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Photo: U.S. Department of Agriculture/Flickr
Photo: U.S. Department of Agriculture/Flickr

Are Elderly Chronic Pain Patients Being Denied Essential Opioid Pain Relief? 

Mar 6, 2019

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By John Lewallen

As politicians are trying to outdo each other in a fervor to attack the “opioid crisis,” I can no longer remain silent about the crisis in my peer group, oldsters who are reliant on a steady, modest supply of opioids to spend our “golden years” without suffering from extreme chronic pain.

It seems every day brings a new spate of federal, state, hospital and clinic restrictions on the opioids needed by millions of chronic pain patients to be functional human beings. Some are seeing their doses cut back. Others are cut off completely.

Even people of all ages recovering from surgery are being denied opioids, the only drug truly effective against acute short-term pain.

All factual statements and quotes in this commentary are from  Avoiding Opioid Abuse While Managing Pain by  Lynn R. Webster and Beth Dove (Sunrise River Press, 2007) a book for pain management doctors by two leading experts in both opioid addiction and chronic pain management.

Opioids are the most effective pain relievers discovered so far. When used responsibly, they can enable life for many people without serious side effects.

Professionals categorize opioid users as “chronic-pain patients,” whose lives are improved by opioid use and who use opioids as prescribed; “abusers,” who use opioids for anything except prescribed pain relief for the person they are issued to; and “addicts,” who suffer from the disease of addiction, which is, to quote Webster and Dove: “A primary chronic neurobiologic disease influenced by genetic, psychosocial and environmental factors. It is characterized by impaired control over drug use, compulsive drug use, and continued drug use despite harm and because of craving.”

There is nothing mystical about opioid withdrawal. Simply stated, people naturally produce endorphins, literally “internal morphine,” which intervene when the nervous system sends pain signals to the brain to take the edge off the pain. Opioids supplement, then eventually overwhelm, endorphins, which the body eventually stops producing. When opioids are discontinued, it takes several days for natural endorphins to recover.

Whether happy patient or desperate addict, long-term users who suddenly quit opioids get “a syndrome characterized by symptoms that include sweating, tremor, vomiting, anxiety, insomnia, and muscle pain…It can be avoided by carefully tapering the opioid dosage.”

The opioid crisis is not going to be solved by terrorizing doctors into denying people effective pain relief. As Webster and Dove wrote, “about 70 million people live with chronic pain in America today. In a world with few alternatives, opioids remain the best treatment available for many chronic pain conditions and are the first choice of therapy for acute and postoperative pain.”

Are we becoming a sadistic society, forcing millions to suffer unendurable pain because of fear and ignorance about opioids?

As Webster and Dove wrote:

“People who live with chronic pain live with pervasive stress, and their lives are forever changed. Pain is physically stressful. It interrupts sleep and disrupts hormone levels. Unremitting pain is also psychologically stressful. It causes low self-esteem and may result in loss of job or social standing. Financial worries may be overwhelming. Independence, mobility, and family relationships are compromised. There appears to be no escape from the merry-go-round of life lived in hospital emergency rooms. The chronic-pain patient is forever called on to justify his or her experience and to explain what is unexplainable. The possibility always looms that whatever pain relief is available will be snatched away because if the fear, misinformation, or apathy of the latest caregiver….Oblivion can seem an attractive alternative to consciousness. People living with chronic pain have high rates of attempted and completed suicides.”

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