Ben’s story in When Is a Pain Doctor a Drug Pusher?, the NY Times Magazine article I wrote about yesterday, brought up something I’d never thought through: Opioids don’t correct the problem that causes pain; they just mask the pain. Couldn’t this cause more harm than good?
Ben, a farmer for whom “. . . years of pushing 800-pound bales of hay wore out his back,” said:
“They [opioids] helped my pain. I could get out and work, use the bulldozer. I was working a 250-head cattle herd. I was doing everything relatively pain-free because of the drugs. They gave me my life back.”
When there is a physical cause of pain, won’t doing activities that the injury made impossible cause further degradation in the damaged area? The same areas of the body are stressed as were before, but the body’s warning system can’t do its job.
Even when pain can’t be traced to a direct physical cause, as with headache disorders and migraine, masking the pain may still be harmful.
Say I have enough pain relief to return to my previous levels of activity. The “lifestyle management” tools I use now — regular sleep, exercise, minimizing triggers, etc. — would no longer seem as important. I’d probably let them slide. Why worry about triggers if they don’t affect my daily life?
But I’d still have chronic daily headaches and migraines, I just wouldn’t feel the pain of them. Getting rid of pain would not keep chronic daily headache and migraine from doing harm in my body and brain. The potential for long-term damage remains. Also, migraine has many symptoms other than pain that a painkiller can’t treat.
On the contrary, some argue that the brain learns to be pain and gets stuck in a rut. If something no longer causes pain, then the pressure on this mechanism could let up and allow the brain climb out of it’s pain rut. If this is the case, opioids make sense.
I’m not arguing that opioids shouldn’t be available for patients who need them. (My stance is the opposite.) However, treating an illness and treating pain caused by the illness require different approaches. Getting closer to the source of the problem when possible seems the logical place to start.
Addiction is the problem child in the realm of opioids. Sometimes the quieter kid really needs the attention.