Treating severe pain – the dilemma

While I am from Canada, and we seem to have a fairly good mandate to use opioids for chronic pain in our province, it is not always so in other provinces. Chronic pain MUST be treated, with whatever works. Unfortunately, these drugs come with numerous side effects on top of their ability to be misused.

I am living through hell right now watching someone close to me titrate up and down over the last four years to manage pain and side effects. On top of that, we have had discussions with “people in charge” at the insurance company who insist that this person is addicted. I have argued that dependence and addiction are not even close, as the psychological manifestations of addiction are not evident in this person’s behaviour. They don’t want to pay, so he is labelled- until someone advocates. I have charted the prescriptions – 120mg per day down to forty down to 0—-all to settle at an average of 70 over the last two years due to how the injury presented, was treated, and then returned. Doing that became a lifesaver emotionally and psychologically, and even legally, as then I could point to a piece of paper that said what and how the doses were adjusted and for why.

The DEA in the States scares me, as these individuals, like insurance agents are always so on the lookout for the abusers that all who use the medication are painted with the same brush. There is no reason, only a fallacy that All People Who Take Drugs Are Abusers.

If Canada goes towards more privatization of health services I truly believe that these chickens will come home to roost in my back yard as the system and common sense break down. It is not hard to see that in a ME FIRST society that everyone suspects each other of being as selfish and devious as themselves- not a slam against Americans( I have relatives and friends, who are American…) but a real comment on how individualism perpetuates a certain suspicion. Trust me, there are downsides to a more socialist style of government, as our wait list problems attest to. Governments can be less responsive to problems than private companies to their clients needs. (Not so much these days, though, with managed care insurance co’s) And people take advantage of “liberal bleeding hearts” and people are just generally self serving. It is a philosophical political comment- NOT AN INDICTMENT!!!!!!!!!!!!!!!

I don’t know- what is the solution. How does it happen that people actually CARE about the invisible, unmeasurable chimera that is pain. Can you make people give a sh@#$??? Maybe if somebody REALLY famous and cute got into major pain we could collectively start to care about them and it could spread that this does happen and people are at wit’s end, and NEED this stuff. Rush Limbaugh may have been in pain, but he certainly is not cute. And as far as I know he hasn’t done Oprah yet so that we can all feel sorry for him- he just kind of bypassed it.

Cynicism and sadness live at my house- I just hope I am never in the situation where the police kick mine or my doctors door open because of a freaking pill.

My grandmother died from lung cancer. When diagnosed she got three months to live. At this point she was already is a lot of discomfort so they started her on a course of morphine. About a month and half into things my mother went into get the next batch of morphine. It turns out the hospitol just didn’t have anymore. I am not sure why exactly-it was a public county facility though. The hospice nurses were really upset along with my garndmother who got to suffer for two days without any pain meds. The nurses came back with a liter of morphine.

When my grandmother died they dumped about half of it down the drain. Those were some stoned sewer rats.

I have watched friends suffer in great pain because of government interference with pain management. If you live in a civilized country like Canada your pain will most likely be addressed. I have seen friends subjected to psychobabble biofeedback programs that teach patients to ‘cope’ with their pain. Unfortunately in some parts of the country this is actually considered legitimate medical practice. I would love to see one of these asshat ‘psychologists’ deal with cancer pain with ‘biofeedback’. I wish every DEA agent could experience great pain for one day and then we’ll see how concerned they are about ‘diversion’. There are bad apples everywhere but innocent patients should not have to suffer because of the actions of a miniscule number of miscreants. The government does not belong in the practice of medicine. Which of these DEA thugs has a medical degree anyway??