It appears that the media is certain enough about the cause of Prince’s recent death that we’re already getting blowback from pain advocates. They’re arguing that it was really chronic pain that was at fault — not the painkillers Prince turned to because medicine had nothing better to offer. We lack effective treatments, they claim, and that’s the real problem.

Well, without the painkillers, there’s no OD fatality, so if pills are involved, they’ll show up first on a death certificate. Not much point in disputing it. Still, I agree that most chronic pain patients don’t receive the treatment that would benefit them most. There are many reasons. One is because contemporary medicine has over-focused on relief of the somatic (body) aspects of pain, while under-emphasizing the emotional and psychological elements. Clinicians are trying to remedy that disparity, with some early success. Here’s a recent article on the subject.

It seems that no one knows in advance exactly which treatments will be most helpful to a particular patient. That’s because science doesn’t fully understand the dynamics of such continuing severe pain. We can describe the syndrome, but only speculate as to the causes. That makes it difficult or impossible to tailor treatment to the patient. Instead we have a smorgasbord of offerings that either appeared effective (versus no treatment) in controlled studies, or received positive reports in patient surveys. The patient has to try various things out to see if they help. Inevitably some will prove to be a waste of time and money. But that’s the best we have.

My observation is that patients who focus on the emotional aspects of life with chronic pain, including the depression that commonly accompanies it, see better results than those who focus solely on the search for somatic relief. Don’t ask me to prove that. It’s just my sense of it.

It may be that chronic pain, like addiction, is one of those conditions that responds best to an approach that’s both individualized and ongoing, and requires considerable commitment on the patient’s part. That’s not a ‘solution’ in the classic sense. But it may be the best answer we have.

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For those who missed the remarkable LA Times investigation into the genesis and growth of Oxycontin– a major player in our current epidemic of prescription painkiller addiction and overdose– here it is. Long, but definitely worth the read.