Chronic pain — and especially idiopathic chronic pain — is a sentence that too many will have to bear increasingly on their own. That is, without the help of various painkiller, or opioid, medication that makes day-to-day existence possible. And yet in a typically overbroad and crudely legalistic rush to address opiod addiction, undertreatment, or an outright refusal to treat via opioids, leaves suffering as what too many chronic pain patients have to face:
We seem to have come, in a tragic way, full circle. Doctors, in particular, have been open in acknowledging their role in the opioid crisis and are trying to balance appropriate prescribing with a duty to treat pain in an effective and compassionate way. Their challenge today is the mirror image of the balancing act they tried to perform back in the 1990s, when efforts to compensate undertreatment of pain gained momentum and led to overcorrection.
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Everyone is trying to do the right thing, but the system sometimes fails patients who need opioids to manage chronic pain. As physicians negotiate this uneasy terrain, they need more data, less ideology—no matter how well-intentioned—and a case-by-case mentality. Until then, the clinical anecdotes that are accumulating should serve as powerful cautionary tales.
