Adam Tufts of Grass

Can we curb the opioid abuse epidemic by rethinking chronic pain?

In a recent article in the New England Journal of Medicine, two physicians from the University of Washington, Jane Ballantyne and Mark Sullivan, argue that physicians need to reexamine the real strengths and weaknesses of opioids. While these drugs can be very effective in relieving short-term pain associated with injuries and surgery, the authors say “there is little evidence supporting their long-term benefit.”

One of the reasons opioids have become so widely used today, the authors suggest, has been the push to lower pain intensity scores, which often requires “escalating doses of opioids at the expense of worsening function and quality of life.” Merely lowering a pain score does not necessarily make the patient better off.

They point out that the experience of pain is not always equal to the amount of tissue damage. In some cases, such as childbirth or athletic competition, individuals may tolerate even excruciating degrees of pain in pursuit of an important goal. In other situations, lesser degrees of pain – particularly chronic pain – can prove unbearable, in part because it is experienced in the setting of helplessness and hopelessness.

Instead of focusing strictly on pain intensity, they say, physicians and patients should devote greater attention to suffering. For example, when patients better understand what is causing their pain, no longer perceive pain as a threat to their lives and know that they are receiving effective treatment for their underlying condition, their need for opioids can often be reduced. This means focusing more on the meaning of pain than its intensity.

2/ ∞  reasons to love Alexis Sanchez: