Siobhan Reynolds
On the Pain Crisis

On the off chance that others remain unconvinced that there is indeed a terrible pain crisis, I will offer some thoughts which might help shed light on this situation.

The World Health Organization has said that undertreated pain is the number one health problem in America. Further, I quote from an APS study:

FEBRUARY 17, 1999, Glenview, IL - More than four out of every 10 people with moderate to severe chronic pain have yet to find adequate relief, saying their pain is out of control, according to a new survey released today by the American Pain Society, the American Academy of Pain Medicine and Janssen Pharmaceutica.

The survey of 805 individuals also revealed a population of sufferers who often don't receive the type of care experts consider necessary -- despite the fact that nearly half have switched physicians at least once and more than 50 percent have been in pain for more than five years.

"Many Americans with chronic pain are suffering too much for too long and need more aggressive treatment," says Russell Portenoy, MD, president of the American Pain Society and chairman of the Department of Pain Medicine and Palliative Care at the Beth Israel Medical Center in New York City. "This survey suggests that there are millions of people living with severe uncontrolled pain. This is a great tragedy. Although not everyone can be helped, it is very likely that most of these patients could benefit if provided with state-of-the-art therapies and improved access to pain specialists when needed."

A majority of all survey respondents reported some difficulty doing such basic activities as sleeping, doing chores at home and walking. These problems are accentuated among those whose pain is very severe (8, 9 or 10 on the pain scale) -- of whom nearly one in five had been forced to visit an emergency room at least once in the past year due to their pain.

Among those with very severe pain, almost a third (29 percent) had switched physicians three or more times. The most common reasons for the decision to search for a new doctor were "too much pain" (42%), the perception that their last physician did not know a lot about pain treatment (31%), the belief that their doctor didn't take their pain seriously enough (29%) and the physician's unwillingness to treat their pain aggressively (27%).

Pain Treatments: Too Little Too Late

Despite the fact that "opioid" drugs, such as morphine and the fentanyl skin patch, were rated the most effective treatments by those respondents who had used them, these medications were seldom used.

This was from a 1999 study, back before the Government Crackdown on Pain Care. Unfortunately, patients die of conditions related to the sedentary lifestyle imposed on them by the undertreated pain and so would not be said to have died of the pain, yet had they been treated for the pain, they would not have succumbed name it. High blood pressure, cardiac arrest, cancer, adult-onset diabetes, etc. You would have to use your imagination to figure out how else a body might deteriorate if it didn't function, and was continually stressed, unable to rest or move or even eat properly, but as you have a medical degree perhaps you will do that on your own time.

Suicides are concealed by the patients who do it because they want to enable their families to get whatever small benefit they might have coming to them for death of the non-suicidal variety like car accidents. If the patient doesn't commit suicide or becomes a drunk, patient's families watch as their loved ones deteriorate unnecessarily.

Worst of all, since there was a flowering of pain care that has since been crushed by the Government Crackdown, patients had a taste of how they might have lived had they been able to continue with their medical care. They had found their lives restored, their dignity returned, their bodily functions under their control; able to work, to love, to have conversations, friends, interests. Stuff I bet you take for granted. I wish you would rethink your position.

Siobhan Reynolds

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