Her.meneutics: Is Pain Relief a Human Right?

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« Why I Envy Young Nuns | Main | Does God Want Us to Suffer? »

September 23, 2010

Is Pain Relief a Human Right?

My daughter's own experience with pain has helped me answer this question.

Ellen Painter Dollar

The International Association for the Study of Pain issued a declaration saying it is. People have a right to receive pain relief, without discrimination, via medications and non-medication techniques; to have pain assessed as a vital sign; to be treated by medical personnel trained in pain management; and to have chronic pain recognized as a disease entity that requires comprehensive treatment.

In a related story, Human Rights Watch published a report revealing that “most Kenyan children with diseases such as cancer or HIV/AIDS are unable to get palliative care or pain medicines,” because existing programs don’t serve children, health-care workers are inadequately trained in managing pain, and inexpensive opioid medications are scarce due to government policy and providers’ reluctance to give these drugs to children.

I learned of these developments while I was also reading — actually, devouring — Melanie Thernstrom’s acclaimed new book, The Pain Chronicles: Cures, Myths, Mysteries, Prayers, Diaries, Brain Scans, Healing and the Science of Suffering. The meticulously researched book covers the history of how we interpret and treat pain; the relationship among pain, the body, and the brain; and Thernstrom’s story of living with chronic musculoskeletal pain.

Thernstrom describes injustices in how pain is perceived and treated. For example, women with chronic pain are more likely to receive medications for depression and anxiety, while men are more likely to receive opioids, surgery, and complete exams. She says women who aggressively demand pain treatment are more likely to be dismissed as hysterical, and women’s fears of being perceived as demanding make them hesitant to report pain. African Americans are also more likely to be under-treated for pain, denied opioids, and to “have their requests for medication interpreted as ‘drug-seeking behavior,’” she writes.

Thernstrom also documents an “opioid backlash” — an overzealous response to prescription painkiller abuse. The backlash has left some patients unable to get relief, as more doctors are reluctant to prescribe opioids as they witness colleagues being prosecuted, sometimes unfairly, for prescribing the drugs. Thernstrom predicts that decades from now, people will look back with pity on patients from whom opioid pain medication was withheld because of misguided fears and misinformation, just as we pity our ancestors who, sickened by infectious disease, were subjected to bizarre, cruel, and ineffective “treatments” before the germ theory came along.

This backlash might lead, unjustly, to the criminalization of people who take opioids with legitimate prescriptions for legitimate pain. As one of those people, I was alarmed to read about some North Carolina sheriffs who want to obtain a list of state residents with prescriptions for pain drugs. Claiming that the list will help them fight prescription drug abuse, these law enforcers apparently believe they need to keep tabs on people like me, as they do sex offenders and ex-felons.

While some Americans are subjected to stereotypes or inadequate responses to severe or chronic pain, residents of poorer countries often lack access to more basic pain relief. In parts of China and Africa, surgery is still often performed without anesthesia (although in China, there is some documented success with using acupuncture to prevent surgical pain). Non-prescription pain medicine is a luxury in many developing countries. I recently loaded up my shopping cart with children’s Advil and Tylenol for a friend to take on a trip to an Ethiopian orphanage, where children get no relief from the pain of sprains, fevers, headaches, and broken bones.

I have a genetic bone disorder that causes both acute pain (due to frequent broken bones) and chronic pain (due to joint and bone deformities). My oldest child shares my diagnosis. If you were to ask me for an image to illustrate what grace looks like, I would tell you about the EMT who responded last summer when my daughter had an accident resulting in multiple fractures. As my daughter lay in agony on the hot asphalt, the EMT lay down next to her and, from that awkward position, quickly and almost painlessly started an IV, through which my daughter received morphine to ease her pain for the ambulance ride. Adequate pain medication, administered by a skilled professional who saw pain relief as a primary duty, made a terrible day a bit more bearable. It was a gift for which I will always be grateful.

Thernstrom notes that “pain never simply ‘hurts.’ It insults, puzzles, disturbs, dislocates, devastates,” leaving those in pain feeling that they have lost their real lives, even lost themselves. As people concerned about justice, dignity, and wholeness, Christians might pay more attention to the emerging movement to relieve those whose selves are threatened by pain. Every human, including Kenyan children dying of HIV/AIDS and the estimated 70 million Americans who live with chronic pain, deserves to have their terrible days made a bit more bearable.

This is the first of two posts on Christian responses to physical pain. The next post will explore Christian understandings of pain as transformative and redemptive.

Comments

I would certainly never advocate unnecessary suffering, but I hope that everyone also recognizes the real danger that painkillers can present when used improperly. My husband is an addiction counselor and sees more and more patients who are hooked on pain meds and who will go to frightening lengths to get more. Pain medication can be a blessing or a curse, depending on how it is administered, and those who prescribe it and those who use it all need to be aware of both sides of the coin. Someone whose life has been devastated by addiction suffers terribly, too.

Thank you for this post and for generating great conversation. This really made me think. I have students with chronic pain, and I have a daughter who suffers from chronic ear infections that create excruciating pain. I just have to drive to the drugstore for pain relief, but what if I were a mother in Kenya? Toothaches and earaches seem so minor, but it breaks my heart that today some children are in pain. To them, it's unbearable.

I have rheumatoid arthritis-a chronic pain condition I have been prescribed antidepressants. I'm not depressed. I just hurt. All the time...usually everywhere. I am fortunate to have a new doctor who treats my pain as a vital sign. She sees me every 3 months, we talk about it, evaluate it, and yes, she does give me prescription pain medication.

One friend asked judgmentally if I was addicted, since I take it every day(very controlled, never more than prescribed). Another friend had an interesting way of putting it. She said to me, "It's like wearing glasses to see. You need to be rid of your pain to function." This helped me.

People in pain don't need to be shamed. They need help.

As a practicing emergency and family physician I want to second what Kelly has stated above. Prescription narcotic addiction is a national emergency that few know is happening. Using pain as a vital sign and a "right" has exacerbated the problem as patients return to exercise the "right" repeatedly and have their 10/10 pain treated with higher and higher doses of the most powerful narcotics. Physiologically the body down regulates the receptors for morphine in the brain and spinal cord and these unfortunate patients cannot even bear the pain of paper cuts, sunburns or stubbed toes. These are typically young patients who have no identifiable disease processes at all and in my mind are different than the patients addressed in the book and in other email responses such as Michelle above with RA.

Just want to clarify that I understand that prescription painkiller abuse is a growing and major problem. But I actually disagree with Dr. Steve that "few know what is happening." In the past two weeks, I've read four or five articles in major newspapers/magazines about this national "crisis"--none of which mentioned those for whom opioid pain relief is a necessary therapy to live full and active lives, the difference between physical dependence (which all long-term opioid use leads to) vs. addiction, and the need to provide pain treatment while lowering addiction risks. Such articles leave people who are legitimately using these drugs for legitimate pain with a heavy burden of shame--and fear that increasing attention to the addiction crisis will just make their (our) lives harder as doctors simply stop prescribing such drugs because they are too risky. As Thernstrom said in her book, "The question for society, then, is not, Does treating pain risk feeding addiction (because it obviously does that) but, To what extent should that risk influence pain treatment? What are the moral implications of denying opioids to patients who are likely to benefit from them?"

I think that understanding pain relief as a fundamental right for those who are living with real, treatable pain is an important step in addressing growing addiction rates without criminalizing pain patients or reinforcing a stereotype that assumes they are all are weak-willed addicts.

Thank you for this post.

I, too, have a condition that causes chronic pain... and am watching in dismay as doctors refuse to treat patients - even those in severe pain - with anything more than Tylenol or Advil. That's like trying to paste tiny Band-Aids over a huge, gaping wound.

I take the meds prescribed for me exactly as written, and can often go without them for days at a time. (They are very mild opoids.) I cannot function without pain relief. *With* pain relief, I'm still not able to get out and do many normal activities, but still... I'm able to do an awful lot more than I am without any meds. (fwiw, I don't drive or use any kind of heavy machinery if I've taken a dose - too risky.)

And yet, even though I - and many people like me - are responsible "users," we are all too often treated like addicts and drug-seekers. Yes, there *are* addicts out there, and yes, it *is* a danger when taking opoids. But there are tons of other highly dangerous medicines that doctors prescribe without a thought, and that patients take without being given any warnings as to the potential toxicity of what they're taking.

Something's wrong somewhere, and I don't think it should be attributed to those who are seeking relief from debilitating pain.

The practice I'm going to currently will only prescribe mild opoids to cancer patients. So... I'm leaving that practice. The docs' hands are tied, and patients are suffering badly are being turned away. To my mind, that's a clear violation of the Hippocratic Oath, but then... I don't think anyone at the companies that issue malpractice insurance really care about *that.*

Apologies for the cynical tone of this post, but I'm tired of being treated as if I'm a drug addict and a liar. (And my guess is that thousands of others - mostly women! - feel the same.)

My husband is in pain management after a being literally RUN OVER by a car 5 years ago. Recently his pain management doctor was suspened and lost his license. We spent too much time desperately searching for another pain management group who would take him as a patient. While his primary care doc wrote him one prescrition to give him time, we worried about withdrawal and the onset of dibilitating pain. It was heartbreaking to hear him trying to explain, to convince potential doctors that he was not seeking meds for recreation, but to make his life bearable. Though we finally found another doc, it continues to be a struggle to have his condition and his pain taken seriously. As ALWAYS, the bad people (the users) ruin it for the ligitamate patients.

Thank You for this article. It helps us to be aware of people in pain so much more clrarly. Please,Please contact me regarding pain relief with a non prescription highly effctive pain relief method. Through prayer I learned about this method which I am thankful to be able to share. I have suffered ear aches in the past and did for many, many years as a child and..... understand. email: lizzyd80@hotmail.com

I'd be much more comfortable with this subject if drug companies weren't making so much money selling opiate derivatives for pain relief. Is this the best pain relief available or the most addictive? Aren’t we really just legalizing the sale of heroin and making it very profitable. Vicodin is the most prescribed pain killing drug because doctors don’t have to do any extra steps to prescribe it, what does this tell us?

That's a great point, DAWicker. I think that saying we're "legalizing the sale of heroin" is an exaggeration (again, equating legitimate use of effective medication with something nefarious)...BUT the development of pain drugs that are non-addictive should be a priority. I didn't develop chronic pain until after Vioxx was taken off the market, but I understand that for many people with arthritic and similar types of pain, it was extremely effective, and many of those people haven't found a good replacement since it was pulled.

@ Ellen: Vioxx was an anti-inflammatory, not a pain-control med like Vicodin. I couldn't (still can't) take Vioxx and related drugs due to the havoc they wreak on my stomach; many other chronic pain sufferers are in that same boat.

Without being able to take anti-inflammatories, there's little left, except for opoids.

@ Jodi: I don't think "users" are as much to blame as you might think. Old prejudices about prescribing certain kinds of pain meds + assumptions that people who ask for them (or need them) are, by default, "users" has a lot to do with why they aren't prescribed.

As for what meds work for a given individual - one size does not fit all. (Which I'm sure you already know; so sorry to hear of your husband's accident and battle with pain.)

I read this thoughtful article with great interest as a woman contending with chronic, intractable migraines AND a professional who, for 14 years, worked intensively with addicted women, including a few addicted to opioids. Here are some observations from both of these experiences:

1. There are many ways to manage pain (I talk about the ones that work for me on my blog).but it does seem to me that the operative word is "manage." I am a grateful and constant practitioner of methods like meditation and deep muscle relaxation, AND a grateful consumer of medications that take care of the pain these practices do not touch.

2. For anyone who takes the time to attend to such things, the behavior of a person addicted to pain medication is very different from that of a person taking pain medication for "legitimate" reasons. The signs of addiction are not hard to see, and should not be applied to all consumers of opioids.

3. All of the drug addicts I knew who were strong in their recovery and also suffering physical pain were adamant about never taking opioids for fear of becoming addicted. I just mention that because the image of the strong and courageous recovering addict isn't raised very often.

4. Constant pain is exhausting, physically and emotionally, aside from the extremely unpleasant sensations that are bodily pain. Good paliative care professionals will tell you that the best practice is to treat the pain prophylactically (not sure I am spelling that correctly!) so that you are not in raging pain before you do anything about it, because that is when pain is hardest to manage and to bear. A judicious schedule for taking a prescribed opioid keeps the pain at a relatively bearable level and helps to prevent the need for escalating doses so feared by those who do not want to become addicted and by those who are afraid of addicts.

Thanks for letting me share!

I think, though I may be wrong, that the idea of pain relief as a human right is more about not discriminating regarding who gets it, rather than advocating that opioids be handed out like candy. If certain groups are denied pain relief because of their fundamental characteristics (race, age, etc), then that is a problem because they are being treated not based on medical necessity but on someone's prejudices. Anyway, that's what I got from the International Association for the Study of Pain statement.

Despite it's utter lack of medical "value" we outlaw whiskey because some people are alcoholics? NO. At some point we need to take responsibility for our own actions. Why should *I* suffer debilitating pain because someone else has an oxy addiction??? That is what I'm dealing with. My fiancee btw was a heroin addict for 25 years and no one could stop him from being an addict despite the fact that heroin is illegal... until he got with me, a non-addict, and decided to get onto a methadone maintenance program. The government needs to back off of doctors who are trying to do their job and patients who are trying to live a normal life despite pain issues. Addiction and pain are two different health problems but they are both HEALTH PROBLEMS.

According to the prevailing research data, only a very small percentage (anywhere from .03% to 4%) of patients with legitimate pain become addicted to opioids. The majority of people who become addicted to opioids are using them for nonmedical purposes, i.e., for their euphoric effects. To deny patients with intractable pain adequate pain relief is indeed a violation of human rights.

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