Posts Tagged ‘Medical Group Management Association’

Our Dangerous Fear of Pain

January 10, 2020

The title of this post is identical to the title of an article by James D. Hudson in the Outlook section of the 1 December 2019 issue of the Washington Post. He writes, “It’s good to have a healthy fear of pain. It protects us from injury and reminds us to allow time for healing. Acute pain can be made more tolerable by a short course of opioid medication (the Centers for Disease Control and Prevention recommends only three to seven days, even after surgery or injury). And there is a good case for opioids over longer periods to treat end-stage cancer and other terminal ailments that can bring unbearable suffering. Palliative care in those situations is almost always necessary and compassionate.”

Dr, Hudson continues, but otherwise, the fear of pain, and the belief that a pain-free existence is optimal or even possible, has been a catastrophe for patients. Before the opioid revolution, doctors understood that pain was important to keeping us safe, to be lived with and managed. Even if this meant we bore frequent episodes of discomfort, that was better than the nationwide crisis America faces today. “Life isn’t ‘pain free.’ If we want to end the epidemic of addiction, we need to relearn that lesson.”

The opioid industry bears the ultimate responsibility for this epidemic. It did heavy lobbying of legislatures and of physicians. According to a study in the journal JAMA Network Open, this marketing correlated with overdose deaths. The CDC has thoroughly-documented the rapid rise in opioid prescriptions and deaths since 1999.

Dr. Hudson writes, “many doctors listened to the marketing campaign. In our hubris, we began to think we had the capacity to banish chronic pain. Pharmaceutical companies were developing ever stronger and longer-lasting opioids, and surgeons were replacing more and more worn-out joints. New techniques meant the pain anesthesiologists could block nerves, sever the signals to the brain, and insert catheters or electrodes into spinal columns and brains. Pain was to become a thing of the past, conquered by modern medicine.” This could have been true, but they ignored the addiction problem.

Obviously patients did not benefit. So who benefited besides the drug companies? “Physician experts” compensated by drugmakers hawked these medications at conferences, telling doctors that new and more potent analgesics were not addictive when prescribed for pain. They said that there was no upper limit on dosing, that patients would develop tolerance to medication and that some would need extremely high doses for their pain. But they said that physicians were not to worry, that this was normal. A new unsubstantiated ailment called “pseudo addiction” was offered as an explanation for patients who ran out of pills early and borrowed more from friends and family or got their drugs on the street. There is no such thing as pseudo addiction, only real addiction.

In addition to the drug companies, many got rich. There were new business opportunities. Physicians and health systems benefited from an explosion of diagnostic testing with CT and MRI scans. Unethical medical practioners were opening “pill mills,” often taking only cash for almost unlimited amounts of addictive medications with no real attempt to make a diagnosis or assess the need for such prescriptions.

The Medical Group Management Association, reported that anesthesiologists who specialize in pain management earn almost $530,000 on average annually, making this a lucrative speciality. By comparison, primary-care providers make less than half this (while the average physician makes $300,000).

Fortunately, the medical profession is maturing in educating patients about pain management However, the article makes no mention of hypnotism or meditation.

One of the most impressive surgeries HM has read about is the surgical removal of a scrotal tumor while the patient was under hypnotism.

Some research on pain perception has used buckets of ice water. This is called the cold presser task. It becomes extremely painful fairly quickly, and participants feel a need to pull their arm out of the ice water. During these experiments the participants make ratings of their pain. While hypnotized, participants were able to provide consistent ratings of their pain perception and they were able to keep their hands in the ice water at ratings they would have felt forced to pull their arms out. In fact, the experimenter had to tell them to remove their arms before tissue damage occurred.

Highly skilled meditators actually focus on the pain, but reinterpret it. Most of us deal with pain by trying to ignore it and think of something else. But if one is an experienced meditator they are likely to focus on the pain and reinterpret their perception as not being of pain.

© Douglas Griffith and healthymemory.wordpress.com, 2019. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Douglas Griffith and healthymemory.wordpress.com with appropriate and specific direction to the original content.