An Op-ed by J. Donald Schumacher, PsyD
Today and every day, 56
million Americans try to get by in a condition of chronic pain. That's more
than one of every five adults.
Yet in many cases, their
suffering is undue. Those with chronic pain often do not receive medication or
treatment that could safely alleviate their pain.
The simple truth is that pain
can be relieved in most cases. Afflicted patients and their families should
insist that their healthcare providers control and treat their pain
accordingly.
The vast majority of those with
chronic pain are not terminally ill. Some suffer from severe back or neck pain
or from debilitating migraines. Others may have arthritis, multiple sclerosis,
fibromyalgia, shingles, or nerve damage.
The afflicted are of all
ages. Those most affected by chronic lower back pain, for instance, are
typically between 30 and 50 years old.
And chronic pain isn't just
physical. Patients also have to grapple with feelings of despair and isolation.
Despite the scope of the pain
epidemic, many doctors are wary of dispensing medication because they fear that
patients will become addicted. Some point to the fact that one in five
Americans reports misusing a
prescription drug at least once in his or her lifetime.
But their fears are
overblown. Just 4.5 percent of those without a predisposition toward alcohol or
drug addiction who were prescribed painkillers developed a dependency.
Doctors also tend to look at
pain as a symptom of an underlying problem -- thinking that if they can find
and treat that problem, the pain will go away.
But according to a recent report
from the Institute of Medicine, chronic pain itself can be the problem. Such
pain can cause changes in the nervous system that worsen over time -- even
after the original source of the pain has gone away.
Because many doctors are not
properly trained in the study of chronic pain, patients often suffer unnecessarily.
One study of nursing home residents with chronic pain found that 44 percent
were not getting any treatment at all.
In some cases, the need for
pain treatment may not be obvious. Older patients, especially those with
dementia, often struggle to communicate their needs.
Yet according to a report
from the Hartford Institute of Geriatric Nursing at New York University, the
burden to communicate with patients who may be in pain does not rest with the
patients. Clinicians must take on that duty. They can do so by learning to
identify non-verbal behaviors, such as "agitation, restlessness,
aggression, and combativeness," which "are often an expression of
unmet needs."
Old age must not become an
excuse for the failure to pursue effective treatment for pain.
Of course, patients must
assume some responsibility for treating their pain, too. Approximately 50
percent of patients do not take their medication as prescribed. Many mistakenly
wait for pain to recur before administering another dose. Such on-again,
off-again treatment just results in cycles of pain -- rather than preventing it
altogether by maintaining adequate levels of medication in the bloodstream.
Patients should also educate
themselves about available treatment options and the risks of possible drug
interactions. And they must talk candidly with their doctors about their needs
and the effects of the treatment they are receiving. Too often, patients settle
for a little bit of pain relief when more is possible.
Patients who are not getting
adequate relief should ask their doctors about palliative care or availability
of pain clinics, where specialists may be able to suggest more effective
treatment options. Many patients have benefited from keeping a pain diary to
which they and their doctors can refer when devising a treatment regimen.
Whatever the condition
causing the pain, the person best equipped to take the lead in finding the
proper treatment is the sufferer. People know their own bodies, and they can
judge when medications are inducing unwanted side-effects.
No one deserves to be incapacitated
by chronic pain. The means to alleviate it are available. All that's required
is the will to find the right treatment.
J. Donald Schumacher is President and CEO of the National
Hospice and Palliative Care Organization.
