Pain is the most common symptom presenting to doctors, yet arguably we don’t understand it all that well. It is something felt by all of us at some stage, but the experience is unique to each individual.
In second-year medical school we were taught about pain versus pain behaviour, which I ponder when looking at the difference in attitude to the pain of sportspeople such as AFL footballers and most of the rest of us. There is no right or wrong, simply a different level of acceptance of pain and discomfort.
In the 1990s, pain was made a vital sign. This was well-intended but may have contributed to the opioid crisis, especially in the US where close to 70,000 deaths are recorded annually from prescription medication overdose.
Funding of hospitals included consideration of feedback surveys. Patients not receiving prescriptions gave bad reviews, leading to allegations of hospital administrators pressuring doctors to accede to demands. Individual doctors also feared bad reviews and found prescribing the easier option.
A $US 8.3 billion settlement was reached between Purdue Pharmaceuticals and the US Federal Department of Justice over
the promotion of prescription opiates last year.
In Australia, we have also had problems although not as bad. Nonetheless, regulations regarding prescriptions for opiates were tightened last June.
Doctors are often caught in the middle. We do not want to deny pain relief to those in distress. Neither do we want to be a ‘soft touch’ and eventually incur the wrath of regulators. Appointments with public pain clinics can take 12-18 months from time of referral. Chronic pain does disproportionately affect those in lower SES groups who are least likely to have private insurance.
Doctors are often caught in the middle. We do not want to deny pain relief to those in distress. Neither do we want to be a ‘soft touch’ and eventually incur the wrath of regulators.
This month, we examine aspects of pain, including TMJ problems, spinal surgery, use of medicinal cannabis (for the record, I am medical advisor to Little Green Pharma) and new ideas on CRPS. Lifestyle approaches to weight loss are also featured as is adaptation in GP education.
To the proverbial man with a hammer, most problems look like nails. To doctors most problems can look like they need a script. Other methods of managing pain such as exercise, physical therapy, mindfulness, weight loss (if applicable), psychological methods and even some degree of acceptance are less favoured. Government policy, which subsidises pharmaceuticals to a greater extent than other options, doesn’t help.
Rightly or wrongly we cannot make everyone pain free 100% of the time. We can but do our best. Maybe this is a message that is not conveyed as honestly as it could be.