The Politics of Pain and Its Impact on Pain Medicine

Abstract

As pain specialists, we are often the last resort for patients who have endured months, sometimes years, of pain. Despite the help that can be offered, doctors, patients, and families fail to seek or offer treatment for the most agonizing conditions. The federal government's efforts to curb drug abuse, however well intended, has further complicated the treatment of pain, particularly with the use of opioids. Regardless of where each of us falls in the debate over opioids for chronic pain, few would disagree that the regulatory and legal environment is changing. How did we get here? Several medical, social, and political trends have converged to create a perfect storm of controversy and confusion. In recent years, pharmaceutical companies have developed more varied pain relievers. Simultaneously, some of these new, potent medications have been diverted to a growing black market. A change has subsequently emerged in street abuse of opioids, and we have seen rising rates of prescription-drug abuse. In direct discussions between the American Academy of Pain Medicine (AAPM) and the Office of the Nation Drug Control Policy (ONDCP), it is clear that this trend now appears to be leveling off, and even the ONDCP does not know how this increase in prescription-drug abuse relates to rates of overall drug abuse. They, and therefore we, simply do not have the data. We all must not only acknowledge the prescription-drug abuse problem, but also recognize that that this is likely, at least in part, a redistribution of abuse of nonprescription to prescription drugs. Thus, targeting prescribers and hoping that they will prescribe less likely abused drugs, as was suggested in the March …