Pain matters

According to a study published in The Journal of Pain negative doctor attitudes about opiate medications are closely linked with lower rates of prescribing them and more favourable attitudes linked with higher levels of prescription levels.

“In 1994, Dennis C. Turk, PhD and colleagues at the University of Washington conducted a survey of physician attitudes about prescribing opioids for chronic non-cancer pain, which identified significant differences in attitudes and beliefs throughout the country and by medical specialty. The current study, also conducted by University of Washington researchers and collaborators, was intended to assess how physician beliefs about opioids have evolved over time and may coincide with changes in regulations, increasing drug misuse and negative public opinions about narcotic pain medications.” Negative Physician Attitudes About Opioid Pain Meds Linked with Lower Prescribing 

We as patients obviously do not need a study to be aware that some doctors are extremely averse to opiates as an option regardless of a patient’s pain or pain management options. Whereas others are clearly understanding that in some situations pain levels are a concern and pain management is an issue that needs to be addressed in the patient when other options are not effective. Obviously how public option reflects on the doctor, how the regulations have changed and this stigma of chronic pain patients seen as drug seekers are all factors in how this affects the way a doctor prescribes. And of course the patient’s overall wellbeing as a result.

The study involves a 38 item questionnaire that delved into the attitudes on implementation and concerns regarding the prescription of opiates, perceived efficacy, medical education and the benefits of the tamper-resistant formulations. “Phases Two and Three involved pilot testing and the formal survey of 1,535 physicians. More than 70 percent of the respondents reported they use opioids in fewer than 30 percent of their patients with chronic non-cancer pain. However, physicians who see higher volumes of pain patients were more likely to prescribe opioids and said they are less concerned with impediments surrounding opioids, are not worried about or avoidant of prescribing Schedule II vs. Schedule III drugs, believe in the benefits of TRFs, and know they were adequately trained to treat chronic pain. These results are consistent with other studies showing that physician uneasiness with prescribing long-term opioids is linked with inexperience in using the medications. There were no differences shown in overall physician attitudes about opioids in various areas of the country. The authors noted that orthopedists expressed the most negative views of opioids, showed the lowest level of confidence in drug efficacy, and had the highest mean levels of concern about opioid addiction, tolerance, and dependence.” Negative Physician Attitudes About Opioid Pain Meds Linked with Lower Prescribing 

Well then, if attitudes of the doctors reflect how they prescribe then what are they prescribing instead and how does that affect a chronic pain patient? The answer should be pretty obvious… NSAIDs. Quite a bit in fact according to The Journal of Pain. A study at the University of Missouri Kansas City School of Pharmacy, Children’s Mercy Hospital, Kansas City and University Health System, San Antonio looked at information from more than 690,000 patient visits to doctors offices compiled for the National Ambulatory Medical Care Survey from 2000 to 2007. Data included patients 18 and over with common non-malignant chronic pain.

“With regard to pain medicine prescribing practices, the authors reported that, in compliance with published guidelines, non-steroidal anti-inflammatory drugs were with most common medication class prescribed as a first-line option. NSAID use was surprisingly high with rates of 97 to 99 percent in all chronic pain types studied. Acetaminophen use was very low at 4 percent. The authors surmised that many chronic pain patients have not achieved sufficient pain relief from acetaminophen by the time they decide to see a doctor” Primary Care Doctors Prefer NSAIDS for Chronic Pain Treatment

And opiates? Must be used a lot for people to be so concerned about them right? Nope.

“No other medication class was used in 26 percent or more of the study population, and there was a lower than anticipated utilization of opioid analgesics. They were prescribed for only 10.5 percent of the general pain group.” Primary Care Doctors Prefer NSAIDS for Chronic Pain Treatment

Yet no one seems to care about the risks that come with NSAIDs especially the heavy-duty ones that are prescribed by doctors. I will say this was the option given to me when I had adverse reactions to triptans… I was put on Toradol. Had a very adverse reaction to that. Not very surprising. I have IBS-D so going on that sort of thing for any length of time I guess maybe carries the risk of causes severe abdominal pain, cramping, and diarrhea. Maybe I had a doctor adverse to opiates because she went for a different NSAIDs… Arthrotec. One that has a stomach coating. And I admit it was easier on the stomach, just not the intestines. I said, hey, this is still causing pain, cramping, diarrhea. Sort of hard to treat a migraine and work with this. She said it would go away when I got used to it. I think this to be generally true for this med but not in the extreme case I had so I think I may not have expressed myself well. And I think it was my mistake to believe this for one, to keep taking it for two (but work is work) and to not really be insistent to the amount of pain for three (too damn stoic).

Anyway… NSAIDs… can cause all that internal bleeding business. And so it was. And I can’t take this class of medicine anymore. Not even OTC. Extreme adverse reactions now. It really pissed me off at the time to the point of stopping seeing her even though aside from this issue she was a damn good doctor and I don’t actually care if she was adverse to opiates, in general, to be honest as long as she was a damn good doctor… in general she listened exceptionally well, but in this case there seemed to have been a bit of a miscommunication. Maybe she assumed something there. I think it was that she didn’t believe the seriousness of my expressed symptoms to be honest because it is hard for someone in chronic pain to express the seriousness of pain when it is so commonplace and you don’t want to seem like you are exaggerating. Either way the whole bleeding business that progressed to just blood didn’t feel like exaggerating or being on pills to ‘fix’ it for a year either… and whatever happened there didn’t ever fix my extreme intolerance to NSAIDs or aspirin after either so that really sucked. Sort of wish we had stopped at the first one and maybe considered different options before all that damage had occurred.

And in regards to these doctors so adverse to opiates and I would like to point out not treating a patient with chronic pain that isn’t being managed at all by other means is dangerous to the patient. They have a hard time functioning in the workplace but many need to actually work… so the damage you are causing is extreme. And the danger mentally and emotionally cannot be underestimated given the fact pain alone is a suicide risk and yet That is completely ignored.

See other posts on opiate stigma

Pain awareness: The opiate issue

Chronic pain: don’t steal lives, doc

The war on pain

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