Note: This is the third article in a series on chronic pain.
Doctors are increasingly being pressured to curb access to drugs. And for those who face a chronic pain condition to function daily, these doctors are keys to the drugs they need.
The American Academy of Pain Medicine estimates 100 million people in the U.S. suffer from some sort of chronic pain condition and, for many of those individuals, relief comes in the form of an opioid. These drugs can help them simply get through the day by decreasing their pain enough to allow them to function.
There were 206 opioid overdoses in Monroe County last year. And with over 63,000 people dying from a drug overdose in 2016, most of which were opioid overdoses, it can makes sense to limit access to opioids, but these limitations come at a cost for the people like Calvin Eaton, founder of Rochester’s 540WMain and an Ambassador for the U.S. Pain Foundation.
Eaton was diagnosed with fibromyalgia in 2010 after spending months dealing with chronic fatigue starting in fall 2009.
“Someone like me who takes an opiate every day to survive is very different from someone who is suffering from the illness of addiction,” Eaton said.
Yet there are guidelines from Center for Disease Control for Prescribing Opioids for Chronic Pain that seem to push doctors away from giving patients opioids as a treatment option, something particularly affecting patients who are starting treatment for chronic pain for the first time, or who have been treating chronic pain for years but are seeing a new doctor.
The guidelines urge doctors to avoid prescribing opioids whenever possible, and they should begin by prescribing the lowest amount possible.
This may seem like common sense, but this provides a unique hurdle for chronic pain sufferers: If they’re just starting out on their pain treatment plan, it may be years before they experience some sort of relief as doctors begin with alternative pain treatment methods, such as physical therapy or massage. If someone is starting with a new doctor, it may mean the doctor attempting to lower their current opiate dosage in an attempt to try alternative treatment methods per the guidelines’ urging.
Joan Hall, a Fibromyalgia Association of Rochester N.Y. Support Group Leader, saw this throughout her years running support groups for people with chronic pain.
“Somebody new going to a new doctor, and going to new pharmacies, they would have difficulty getting a seven day supply (of opioids),” she said. “I feel really bad for the new people coming in because they’re just at a loss.”
The key to getting access to pain relief is continuous and honest conversations between patients and doctors, according to Eaton, Hall, and Dr. Elizabeth Loomis, an assistant professor with Highland Family Medicine. Understanding your body and logging your symptoms can provide an accurate record for your doctor visits. But in order to treat the chronic pain effectively, the doctor must understand your pain and you as an opioid user.
Loomis is one of the first doctors many with chronic pain symptoms would see at Highland Hospital and also co-directs the Buprenorphine Clinic, which helps treat opioid addiction. Her relationship with both communities gives her a unique perspective on treating chronic pain with opioids.
She stressed that for proper treatment of chronic pain, patients should be aware of their bodies and how they respond to different changes like medication, the weather, temperature and more, and to have a realistic goal of pain management.
“Often the goal to be completely pain free is not realistic,” Loomis said. “But other goals like being able to work, being able to take care of family members, being able to go shopping, being able to cook meals – those are the goals people are really looking for.”
From the doctor’s side, Loomis said when treating chronic pain she has to be careful to think of chronic pain as a symptom, rather than a condition. This means looking for underlying causes for the pain and treating those as well.
Paul Gileno, President of the U.S. Pain Foundation based in Connecticut, said doctors need to be careful not to over prescribe pain medication, but also not to air on the side of caution, leaving a chronic pain patient in suffering. Conversations with opiate users and all chronic pain patients should be ongoing, he urged, and Loomis agreed.
Loomis said opioids are typically not the only drug treatment plan people with chronic pain should be pursuing. Rather, opioids can typically be used as a long-term, intermittent fix to chronic pain in addition to regularly working out, going to acupuncture, making diet changes, and other pain relief options.
This is often the route Eaton takes. Eaton relies on opioids to help manage chronic pain caused by his fibromyalgia, but he also meditates daily, follows a vegan diet, tries to be active on the days his pain level allows him to be and has used a myriad of other pain management methods in the past.
Hall takes opiates to help her be able to walk due to the pain of her fibromyalgia, but she’ll also do things like lay warm towels across her legs and sleep in a recliner rather than her bed to help manage her pain.
Open Mic Rochester attempted to speak with Rochester Pain Management for the article to learn more about steps they take when prescribing opiates, but after several attempts to set up an interview, a spokeswoman declined any further assistance.
Loomis and Gileno agreed that typically opiates should be restricted for short-term use, but for those with chronic illness, but Gileno said making patients jump through hoops to get pain medication is not only frustrating, but expensive on top of an already expensive chronic illness.
“I think when you’re restricting any kind of medicine you’re hurting the people who really need that medicine,” Gileno said. “When we put restrictions on the number of pills people can receive or the number of times they can see a doctor, you’re hurting someone who has a legitimate need for that medicine and you’re adding that cost for that person.”