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Sensitivity Irrelevant to Chronic Pain Says PROP’s Doc

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By Celeste Cooper

This blog is based on the New England Journal of Medicine article, Intensity of Chronic Pain — The Wrong Metric? by Jane C. Ballantyne, M.D., and Mark D. Sullivan, M.D., Ph.D.

Ballantyne and Sullivan: “Opioids are a case in point: they have good short-term efficacy, but there is little evidence supporting their long-term benefit.”

To say there is “little evidence supporting the long-term benefit of opioids for managing pain” is simply not true. There are plenty of us who are able to function better because our pain is managed with opioids. You simply do not hear about them because good news is no news. Maybe you meant to say there are few studies. To which I reply, “Where is the EVIDENCE that long-term opioid treatment doesn’t work for managing for chronic pain?”

Ballantyne and Sullivan: “But is a reduction in pain intensity the right goal for the treatment of chronic pain?”

I doubt few chronic pain patients, if any, expect their pain to be completely alleviated regardless of the treatment pathway. But they do expect reduction in intensity. Patients with this goal are far wiser than you are.

Whether pain is acute or chronic, it is a symptom. Assessment for location, onset, duration, character, AND intensity of any symptom is considered the standard of care for good reason. I hope I don’t have to explain why.

People experience chronic pain for two reasons:

  1. the underlying cause is untreatable, and/or
  2. misfiring in the brain causes pain to persist that otherwise wouldn’t.

Our brain extrapolates information and responds to chronic pain differently, but it is still pain. So, I ask Dr. Ballantyne and Dr. Sullivan, “Do you seriously believe assessing pain intensity is not important?” If you truly disagree with your peers on this, you are breaching the standard of care. You might want to think about this too, editors and publishers of the New England Journal of Medicine. Is the message of bias against a certain patient population the one you want to send?

Ballantyne and Sullivan: “Patients who report the greatest intensity of chronic pain are often overwhelmed, are burdened by coexisting substance use or other mental health conditions, and need the type of comprehensive psychosocial support offered by multimodal treatment approaches.”

Often? I disagree. As part of a citizen’s leadership group of chronic pain patients, I see these people, I am one of these people, and you are way off base. When you make such statements, YOU become part of the problem.

I agree that people who live with chronic pain can feel overwhelmed. I am feeling overwhelmed reading this article. Why don’t you ask the pain doctors who include this aspect of their care for their opinion?

Sure, we experience situational depression and anxiety, just LIKE YOU DO! But you are describing people with addiction, very real, but needing a different treatment, also woefully unavailable. Why should I even have to ask, “What does addiction have to do with pain intensity?”

Ballantyne and Sullivan: “Multimodal therapy encompasses behavioral, physical, and integrated medical approaches.”

It does take a multimodal approach to manage chronic pain. The pain patient certainly knows that better than you do. We have resorted to, and been the victim of, charlatans that claim they have a cure. I have found meditation to be helpful with coping, but that doesn’t cure the conditions that cause my pain. Ask how many of us keep several ice packs on hand for fear we won’t have enough. Ask us how many times we have been blistered by a heating pad because that was still less pain. Ask us how many use ointments, OTC products, TENS units or are willing to have electricity delivered to our spinal cord, just so we can have a REDUCTION IN OUR PAIN INTENSITY! Maybe you should ask the patient about the remedies they have tried before you write such an “insensitive” article.

And, shouldn’t opioids be included as integrative care if they reduce pain so patients can participate in complementary therapies? Oh, that’s right, you don’t think a reduction in pain intensity is an important measurement.

While we’re at it, “When was the last time your physician asked about your spiritual awareness or your circumstances at home?” And, just on the chance that they did (because they are in tune with treating the body as a whole), were they able to provide you with resources? If they could provide access to alternative treatments, are they affordable for everyone?

On December 2, 2015, my friend Jan Chambers, President of the National Fibromyalgia & Chronic Pain Association and collaborative leader in the PAINS Project, of which I am a participant, had this to say.

NPS misstatement by PROP’s President Ballantyne
Drs. Ballantyne and Sullivan incorrectly state that the U.S. established a National Pain Strategy (NPS) to address the enormous burden of chronic pain to 100+ million American adults. In fact, the NPS draft was completed by summer of 2014 but has not re-emerged from the U.S. Department of Health and Human Services since then (18+ months), despite requests by many patients, citizens, professional medical groups and patient advocacy organizations. Chronic pain patients are worse off now because many doctors refuse to treat them – one result of unintended consequences from recent opioid abuse deterrent policies. Lack of a NPS and research funding hurts everyone. With no access to care or new, effective treatments, people with chronic pain are literally cast aside by society and treated inhumanely. The authors would like us to believe that NPS initiatives are in place, reducing suffering and brain-seizing pain, when they ask the ludicrous question, “But is a reduction in pain intensity the right goal for the treatment of chronic pain?” I guess that life-altering and debilitating chronic pain must not be such a burden after all.

If you are a doubter, be grateful you have not experienced such pain because one day you may. I have witnessed the change in perception in my own circle of family and friends. If you need a narcotic, it isn’t so bad after all.

“The only pain that is tolerable is somebody else’s.”
~David Sherry, MD, pediatric rheumatologist

Put your thinking hat back on. Don’t be part of the problem, be part of the solution. Embrace this adversity as an opportunity for change before you seriously harm someone, including yourself.

Celeste Cooper, RN, is an advocate, writer and published author, and she is a person living with chronic pain. She is lead author of Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain and Broken Body, Wounded Spirit, Balancing the See Saw of Chronic Pain (a four book series). She spends her time enjoying her family and the rewards she receives from interacting with nature through her writing and photography. You can learn more about Celeste’s writing, advocacy work, helpful tips, and social network connections at http://CelesteCooper.com.

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One thought on “Sensitivity Irrelevant to Chronic Pain Says PROP’s Doc”

  1. r1r1r1 says:

    MS Cooper- as you should know both an independent study sponsored by your friends at NIh and a review of 4000 RCTs on opioids both showed lack of evidence of opioids for chronic noncancer pain. Furthermore if you bothered to look at Cochrance reviews on opioids they point out a high rate of drop-outs in opioid trials due to either side effects and or lack of benefit.
    Your colleagues and friends created the national pain strategy- which sought to exclude the voice of individuals in pain and mainstream medicine. And in the NPS- no mention of marijuana, of course, because needless to say pain specialists and pharmaceutical companies that support them view marijuana as a threat. No mention either of anticonvulsants, antiinflammatories. I gues the NPS is another effort at the big lie technique that often “there is no alternative” for pain other then opioids. Whereis your proof of such. Since, typically pain specialists receive little education in pain care- and mistakenly assert another big lie that chronic pain is incurable- your colleagues are ignorant of the many people who do become pain free of migraines, arthritis, back pain cancer, ms- to name a few. Iguess becuase its not consistent with your colleagues goal of creating the lifetime pain patients- pain specialists dont want to know about curative treatment of stem cell therapy- and no mention of that in the NPS, of course.
    MS Cooper- you and your colleagues live in glass hoses and throw stones. You claim to speak for all people in pain-as if you knew everyones orientation for pain. It was your epistemic community that sought in the IOM report on pain care in American and in the NPS to suppress input by individuals in pain and mainstream medicine. And so i wasnt surprised your NPS is still not implemented- no sense of urgency on the part of NIH or pain specialists-and of course no mention in the NPS of pain specialists having to get more education and improve the standard of care. Its is your epistemic community that selfishly promoted its pharmaceutical backed interests and refused to hear the concerns of mainstream medicine and individuals in pain- so maybe you need to do some more self reflection. Your nps will profit you and some so-called pain advocacy organization- but it lacks vision, imagination, idealism and eseentially is a regressive plan that ignored multimorbidity, individual choice and those that wish to be pain free- try proving me wrong-and like i have said before- anytime you and your self-centered epistemic community wish to debate the issue in pblic- my basomedial amygdala is more then methylated for that.

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