by Susan Austin Yoder
A principal argument for physician-assisted suicide is that every individual should have the right to determine just how much pain to endure. Likewise, proponents of legalizing marijuana for medical purposes argue that it is wrong to deny patients relief from the pain of debilitating disease.
Just what is this unendurable pain we're trying to escape through drugs and suicide? And, as a nation, how do we support and succor those who daily must endure agonizing physical pain and the ravaged economic and social well-being that accompanies such pain? And if we successfully address the problem of chronic pain and suffering, doesn't the moral quagmire inherent in physician-assisted suicide than go away?
Chronic pain is one of the nation's most costly health problems, estimated at nearly $50 billion in medical costs, lost income, lost productivity, compensation payments and legal costs, according to health care experts. And the majority of its victims are the middle-aged and the elderly -- both groups that are growing in their numbers.
The impact of chronic pain can be devastating to patients and their families. It can impair sleep and appetite and trigger anxiety, frustration and depression. Over the long haul, pain can cause lower self-esteem and bring on significant psychological problems. And as many of Dr. Kevorkian's patients could have attested, chronic pain can destroy the will to live.
"My mother has suffered with chronic pain for three years. She has degenerative disc disease and her spine is deteriorating. Medical specialists say her condition is inoperable and incurable. But no one will take responsibility for prescribing narcotics to make her more comfortable. They fear repercussions from the state medical board. They commiserate with her plight while they treat her like an addict looking for her next 'score.' After leaving each doctor's office, we feel abandoned and defeated."
--A daughter in Virginia
--A son in Illinois
Traditionally, pain management has not been a priority in the American health care system even though the problem is costly in terms of both its human toll and its financial impact on society. Instead, our health care policies and practices contain serious financial, legal and social barriers to effective pain management.
Health care professionals lack training in pain management and often do not realize its importance. Cost containment too is taking a toll -- shortened hospital stays and reduced home health visits leave less time for providers to diagnose, educate and treat pain patients. Cost control also is reducing the availability of more expensive but more effective pain treatments and drugs.
Finally, the underutilization of narcotic pain killers is a major contributor to the undertreatment of chronic pain. According to the Medical Board of California, "...exaggerated fears of opioid side effects and addiction, and fear of legal consequences when controlled substances are used" also interfere with effective pain management. This fear of addiction, and legal prosecution, leads many doctors to turn away chronic pain patients, further impeding treatment.
These fears are placed in perspective by the Medical Board of California in its ground-breaking work on the use of controlled substances for pain. "Physical dependence and tolerance are normal physiologic consequences of extended opioid therapy and are not the same as addiction. Addiction is a behavioral syndrome characterized by psychological dependence and aberrant drug-related behaviors. Addicts compulsively use drugs for non-medicinal purposes despite harmful effects... Patients with chronic pain should not be considered addicts or habitués merely because they are being treated with opioids," the Board's May 1996 statement concludes.
They get their drugs through criminal means. They tend not to use drugs to hold down jobs and to increase their function in other socially productive ways. You know, Doc, with all the crack house doors I've kicked down I haven't found any chronic pain patients."
The State of California formed a coalition of more than 120 leading health care practitioners, educators, academicians, professional association representatives, pharmaceutical manufacturers, health care consumers, pain patients, regulators, law enforcement officials and legislators. This group identified and recommended solutions to the "legal, professional and educational barriers to effective pain management."
Effectively treating chronic pain in this country must begin with an awareness that there is a problem. Solving that problem will require a holistic, multi-disciplinary approach, like that taken in California, in each and every state.
As we address the issues of Medicare and Medicaid reform, assisted suicide and the legalization of marijuana in our society, let us not forget to ask: How do we respond to the one in nine Americans who suffers excruciating, intractable pain? And is suicide, with or without the help of a doctor, a viable treatment for chronic pain?
The debates raging over physician-assisted suicide and the medical use of marijuana are bringing the issue of chronic pain to the forefront of our collective national consciousness -- where it belongs. What is this thing called pain?
Chronic, or intractable, pain is defined as acute pain lasting more than four to six weeks. An estimated 30 to 50 million Americans suffer from chronic pain -- pain that will continue for months or for a lifetime. The causes of chronic pain are many. Low back pain is the most common and afflicts about 15% of the population. Accidents and athletics leave many the victims of unending pain. Add to that the host of diseases that cause severe, long-lasting, non-terminal pain and you have a significant health issue. Chronic pain -- first person singular
The voices of care-givers often tell the story best...
"My father died of an embolism three weeks after suffering a broken back. He had rheumatoid arthritis and severe osteoporosis and was in agony the last three weeks of his life. A nurse refused him when he asked for pain medication. The doctor had ordered the medication -- demerol -- but the nurse said it was 'just too much' medication. I've never seen a nurse question the insulin my Mom needs to live. This goes beyond doctors fearing the DEA. There is an anti-narcotic hysteria in this country that is so pervasive even nurses are caught up in it."
Barriers to effective pain management
Less scientific, but perhaps more telling is this police officer's Internet "post" addressed to doctors surfing the Web:
"I'm a cop and I've known a lot of criminal drug users. Here's how you can spot them: They have no medical condition that requires drugs. They are chasing the dragon and must use ever-increasing amounts of drugs to catch him. They kill, maim, rob, rape, kidnap, torture, steal and lie to get their dope -- Sound like your patients?Where do we go from here?
Susan Yoder is a Washington, D.C.-based freelance writer and editor, and is also copy editor for IntellectualCapital.com
Reprinted with permission
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Email: ChronicPain@angelfire.com
