About pain, the gateway to opiods

Without pain you do not legally get access to narcotic pain medication. For those predisposed to addiction, a complaint of severe pain is often enough. Maintaining a continuing supply or getting off the medication is more difficult. Drug companies and the medical community have contributed to the abuse of pain medication epidemic so evident today.

Doctors are taught to accept a patient’s description of symptoms. They do not normally assess a patient’s credibility. They are healers, not judges, and thus are not inclined to challenge a patient’s claim of persistent pain. Too often they put patients on a routine regimen of narcotic pain medication, believing it is the only way to keep them functioning.

Even where diagnostic testing fails to reveal an acute condition, and a request is based almost entirely on complaints of persistent severe pain, drugs are provided. The patient may have real pain. But those with contrived or imagined pain can only get drugs by fabricating or exaggerating pain symptoms. Fearing the consequences of withdrawal, an addicted patient may believe the only way to avoid that “pain” is by the continued use of narcotics.

Hearing personal injury cases, I frequently see claimants who have been maintained for years on narcotic pain medication. Their only “treatment” is to go to the doctor’s office once a month to pick up their prescriptions. It is often difficult to determine the cause or extent of the condition that causes the pain. With no objective findings, symptoms appear far out of proportion to the medical evidence.

In determining credibility, a judge must consider to what extent, if at all, the symptoms may be influenced by (a) drug seeking behavior and (b) the temptation to inflate a claim to enhance recovery. Both factors may undermine a claim, particularly when the medical record suggests only a minor injury.

In trying to help patients, doctors may be doing more harm by over-prescribing drugs. By asking doctors to be more skeptical, are we interfering in the doctor-patient relationship? Perhaps, but when the medical evidence indicates otherwise, are doctors running the risk of becoming drug dealers? Pain management often consists of legal drug addiction. While some are more cautious about prescribing drugs, others are reluctant to challenge a patient’s assertions.

Controlling pain is a good thing except when the means to do so result in an addiction epidemic. If a doctor cannot identify or treat the cause, the easiest route is to treat subjective symptoms. Normally, doctors rely on what a patient says. To confront the addiction crisis, they will have to determine the reliability of a patient. This adds a new dimension to the doctor-patient relationship. Skeptical doctors now sometimes identify drug-seeking behavior. Usually a patient so identified simply goes elsewhere. Medical students will have to be trained that “to do no harm” means they must be more circumspect before choosing narcotics.

In my experience, alleged pain, and the drug medication to control, are often manifestations of a more complex underlying problem. Rather than acknowledge that problem, it becomes convenient for a patient to attribute a painful condition to an injury or illness and use narcotics to relieve unrelated anxiety and stress. To blame an external event such as an injury as the cause of distress is a natural tendency, particularly when a “pain” complaint will get more immediate relief.

Chronic pain is a serious medical condition, but in cases without a physiological explanation, doctors must be alert to psychosomatic signs. People can be hurting for reasons other than physical pain. Rather than narcotics, a referral for a psychiatric or psychological evaluation is a better alternative to determine whether underlying depression, anxiety, or other personal problems need to be addressed.