In a paper recently published by the Open Society Institute a leading neurologist specializing in pain and palliative care said that many of the more than 50 million people in the United States living with chronic pain forgo effective treatment with prescription medication due to misperceptions and fears of addiction.
Dr. Kathy Foley, M.D., who authored the lead piece in the “Ideas” newsletter, said that fear of addiction to pain medications were largely fed by sensationalized media reports documenting the illegal abuse of OxyContin and drugs that would otherwise safely treat people suffering from pain.
“By highlighting OxyContin’s illegal use, we fail to educate the public about the role such analgesic drugs play in providing relief for millions of patients suffering from severe pain,” said Dr. Foley, the director of OSI’s Project on Death in America.
Dr. Foley, who is also a leading neurologist at Memorial Sloan Kettering Cancer Center and a professor of Neurology, Neuroscience, and Clinical Pharmacology at Cornell University Medical College, added that misconceptions about these drugs have influenced attitudes and behaviors not only of patients, but pharmacists and health care professionals who report fear of addiction as a major barrier to effectively treating pain patients.
“When physicians and patients confuse tolerance and physical addiction, patients become stigmatized and pain therapy is threatened,” Foley said.
According to Dr. Foley, patients taking opioids on an ongoing basis may become physically dependent; if they stop taking the drug abruptly, they may show signs of withdrawal. However, slowly tapering a patient off the drug eliminates these symptoms. She clearly differentiates this from addiction, the term used to characterize behaviors of compulsive drug use despite harm.
Studies have demonstrated that children, women, and patients with cancer, AIDS, sickle cell disease, and arthritis have been needlessly under-treated for pain; over 35 percent of elderly patients living in nursing homes have inadequate treatment for their pain, based on international standards of the World Health Organization. And minorities, particularly African Americans and Hispanics, are also at substantial risk for untreated pain, although differences in access to care and medications and variation in the quality of medical attention play a role.
The economic impact of pain on society is estimated at over $100 billion per year in treatment costs, workmen’s’ compensation costs, lost wages and missed days of work, which Dr. Foley said is largely avoidable. She adds that unrelieved pain interferes with all aspects of life, diminishing activity, appetite, sleep, social interactions and can lead to depression, feelings of anxiety, and hopelessness.
The paper also documents some encouraging signs that pain management is finally starting to achieve the status it deserves in healthcare and public policy. Hospitals and healthcare facilities must now assess, monitor, and manage pain in all patients or risk losing their accreditation, and pain has now been designated as a fifth vital sign to be recorded along with blood pressure, pulse, respiratory rate, and temperature.
Also included in the Ideas paper is an up-close look at the Pain and Policy Studies Group, (PPSG) a program of the University of Wisconsin Medical School, and a World Health Organization Collaborating Center for Policy and Communications in Cancer Care. They have undertaken the only systematic analysis of the international, national, and state regulations that impact pain management with analgesic drugs, and created public policy guidelines within which physicians can practice adequate pain management without fear of investigation.
Increased media coverage of the abuse of pain medications makes PPSG’s work even more relevant today as people search for balanced ways of responding to diversion without interfering with patient care.
“Our vision is that people who suffer from cancer, AIDS, surgery, accidents, and chronic conditions will have relief from their pain and a better quality of life, and that caregivers will know when and how to use opioid analgesics without fear of regulatory agencies,” said David Joranson, Director of the PPSG.