Saturday, May 7, 2016
In Defense of Opiates
"Ease their pain." That was the first, and best, nursing advice I've ever been given. It was given to me 25 years ago by a very wise Nurse Manager. That's how deep knowledge gets passed on in nursing: by the younger ones listening to the experience of the elders. Treating people's pain was important when I first became an RN.
Easing people's pain has now been limited to ibuprofen and cannabis. Opiates are frowned upon due to the increase in suicides from opiate overdoses. However, in my experience, the suicide epidemic from opiates occurs from the UNDER treatment of pain and the ineffectiveness of pain management and NOT because of the opiate itself. I believe this current epidemic of heroin overdoses is a result of NOT treating pain properly. We are getting it wrong.
We don't have many arrows in our quiver when it comes to treating pain. And when it comes to treating severe pain, most of the arrows don't work. Yes, I know every Granola Guru thinks that Cannabis is the answer for everything from chronic pain to cancer, when in reality, cannabis can be helpful but it pales in comparison to an opiate.
A few years ago, a 300 pound homicidal Schizophrenic with command auditory hallucinations to kill people, hit me as hard as he could with his elbow. He broke a couple of my ribs, damaged a lung, and injured my back. The back injury resulted in something called Peri-Scapular Myofascial Pain Syndrome. It means that the area around my right scapula is in constant spasm and pain. The pain feels like a dozen hamsters are chewing on the muscles in my back. The feeling is similar to the sensation you would have if someone stuck a knife through your back and twisted it.
I've been in treatment for this injury for years. I've tried injections to cure it. All of the pain medications. Two different chiropractors. Massage. Nothing works long term.
Norco takes care of the pain.
Without Norco (an opiate) I couldn't function. Thankfully I have a Physician who understands me, has seen me through out this injury, and has the wit and the compassion to prescribe the medication to me despite the current pressure to no longer use opiates.
We used to believe that pain was the "Fifth Vital Sign". Now doctors are being harassed for prescribing opiates--even being threatened with jail. I have seen the consequences of this in my own practice. You see, I work outpatient as a Home Health Nurse. Nothing makes you feel more helpless than watching an elderly person suffer from the cessation of pain medication. They not only go through withdrawal but they lose function. And they suffer pain. I had one client who could walk when she had Norco; now she is wheelchair bound because her doctor refuses to prescribe it.
That's how to gauge the effectiveness of a pain regimen: does it increase activity and function. The same should be true when pain medication is withheld: if activity and function decreases, then the pain medication should be restored. Not to mention the compassionate aspect of Easing Their Pain.
Life in capitalist America isn't easy for the majority of people who have to work for a living-- sometimes holding two or three jobs at the same time. Low wages and too many hours are causing injuries and wearing out workers. I don't believe the record use of pain medication and anti-depressants in the United States is caused by Big Pharma; I believe the record use of these drugs is caused by an economic system that is downright cruel to the poor, workers, and the oppressed. Percocet and Prozac have become the new opiates of the people (replacing religion, like Marx thought). We need the anti-depressants and the opiates just to summon the energy and pain relief to plod through the day. Getting old isn't easy. Working in America isn't easy. Rare is the elderly person who doesn't suffer from a bit of pain.
Over the past year, the toughest part of my job has been watching people suffer from the under treatment of pain. It has caused a near existential crises in me, as I watch people try and cope with the pronouncements of their Doctors that "We have to cut your pain medication down." Many live in fear every month that their Doctor will decide that treating their pain is no longer worth jeopardizing their license to practice medicine. Many consider suicide. Some have attempted it. Some have died.
It doesn't help when a celebrity, like Prince, dies from a probable Percocet OD. The knee jerk response is to blame the opiate and the use of them, resulting in the pressure to discontinue easing people's pain, which, in the long run, just ends in more overdoses, more pain, more suffering.
We have branded the person who suffers from Chronic Pain to be Drug Seeking Addicts if they use opiates. They (or we, because I am one) have become second class citizens. We are punished by having to see a doctor every 30 days. Our scripts are given on a triplicate form that must be brought to the Pharmacy and not sent electronically like every other prescription. We must show an ID to pick up our medications and we have to make the trip to the pharmacy as the meds cannot be delivered.
People who suffer from Chronic Pain now wear a scarlet letter. The pendulum has swung too far. We need to Ease Their Pain.