Do Patients Have a Right to Complete Pain Relief?

 

A new book presents an important new understanding of chronic pain and the role of 

prescription opioids. One that can help both troubled patients and their beleaguered doctors. 

The Right to Pain Relief and Other Deep Roots of the Opioid Epidemic. Oxford, 2023 

Psychiatrist, philosopher, and pain expert Mark D. Sullivan and anesthesiologist and pain expert 

Jane C. Ballantyne argues that changing our cultural concepts. And values ​​about pain and 

opioids they created the opioid epidemic. They support this idea with fascinating historical and 

philosophical overview.

Source:

 Courtesy of the authors and publisher

It wasn't until 1500 AD that people understood "why" they had pain: God wanted it as 

punishment for their sins. This led them to work to atone for their sins to meet salvation. 

Between 1500 and 1700 AD, this magical, all-powerful image of God gave way to deism. The idea 

that once created he no longer operates in the world. And that man must use his God-given 

potential to thrive. People could now prosper on Earth instead of only achieving happiness in the 

afterlife. This transition expanded the idea of ​​pain as an obstacle to the good life. Pain was no 

longer perceived as necessary suffering.

After 17the 00 AD, society expanded this view:

Human fulfillment could occur during our lives. And the reduction of pain and suffering was a 

desirable part of that. Pain became escapist and something to be treated. This fits with the 

influence of the philosopher René Descartes. And the increasing medical and scientific advances 

of the Scientific Revolution. Thinkers in this period sought to understand how pain occurred 

and. Once understood, how they could treat it; the answer to "why" the pain occurred remained 

with the church. Society and the sciences evolved to regard health as a prerequisite for happiness. 

And medicine, rather than the Church, became the arbiter and administrator of physical pain.

The opioid crisis of the last 35 years stems from this new culture. More important than the 

misunderstanding of opioids is that medicine has adopted an approach. That has treated pain as 

a mechanical, medical disability, pain as passive and innocent suffering. This reflected society's 

belief in the right to full relief from pain.  But only for physical pain, the pain of psychosocial 

suffering was ignored. Still, several of them believed that pain treatment was more 

comprehensive. And established many multidisciplinary pain clinics. Where psychologists and 

other pain specialists cared for the whole person. But, this holistic approach would soon fall away.

Several social events set the stage for what became America's effort to completely eradicate pain. 

After the horrors of World War II, Western nations created the United Nations. Which published 

its Declaration of Human Rights in 1948. later amendments established a right to end-of-life pain 

relief as did a US Supreme Court decision. Influential international pain societies materialized 

and  wrote that "access to pain management is a basic human right." Three specific advances 

then led to the search for complete pain relief in the US: 1) The birth of anesthesia increased the 

possibility of complete relief from physical pain. for example, surgeons could now perform 

painless tooth extractions and amputations. 2) The palliative care movement advocated that the 

dying should not experience a more burden of pain. 3) The Sackler brothers developed 

OxyContin is a much more potent narcotic than morphine which was used earlier. A huge effort 

to promote the use of opioids for chronic pain followed, using this rationale. If we could 

completely relieve pain in ill and surgical patients. Why not do the same for chronic pain 

patients. To achieve this goal, pain organizations, US government regulators, and Congress 

promoted pain relief as safe opioids and recommended their use. Not, the holistic, 

multidisciplinary model of pain management from psychologists and other pain professionals has 

shrunk. And the high levels of depression and anxiety in the pain patient have disappeared from 

the radar screen. This treatment took too much time and required specialist care. Whereas 

opioids were administered and provided rapid control. Because of this, and the increasing 

number of patients seeking pain relief. Chronic pain management has shifted to primary care 

physicians. (My earlier post describes their complete lack of training in this area.) With 

unprepared doctors understand opioids as safe and effective and desperate patients demanding 

relief. The floodgates opened and massive prescribing ensued. Patients and doctors deluded into 

the false hope of a cure, only pharmaceutical houses benefit. The authors summarize the now 

well-known research data (from non-pharmaceutical sources) that opioids caused much death. 

And disability and had no beneficial effect on chronic pain. But they go beyond a 

misunderstanding of opioids to the deep roots of the crisis. They explore how the idea of ​​pain as a 

disease defies both the biopsychosocial model and modern learning models. Both of which 

integrate the psychological and social features of the pain patient into treatment. The disease 

model overlooks that the problem is not the pain itself, but rather the emotion it evokes. In an 

extensive review of the evolutionary role of pain and its biological and neurological mechanisms. 

The authors explain how wrong it was to view pain as a disease amenable to opioid treatment. 

For example, evolution co-opted ancient brain pathways devoted to physical pain to also dampen 

psychological. And social pain in much later evolving humans and other higher animals. That is, 

physical, psychological, and social features often co-occur in response to anxiety of any type 

in 

humans. That physical pain cannot be understood in isolation. Additionally, problematic, 

prescription opioids engage our normal internal (endogenous) opioid systems to great detriment. 

Endogenous opioid systems not only mediate pain relief. But also mediate our stress responses, 

our moods, our energy, and our drives. Our protective emotions and behaviors needed to 

function in society. They thus mediate socialization, the most important human task for survival 

in a complex society. Unfortunately, delivered opioids disrupt this system. The authors describe a 

particularly harmful disabling effects of prescription opioids. Where “…a chronic opioid user will 

tend to seek further drug use for the positive effects of pain relief and reward. Rather than more 

natural alternatives such as exercise, laughter., music, meditation, touch, close relationships and 

friendships. All stimulate the endogenous opioid system. As a result, chronic users lose libido, 

energy and drive and tend towards passivity rather than action. The authors then revise the 

"salience network" (some call it the pain matrix).  Rather, it focuses on reducing the pain itself 

by changing the patient's understanding of the pain mechanism. The authors conclude that 

medicine cannot solve all human suffering. Nor can we abolish the pain and suffering of human 

life. Not realizing this was an even bigger misunderstanding than the use of opioids in medicine. I 

had two problems with the book. First, I was troubled by the authors' seeming ambivalence 

toward the biopsychosocial model. At one point saying it had failed, while at other points 

pointing to its value. And throughout the book emphasizes the need to integrate the biological, 

psychological, and social aspects of patients. Second, while some of the repetition was helpful in 

tackling this complex subject, I found it a bit distracting at times. But, these concerns are minor 

and I recommend this book. This new, before unarticulated concept, may serve as the basis for a 

more. an effective and humane approach to problematic chronic pain care. All clinicians, 

educators, and pain patients can enjoy reading this engaging, thought-provoking book.