Conversation Continues feature ongoing discussions or news on current health topics with links to related materials.  They are part of the Center for Advancing Health’s portfolio of free, evidence-based coverage of what it takes to find good care and make the most of it. Written by Monica Kriete, CFAH Communications Associate, and Goldie Pyka, CFAH Communications Manager.

Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research, a report by the Institute of Medicine (IOM) released in June, estimated that chronic pain affects 116 million Americans.  The report also called attention to the economic cost of chronic pain as well as to the difficulties patients face in accessing treatment.  Follow-up articles by the press commented and expanded on some of the report’s finer points.

Tara Parker-Pope of the New York Times’ Well blog highlights the IOM finding that chronic pain often includes changes in the way the brain processes the sensation of pain.  In time, pain becomes its own disease rather than a symptom of an underlying problem.  Tara writes, “For patients, acknowledgment of the problem from the prestigious Institute of Medicine is a seminal event.  Chronic pain often goes untreated because most doctors haven’t been trained to understand it…[they] tend to throw up their hands, referring patients for psychotherapy or dismissing them as drug seekers trying to get opioids.”

Stereotyping pain sufferers impacts their access to care, elaborates Maia Szalavitz, on Time’s Healthland website. According to her article on the IOM report, “Pain patients have long been viewed with skepticism and suspicion, rather than understanding, presenting a barrier to care. Rising rates of prescription drug misuse, addiction and overdose have further led to the establishment of legal and regulatory barriers, such as prescription databases, that can prevent even legitimate pain patients from getting much-needed drugs.”

A CNN Health article tells the story of Jim Heckler, who chose alternatives to opioids to relieve his pain.  His story, Facing Chronic Pain Without Drugs, highlights the differences of opinion among doctors around how to treat chronic pain—with narcotics or without them?  Elizabeth Cohen writes, “On the one side are doctors…who do everything they can to avoid opioid painkillers…On the other side are doctors, many of them pain medicine specialists, who believe narcotics can be used safely on a long-term basis.”

Patients themselves are aware and wary of the threat of dependence.  RA Warrior Kelly Young avoided opioids for years, relying on high doses of ibuprofen and similar drugs.  But when the pain became excruciating, her doctor suggested she try an opioid.  “I was afraid of side effects,” she says. “One night it was really bad so I took it.”  At first, she felt severe dizziness.  “But in 30 minutes, the pain started going away and I thought, ‘This is amazing, this is the first time in 4-5 years that I’ve been without pain.”  Starting with a very low dose, she was able to find a level at which she’s comfortable and has not become dependent.

Kelly was interviewed about her experiences with pain for our latest Prepared Patient feature article, When Pain Doesn’t End, which provides helpful information about chronic pain, such as finding the right doctor, deciding on a treatment plan, what to know about opioids and where to find pain management resources.

Related Links:

• Pain: a Constant Companion – a Prepared Patient® First Person interview with Teresa Shaffer