aware of the burdens of chronic pain. Pharmaceutical companies saw an
opportunity, and pushed doctors — with misleading marketing about the safety and efficacy of the drugs — to prescribe opioids to treat all sorts of pain." Pain was spoken of as the "5th vital sign" and patients were asked to assign a numerical value to it (for instance on a scale of 1 to 10). Research indicated that chronic pain actually changed the way the brain worked. Now this is being called into question. However nowhere have I seen studies indicating that the research was wrong.
PSTD is a way in which trauma, including pain, does in fact change the way the brain works.
This is an article in which a sufferer of chronic pain expresses some frustration with the hype now surrounding pain and its treatment: http://nationalpainreport.com/rebutting-media-hype-about-opioids-8831149.html
Some research indicates that most deaths involving drugs actually involve more than one drug; people mixing them, or mixing them with alcohol: https://www.theguardian.com/us-news/commentisfree/2016/jun/08/opioid-epidemic-drug-mix-overdose-death
Those raising the alarm say that they are only interested in stopping addiction, and not keeping drugs from those who truly need them. Somehow it reminds me of the welfare reformers and that elusive category, the "deserving poor". It is to be hoped that things won't just go from pain being the "5th metric" to "bite a bullet and offer it up!"
I will be in favor of the bandwagon against the Opioid Crisis when I see that resources and funds are also going to be directed to better ways to control pain than opioids, which tend to wear out their effectiveness over time, and have undesirable side effects. There is a lot of good research out there; it needs to be funded.
I was reading that a third of the US populations lives with chronic pain. I hope the reaction to the crisis doesn't cause people in pain to lose their prescriptions. I take Advil for pain. One doc wanted me to switch to a narcotic but I was too worried to change. Strange - when I was a teen I tried a lot of recreational drugs but now I try to avoid all that ;)
ReplyDeleteI've only had opioids prescribed a couple of times (I guess Darvocet is an opioid), once after a tooth extraction, and another time after surgery on a broken elbow. I only took a few of the pills, they made me feel strange and gave me nightmares. It seemed like plain Tylenol or ibuprofen worked just as well.
DeleteThat's my experience too. I was given Vicodin when I had a root canal and once after surgery I got morphine in the recovery room. It must be hard to function if one is taking these kind of drugs on a daily basis, but I guess if you're in terrible pain, you just want that to stop.
ReplyDeleteI told my physical therapist when I started my stint there this summer that I didn't expect to be pain-free given age and infirmities, I just wanted to be able to sleep through the night without the damn sciatica waking me up several times. She told me two interesting things:
ReplyDelete1) Insurance companies are cutting payouts for physical therapy; it's cheaper to pay for drugs than PT, especially since many patients don't
comply with the PT regime anyway.
2) Older patients come in with a variety of health problems in addition to whatever precipitated their PT visits, and expect to be cured of all pain in a few sessions.
I explaines to her that I can't take n-saids because of bleeding risks, and I have to use Tylenol sparingly because the cancer weakens liver function.
The PT recommended massage, and this has reduced all pain symptoms. When you hurt, you get tense, and when you're tense you hurt more.
Again, insurance won't pay for it--it's $60 a month--but insurance WOULD pay for painkillers that are more expensive.
I think the way we view pain, the fact that we are an ailing society that wants quick fixes in pill form, and the mistrust insurance companies have in more "high touch" therapies all contribute to the opioid crisis.
Jean, you really know how to limn out America the Beautiful. Vacationing in Germany's Black Forest region, I could only get a place to stay at a spa area. There, Germans were taking die Kur. Pools, hot baths, massage, PT. They seem to be opposite our philosophy which is probably good for corporations which is all that matters here.
ReplyDeleteDemand for massage therapy is up in the U.S., but it is expensive for low-income people, especially if you can't get to the spa and tjey have too travel to you. We had a massage program at my college where I could get a full-body hour-long massage once a week. Always the off chance one of your students would see you in your skivvies, but the effects were pretty astounding. The program folded when the director retired. The biggest problem I find are the gals who want to blab and chat. I also don't care for the aromatherapy, space music, and aura readings. Just the massage, please, no woo woo.
DeleteJean, it's too bad the program folded at your college. It's one occupation where someone can make halfway decent money in a health field without a string of degrees.
DeleteJean,
ReplyDeleteI kind of know how you feel. I wake up almost every night because of arthritis pain in my knees - I walk around for a while of play mahjong on the compute. I take 600 mg of Advil every 6 hours. Too hard to get to PT ... maybe after I win the lottery and buy a robot car :)
Can you get home PT sessions with Medicaid? I looked up sciatica exercises on YouTube just for fun, and they're the same exercises the PTs did for me. The problem is that with a knee, you want to know how bad it is so you don't make it worse.
DeleteIce is about the best pain killer for arthritis for me, given that I can't take much in the way of pain killers without risking a cerebral or gastric hemorrhage.
Pillow between knees to ankles helps, but legs keep slipping off! Duct tape?
I don't know about Medicaid and home visits of PT - must learn more. It is great how much one can find out via the internet. There are even PT sites with advice about exercise. One thing that's supposed to help is drinking milk ... http://www.webmd.com/osteoarthritis/news/20140407/drinking-milk-may-slow-knee-arthritis-in-women-study-finds#1
ReplyDeleteUsed to be a big milk drinker, but, like many women of a certain age, suddenly became lactose intolerant. I take calcium supplements. Yogurt and cheese in in small amounts at OK.
DeleteMaybe lactose free milk would still work for helping joints? The study showed it was only milk that would help, not cheese, which seems odd.
DeleteI don't know if Medicaid covers chiropractic treatments, but Medicare does. Seems like it should cover massage therapy too. But the difference is having the clout of a large professional organization pushing it, also a lot of money lobbying for coverage. Which the massage people probably don't have. Chiropractic has some borderline ethical problems in my opinion, even though it really does seem to help some kinds of problems. My dad goes to a chiropractor occasionally, his main problem is that 70 years of being a farmer-rancher has taken it's toll. Massage would probably help more, but that's way too foo-foo for him.
ReplyDeleteThere ought to be a statistical study of pain reduction from massage therapy. That might help the practitioners and patients gain some traction for more acceptance from doctors, as well as insurance coverage.
I think the opioid crisis is about more than pain control, to go back to Katherine's point. It's about economic despair and addiction. So yes, there is a tendency to just cut EVERYone off opioids, even cancer patients and others who need them. My oncologist gave me a weird lecture about opioid use, even though I do not take them and did not ask for them. I feel sorry for her patients who need them.
ReplyDeleteI don't know that throwing money at opioid abuse really helps. Better labor laws and working conditions might help with the economic despair.
Addiction's tougher. Twelve-step programs still seem to be the gold standard, but the recovery rate is low, probably even lower given their notion that "relapse is part of recovery."
Lots of addictive personalities in my family. One forced off a benzo she'd been taking for 40 years prescribes by doc to curb drinking. Ended up in ER on withdrawal, back on a lower dose, and life now revolves around finding a new doctor who will crank the dose back up while she drinks to supplement the lost benzo.
I think addiction is equal parts genes, untreated/untreatable underlying mental health issues, and moral failure (enjoying the addiction and to hell with anything else). Not a popular view, but I've seen addicts who I think need to be in institutions for their safety and that of others.
I think part of the problem is the lingering feeling that addicts are bad people and that being addicted is a morally bad thing. Maybe in a way this opioid problem, one that people from all walks of life are caught up in, will help to change that. I think I must be psychologically addicted to the Advil - I get very worried when I start to get to the bottom of a bottle. But it's over the counter and no one can really stop me from taking it, so it's ok.
ReplyDeleteAddiction is a medical disorder, and likely has a genetic component since it runs in families.
ReplyDeleteUnfortunately it is viewed as a moral problem unlike a lot of other things such as high blood pressure, obesity, and depression which also likely have a genetic predisposition.
Mental health boards here in Ohio used to serve only the mentally ill. We have the ability to put levies (property taxes) on the ballot. Boards did a good job educating the public about mental illness. My county board even put an additional levy on the ballot targeted on children's mental health serves. We got an unheard of 60% of the vote.
When boards got responsibility for alcohol and drug addiction we tried to educate the voters and pass a levy for treatment. We got something like 40% of the vote. A lot of voters want to lock addicts up and throw away the key.
While there is likely a genetic predisposition to addiction, circumstances also predispose people to addiction.
ReplyDeleteMentally ill people have a higher incidence of substance abuse. They often try to solve their mental illness by self medication. This is even true now with opioids. One individual who died locally had a rare form of schizophrenia. Fortunately a psychiatrist diagnosed it; unfortunately the person was too far into opioids to get weaned off them, and died of an overdose.
Yeah, like how genetics has a role in why some people of Asian ancestry might be affected differently by alcohol ... Research on alcohol metabolism among Asians and its implications for understanding causes of alcoholism.
ReplyDeleteSorry, but I don't feel much empathy for addicts, so good thing I'm not in the mental health field.
ReplyDeleteI'm all for needle exchange programs, getting addicts off the streets and into safe housing, treating underlying mental health problems, and getting them medical care to get them over the withdrawal.
But I will never be persuaded that there isn't a moral element involved. Addicts choose to use, and then walk around spreading chaos to everybody else.
Jean, I respect your personal experiences. Addiction does run in families; no one in our extended families has had that problem.
DeleteHowever one of my aunt's had a life time disability of severe depression. She was not easily to deal with. She lived with my grandmother, and took over the house when Grandma died, and basically lived alone very reluctant to see any of us. She was a religious fanatic into faith healing etc. and went from church to church until they found out she was ill. But it eventually ended well, she accepted placement in an assisted living home, and did quite well there, we visited her frequently.
I am happy that your aunt ended up in a good place. Depression isn't addiction, of course.
DeleteI'm sure in your profession you have been to Al Anon meetings and have seen the toll that addicts take on other people. In fact, the more a family member tries to "help" an addict, the more the helper gets sucked into a morass of enabling and feeling responsible, while the addict simply continues his love affair with the drug.
I'm not against trying to curb addiction, but these efforts are utterly useless unless an addict wants to stop.
I just have no idea what you spend money on, beyond basic care, that will do any good.
I think that given the right circumstances, any of us could become addicts. I don't see any moral element in that throw of the dice. There but for fortune ...
ReplyDeleteMy last word is that I think there is a difference between addiction and dependence. Jim's spouse depends on pain medication to function at normal levels. Someone who self-medicates for depression or schizophrenia is shooting for normality.
ReplyDeleteBut an addict wants to function at abnormal levels--to alter reality, to feel high, to create drama, to be the star of his own show and assign parts to everyone else.
In taking the moral element of responsibility out of addiction, addicts will continue abuse.
I don't think that's so. I think people use drugs, alcohol, cigarettes, for all kinds of reasons. Probably most of them don't believe they will become addicted. Once they are, I think it's an incredibly hard place to get out of for most people. I thank my lucky stars I didn't become addicted to any of the drugs or alcohol I used in the past and I feel sorry for those people who haven't been as lucky as me.
ReplyDeleteOne person I really like is Eric Clapton. He was a heroine addict and an alcoholic for years. The thing that saved him from that was rehab help that was non-judgemental and which saw his problem as an illness rather than a moral failure. After he got better, he opened a clinic for other addicts.