You may have seen the recent NY Times piece describing an extraordinary increase in mortality rates among middle-aged white men– well beyond the increases seen in other populations. Nobody expected that. Here’s what the study’s authors think might be going on.
They point the finger at our over-reliance on prescription painkillers.
The timing sure fits. As you’ve no doubt heard, there was a concerted effort on the part of some pain physicians, patient advocates, and Big Pharma to promote the use of more powerful opioid formulations (think Oxycontin) to remedy a perceived epidemic of “undertreated” chronic pain. From the start, this was viewed with suspicion by addictionologists. But the tide was against them. We entered a new era of pain management.
And here we are today, in the grip of its principal unintended consequence.
Chronic pain is never easy to treat. Some of the challenges:
- It’s difficult to define. Chronic simply means long-lasting, and chronic pain is any pain of any type that persists past 12 weeks. Maybe it results from an injury or illness but that’s not a requirement. There may be no identified cause at all.
- It’s difficult to diagnose. There’s no test to measure it. Docs are forced to rely on patient report. Or as NIH’s Medline puts it, “pain is a very personal and subjective experience.” Translation: we don’t really know what’s wrong with you, but we’re going to treat it as if we do.
- It’s easiest just to prescribe a painkiller. It takes thirty seconds to write a prescription, and the patient usually goes away happy. That fits very well into a scheduled 15 minute office visit.
The rising rate of OD and addiction finally caught the attention of the medical establishment, who responded with restrictions on prescribed painkillers that inadvertently pushed addicts towards heroin.
Meanwhile the standard for pain management has changed, to emphasize a more integrated team approach. Here’s Medline on the subject: “… new research suggests that the best self-management programs teach people different ways of thinking about and responding to pain, making their actions to relieve it more effective.”
Or as one pain patient put it, during a group therapy session in an addiction program: “Now you tell us.”