With the posting of our new webpage, Opioid Dependency and the Intolerability of Pain, the Institute for Chronic Pain marks the addition of a new category of publications under our Changing Pain banner.
On the Changing Pain heading, we’ll publish articles that thoughtfully take a stance that is different than the generally accepted views on the particular topic of the article. These articles may offer a new perspective or challenge conventional wisdom.
As such, you may not always agree with the articles published under the heading of Changing Pain. Indeed, even those of us who publish at the Institute for Chronic Pain might not all agree on a particular author’s viewpoint.
But that’s really the point of the Changing Pain banner. The articles published here will be well-argued stances on topics that are not fully settled among stakeholders in the field of pain management. These articles, in other words, will take stances that reasonable people might disagree.
Our hope is to create a space in which stakeholders can come together to initiate dialogue. In this dialogue, we recognize that not everyone will agree, but we aspire to thoughtfully consider the points of view of others. Often, in pain management, like politics these days, stakeholders have very strongly held views in which dialogue ensues, not as reasoned discourse, but personal attacks against the character of those who hold the contrary view. Issues related to opioids, disability, the role of coping, stigma, and even the nature of pain itself can often be such points of contention among different stakeholders.
Changing Pain attempts to be a place to publish articles from different points of view in the hope that all of us thoughtfully reflect on views that may or may not adhere to our own. Our hope is that these articles serve to bring us together in our differences, rather than being an arena for attacking each other.
To this end, as stated, we publish the first of these articles, entitled Opioid Dependency and the Intolerability of Pain. This article explores the different, and often contradictory viewpoints, of whether and how severe pain is intolerable and thus requires opioid therapy. In it, we see the reasoning that leads to two contradictory treatment recommendations: how some in the field conceptualize the intolerability of pain in such a way that the long-term use of opioids is the only ethical and humane practice; while still others conceptualize the intolerability of pain in patients using long-term opioids as the result of the therapy itself and so opioid tapering is the only ethical and humane practice.
Anyone remotely familiar with issues of pain management will readily recognize that we live and work in a highly unusual time: stakeholders in the field can hold diametrically opposing views, both espousing to be the most ethical and humane practice – some espousing long-term opioid management for patients with severe persistent pain while others espousing that we taper those very same people from opioid management.
It’s a unique time in the history of our field and society.
So, upon reading Opioid Dependency and the Intolerability of Pain, we hope you reflect and respectfully discuss these views and arguments with all the stakeholder with whom you live and work – even those with whom you might diagree.
Date of publication: April 22, 2018
Date of last modification: April 22, 2018
About the author: Dr. Murray J. McAllister is the executive director of the Institute for Chronic Pain (ICP). The ICP is an educational and public policy think tank. Our mission is to lead the field in making pain management more empirically supported and to make that empirically-supported pain management more publicly acessible. To achieve these ends, the ICP provides scientifically accurate information on pain that is approachable to patients and their families.
Reducing Pain Talk: Coping with Pain Series
A common complaint among people with chronic pain is that their pain has come to occupy too much of everyone’s time, attention or energy. In other words, it can sometimes feel like their pain is the only thing anyone ever talks to them about – that they’ve become almost synonymous with their pain.
We call it pain talk. Pain talk is the persistent verbal focus of everyone’s attention on the pain of someone with persistent pain.
One of the more long-standing recommendations of chronic pain rehabilitation is to reduce pain behaviors. It’s one of the ways that people with persistent pain can learn to cope better with pain. Let’s review how to do it.
This past summer, Minnesota Governor Mark Dayton signed into law an omnibus health and human services budget bill and in so doing he marked a significant milestone in the recent history of chronic pain management. The bill contained language, introduced by State Representative Deb Kiel and State Senator Jim Abler, authorizing the trial of a new payment arrangement through Medical Assistance, which makes it possible for state recipients of the public health insurance to receive care within an interdisciplinary chronic pain rehabilitation program.
I am nearing the end of a forty-five minute initial evaluation for our interdisciplinary chronic pain rehabilitation clinic and my patient is an amiable woman in her late forties from the suburbs. She drove a minivan to the clinic and attends the evaluation while her three children are at school for the day. Her primary care provider had referred her to us because of her chronic and disabling low back pain, which over the years had become progressively worse and more widespread.
Opioids, or narcotic pain medications, are commonly thought of as powerful pain relievers. Patients frequently request them and healthcare providers often prescribe them for back pain because they think that opioids are the most effective pain reliving treatment. Popular media and others in society also commonly think that without opioids patients will suffer intolerable or “intractable” back pain. The implication is that, again, opioids are the most powerful and effective pain reliever.
But are they the most effective pain relieving treatment for back pain?
Exercise, of course, is good for you. Activity is good for you too. Both are helpful for those with chronic pain. Yet, they are different. They are not an equal substitute for the other. Let’s explain.
Opioids are certainly in the news. The US Surgeon General recently issued a statement on the relationship between their widespread use for chronic pain and the subsequent epidemics of opioid addiction and accidental overdose (US Surgeon General, 2016). The US National Institute for Drug Abuse and Centers for Disease Control have also issued concerns (see here and here, respectively). Mainstream media reports on the problems of opioids appear almost daily.
The Institute for Chronic Pain is an educational and public policy think tank that produces academic quality information on chronic pain. We aim to provide such information in a manner that’s empirically accurate, yet also approachable to patients, their families, non-specialist healthcare providers, third party payers, and public policy analysts. We do so because the field of chronic pain management needs to change.
It's cold and flu season again and we all do the best we can to stay well and avoid catching an all-too-contagious virus. We each have our own go-to plans of how to fight it: vitamin C, zinc or elderberry supplements, gargling with salt water, staying warm, rest and binge-watching Netflix shows. My grandmother swore by anise candy that she made from scratch, while my father prefers a hot toddy to remedy a cold. Washing hands is still the number one way to avoid illness -- along with avoiding contact with your face, and keeping your immune system strong.