April 11, 2011
Shooting, stabbing, burning, throbbing, unbearable, lack of sleep, depression, alcohol, drug abuse and family violence are symptoms and hallmarks of an insidious malady that plagues this nation and the world as a whole number wise eclipsing other major combined illnesses by upwards of 50 million. . as well as a scale of 1-10 ten being unbearable are words people suffering from chronic pain use to describe it’s symptoms when visiting their physician for relief.
It is estimated that roughly 50 million Americans suffer from chronic pain (pain lasting six months or more) due to cancer, AIDS and other health issues for which there are effective inexpensive treatments such as opioid based medication.
The Society for Neuroscience place the number at 100 million. People suffering from chronic pain eclipse other conditions such as diabetes 20.8 million, heart attack and stroke 18.7 million and cancer 1.4 million.
The effects of chronic pain cannot be viewed in a vacuum as only affecting the individual suffering. According to National Institutes of Health. NIH Guide: New Directions in Pain Research I. September 4, 1998 it is estimated that it cost the United States $100 billion dollars per year in health care, lost wages and productivity.
All the stats aside for the moment what most people do not understand is that the adequate treatment of pain is not only one of the greatest ignored social issues of our time but is a human right. This is not to say that other social issues do not hold importance in of themselves.
Pain Relief: A Human Right
The basic assumption that pain management is a basic human right has its roots in international law under Article 25(1) of the Universal Declaration of Human Rights which prescribes that “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care…”
According to the July issue of Anesthesia & Analgesia, the official publication of the International Anesthesia Research Society and published by Lippincott Williams & Wilkins Dr. Frank Brennan of Calvary Hospital in Kogarah, N.S.W., Australia writes that “Medicine is at an inflection point, at which a coherent international consensus is emerging: the unreasonable failure to treat pain is poor medicine, unethical practice, and is an abrogation of a fundamental right.”
According to Human Rights Watch “…international drug control conventions and human rights treaties, countries are obliged to ensure availability of narcotic drugs for pain treatment. Yet many nations have failed to respond with appropriate policy steps, in spite of repeated reminders from UN drug control bodies and the WHO.”
This problem according to Diederik Lohman a HIV/AIDS senior researcher for Human Rights watch is due to a “…failure in leadership…”. Other factors limit the availability of pain medications for those suffering including placing such management on a low priority within health care, the lack of education within educational institutions who train doctors and nurses in some countries and drug control laws and enforcement.
Other issues cited for the lack of adequate pain control treatment include society’s views of prescribing and taking opiod medications, religious ideologies, political views, acceptance of torture and a shortage of physicians willing to take the risk of specialize in pain management.
The later shortage of physicians willing to specialize in the treatment of chronic pain was and continues to be drug control laws and enforcement policies that seem to be a growing at a study rate since 2000 like a malignant tumor within the United States.
These enforcement policies have stifled physicians specializing in pain management despite Intractable Pain Acts passed in several states, the reception of opiod based therapies by the American Pain Society and the American, Academy of Pain Medicine of The Use of Opioids for theTreatment of Chronic Pain.
The War on Physicians and Patients.
One professional I spoke with said the main reason there was a shortage of medical professionals specializing in oral pain management was in a word fear. Physicians are fearful of being harassed and arrested by the DEA for what the agency considers over prescribing opiod-based medications.
This disparity between the millions suffering from untreated chronic pain and the numbers verifies physicians willing to risk treating them. In 2004 the number of board certified physicians specializing in pain management was roughly 4-5 thousand for 30 million seeking treatment.
The war on drugs has crossed over to physician patient relationship pain management relationship due to OxyContin “Hillbilly Heroin” and other opioid based prescription medications seeping into the underground illicit market and the aftereffects of overdoses, deaths, the crimes associated with it’s sale and the subsequent cry from Congress to do something about it and in some instances the over hyping by the main stream media on the issue.
One of the enforcement policies as of 2000 has been the investigation, arrest and prosecutions of physicians specializing in pain management by the DEA Diversion Control Program for what is called the over prescribing of opiod based pain killers due to what Congress called a lack of “measurable proof” that it’s war on drugs was on track.
The same War on Drugs with new targets e.g. OxyContin and other opioid based pharmaceuticals was off to the races via the tried true method of undercover investigations, stings, narcs and asset forfeitures.
This was a departure from the 1980’s and 1990’s concentration in stopping cocaine, meth, heroine and marijuana (all non-prescribed substances all of which have no medicinal value with the exception of marijuana) importation and use within the United States. Legally prescribed medications became illegal and licensed board certified physicians became the new drug dealers.
A prime example of the new war on physicians was the recent overzealous prosecution by Assistant U.S. Attorney Tanya Treadway and subsequent conviction on June 24, 2010 of Dr. Stephen Schneider and his wife nurse Linda Schneider for allegedly contributing to the deaths of 21 patients. Other charges include illegally writing prescription 5 counts, health care fraud 11 counts, and money laundering 17 counts.
As Jacob Sullum of Reason.Com stated in his article “Pain Doctor Faces 20 Year to Life For Trusting Patients” “Prescribing painkillers becomes drug trafficking, applying for insurance reimbursement becomes fraud, making bank deposits becomes money laundering, working with people at the office becomes conspiracy, and a patient’s death becomes homicide.”
Hundreds of pain management physicians have been prosecuted the past decade for the humanitarian effort to relieve chronic pain their patients deal with on a daily basis. This has had a reverberating effect on medical schools advising their medical students “…not to choose pain management as a career because the field is too fraught with potential legal dangers.” Doctors err on the side of caution by under prescribing medication to their patients leaving them still in pain or getting out of the business all together.
The collateral damage in this war vs. the human right to pain relief leads many to doubling down on OTC NADS risking liver and kidney damage, purchasing medications on the black market or the final solution ending their suffering altogether by suicide. It is a complete moral morose that people suffering from chronic pain due to cancer, AIDS are receiving inadequate pain treatment in the land of plenty.