Saturday, February 21, 2015
Pain Care Advocacy in an Era of Opioid Abuse (Part 1)
By Jennifer Van Pelt, MA Social Work Today Vol. 12 No. 5 P. 16
Pain medication abuse is affecting individuals with legitimate needs to manage chronic pain. Learn how social workers can advocate for them.
Prescription drugs now rank second after marijuana as the drug of choice for substance abuse, surpassing cocaine, heroin, and other illegal street drugs. Media headlines, celebrity doctors, and popular TV shows regularly denounce the “painkiller epidemic,” “prescription drug trade,” and “war on prescription painkillers.” Lost in these negative media messages, however, is the fact that the majority of these abusers were not prescribed opioids themselves but rather buy or steal them from others who were prescribed opioids for a medical condition (Manchikanti, Fellows, Ailinani, & Pampati, 2010).
Prescription pain medication addiction has been referred to as a public health crisis in the media. Statistics from the National Institute on Drug Abuse (NIDA) indicate that prescription drug abuse has increased dramatically, and opioid pain medications are now abused by more than 5 million Americans, making this drug class more likely to be abused than prescription antidepressants, sedatives, or stimulants. According to NIDA statistics, 15,600 deaths in 2009 were attributable to prescription pain medications.
But for individuals who legitimately require and benefit from opioids, the undertreatment of chronic long-term pain is a problem unrecognized even by those in healthcare due to the focus on opioid abuse. “The media generally does not report the issues around opioid use with accuracy, neutrality, and critical thinking. The tide has shifted from demonizing pain medication to demonizing people with pain, continuing the suffering of millions with untreated or undertreated pain,” says Yvette Colón, PhD, MSW, a psychosocial specialist at The MetaCancer Foundation.
Opioids typically have been more accepted in cancer care, especially for pain in the terminally ill, and prior to the 1990s they were rarely prescribed for chronic noncancer pain, even when pain was severe and long-term. After some cancer pain research studies showed that most patients did not experience addiction issues and the American Academy of Pain Medicine and the American Pain Society endorsed opioid use for chronic noncancer pain, opioids began to be more commonly prescribed (Schug, Zech, Grond, Jung, Meuser, & Stobbe, 1992; Manchikanti et al., 2010; Fauber, 2012). (See sidebar on page 20 for more information.)
“Unfortunately, this research coincided with increased rates of prescription pain medication abuse and media attention to it,” says Deborah Barrett, PhD, MSW, LCSW, a clinical associate professor at the University of North Carolina at Chapel Hill School of Social Work, a private practice psychotherapist, and the author of Paintracking: Your Personal Guide to Living Well With Chronic Pain. Barrett sees the issue from both the social worker and the patient perspective: She has lived with the chronic pain of fibromyalgia for almost 20 years.
To read more please click here: http://www.chronicintractablepainandyou.net/apps/forums/topics/show/13137789-pain-care-advocacy-in-an-era-of-opioid-abuse-part-1
Dr. Patty's Pain Journey Of 31 Years (Part 1)
Updated July 19, 2014
Hello. My name is Dr. Patty Hagler-Verdugo, PsyD.
I am 51 years old. I am married to a wonderful man that I have known since 1995. We have been married for almost 10 years (2000). I was born in Freeport, NY and I lived on Long Island, NY for the first 11 years of my life (no, I don't have my accent still). I graduated high school in 1980 (Birmingham High School in Van Nuys, CA).
Upon graduation, I went to college at UCSD. I went there for 1 year. Due to financial difficulties, and the divorce of my parents, I did not return to UCSD for a second year. I worked full-time and went to Jr. College (LA Pierce College, Woodland Hills, CA). I saved money, applied for financial aid and then started a large university in LA in 1983. I worked really hard to help my mom pay for school. I had worked part-time since the beginning of my college education, then full-time before going to another school. Once at school I got 3 jobs. I worked in a law office as a clerk, worked at a preschool as an aftercare coordinator and worked in my dorm food service.
On May 15, 1983 at 12:00pm (A date and time that are forever ingrained in my head), While I was working in food service, I was helping another student worker. We were working on dishes in the kitchen. He was taking care of the conveyor belt and I was just taking dishes off one by one. This young man was getting behind on the conveyor belt and dishes; forks, etc. were almost at the end of the conveyor belt with more behind them. I gave him some help of moving a tray of silverware to another location. Unfortunately, at the! At time employers did not educate their staff on proper body mechanics, as they do now. While picking up the tray of silverware and carrying to another location, I felt a pull in my back. Apparently, what I did was not take the tray of dishes off of the conveyor belt correctly. I did not use my knees. Also, while walking the silverware to their location, I carried them in front of me (placing more weight on my spine). I held them too far in front of me. I didn’t think much of it so continued with my shift.
After the brunch rush I went to my dorm room to lie down. My roommate and I had bunk beds and I was on the top. When I awoke I had severe pain in my back and could barely move. I was told by my roommate (who also worked in food service) to go to the hospital. I felt uncomfortable about making a fuss. I thought that it was nothing. After a long discussion, I did what she said (she went to tell the supervisor). I thank the Lord she did.
I went to the emergency room (at UCLA medical center). While I was there, x-rays were given n. I was told that it was probably just a strain or sprain. It was suggested that I stay at bed rest for 2 weeks. I was given some pain medication that made me feel so ill. The first shot of narcotics in my life (Demerol). I told the nurse I was going to be sick. She didn't believe me (lol), so I vomited all over the place (talk about projectile vomiting…LOL). Anyway, I was sent home to rest and employee health got hold of me and sent me to an orthopedic surgeon 2 weeks after my injury. The surgeon just gave me some medications (Tylenol...4 and some NSAIDS and was sent to a chiropractor, physical therapy, and for multiple epidurals. Eventually, because the pain was so bad an oil based myelogram was done (oil based dyes are no longer used today because they were found to cause spinal arachnoiditis). It turned out that what the doctor thought was sprain/strain was a mild disc herniation at the L5-S1 disc space. The pain never got better, just worse no matter what was tried conventionally.
In 1983 a new surgery (experimental) was available called a chymopapain injection. (This is where a papaya enzyme is put into the disc space in the hopes that the herniation was to be dissolved. I remember going to the medical school library and looking everything up on this new procedure. All the studies that I read pointed to the fact that this was a better procedure than cutting into a person. Unfortunately, at that time, no longitudinal studies were done. I was referred by my orthopedic surgeon to a neurosurgeon so that he could do the procedure. I went through the surgery in August, 1983. In 1984, my original workman’s compensation case settled for Lifetime Medical and a few thousand dollars. I was released back to work and school. I worked in the public library as a clerk, worked in a psychological testing firm that scored computerized MMPIs (Minnesota Multiphasic Personality Inventory I); I also worked in a Psychiatric Hospital doing groups. I felt good for 2 years (except every month when I was menstruating). To read my full pain story, please click here: