Perspectives in Intractable Pain Management
An analysis of current diverging viewpoints
Patients' Perspective
Intractable Pain Goes Unrelieved and May Result in Depression and/or Possibly Suicide
Millions of patients require pain relief, yet most are met with inadequate and inappropriate pain treatment and often cannot find physicians to help them. Most doctors are unable to help pain patients because they are unaware of opioids’ effectiveness in treating pain without threat of addiction. Of those doctors who are educated in pain management and who do help pain patients, many are threatened by state medical board investigation, are in the process of being investigated, or have had their medical licenses revoked.
Unrelieved pain can bring about emotional and psychological effects, such as impaired sleep, loss of appetite, anxiety, frustration, anger, isolation, and depression. As pain continually goes unrelieved, pain lowers self-esteem and can even result in thoughts of suicide.7,8
Desperation for adequate pain relief results in pseudoaddiction
As patients get more and more anxious about not receiving adequate amounts of pain medication, desperation sets in for the search to find the physicians who will prescribe the optimum opioid dosage level to relieve their pain. This pain relief-seeking behavior—known as pseudoaddiction—should not be mistaken for addiction.14 The difference between the patient seeking pain relief and the addict seeking euphoria is that patients stop searching for more opioids after their pain is relieved, addicts constantly search for more narcotics to get high.5
Pseudoaddiction is not unusual for intractable pain patients since inadequate pain treatment is so common. One pain patient who has been suffering with lower back pain since 1997 wrote to the National Foundation for the Treatment of Pain and explained his hardship in acquiring adequate pain treatment. He said that his primary care physician continually refused to treat his pain. Eventually, he did find an orthopedic physician who supplied adequate pain relief; but after a while, his insurance ran out, and he was forced to go back to his original physician because his orthopedic physician wasn’t in his new plan. Again, his primary care physician continually refused to treat him. The patient added, "It would have been easier for me to rob the Raley’s Pharmacy at gun point in broad day light on a crowded afternoon then it would be to get pain medication from this doctor. At this point I was completely put out and, not to mention, still in pain."
Suicide and physician-assisted suicide
Desperation resulting from unsuccessful attempts to find physicians to adequately treat pain eventually leads to patients feeling a low sense of self worth that ultimately leads to depression. One patient wrote to the National Foundation for the Treatment of Pain, "I’m not living. I’m existing."
As people "exist" with unending pain for years, considerations of suicide or physician-assisted suicide may result. Those patients who consider suicide usually have lost hope that they will ever find anyone to help them relieve their pain. When asked why they want to die, most patients say it’s because they can’t stand the pain any longer. "Pain is the reason Jack Kevorkian has been so successful," says Dr. Mitchell Max, Director of the Pain Research Clinic at the National Institute of Dental Research.
The National Foundation for the Treatment of Pain received a letter from a patient who has been in pain for 13 years. She said, "Suicide isn’t a matter of consideration, it’s only a matter of time. The constant pain robs me of the strength to go on. I told my husband two months ago that I didn’t know how much longer I could stand it—how much longer I could search or wait for help…It is absolutely unacceptable for any cancer, leukemia, or chronic pain patient to have to consider a ‘Kevorkian’ method due to the lack of a pain pill."
60 Minutes featured a story on David Covillion. David had suffered injuries from a car accident in the late 1980s and had been receiving adequate pain relief from his physician, Dr. William Hurwitz. In 1996, Dr. Hurwitz was brought up on charges by the Virginia state medical board for prescribing too many opioids. Eventually, Dr. Hurwitz lost his license to prescribe opioids. Four weeks after Dr. Hurwitz’s license was revoked, David made a home video in which he said, "It’s pretty damn stupid that the only person I can get to help me, they turn around and take his license away from him. No, Dr. Hurwitz isn’t the only doctor that can help. He’s the only doctor that will help because all the rest of them are a bunch of scared wimps! Suicide was not what I wanted. Pain treatment and control is what I wanted." The next day he committed suicide.9
Dichotomy in pain
A dichotomy exists in society on the topic of pain. Society generally does not support opioid pain treatment because it doesn’t understand the safety and effectiveness of opioids’ pain relief. However, society does support physician-assisted suicide most when it involves intractable pain.17 Opposers to physician-assisted suicide, such as the American Medical Association, hope to educate society about appropriate pain management so that suicide does not remain a solution to relieve pain.17 |
