Link: http://goo.gl/0CyMyb
Read and heed.
A recent review article in the New England Journal of Medicine by Nora Volkow, MD and A. Thomas McLellan, PhD, succinctly sums up the state of affairs surrounding the use of opioids for chronic pain.
Yes, I agree with most everything their article says.
And…
As I read their litany of legitimate negatives, I wonder if anyone has recently taken the time to study “successful” chronic pain management with opioids.
Actually, I wonder if anyone in a position of authority believes it is even possible to be successful treating chronic pain with opioids.
Full disclosure: I am not a researcher. I am a clinician. I am on the front line.
As review articles, guidelines, policies, regulations, and laws keep popping up, I keep reading. And as I read it occurs to me that defining “success” is as subjective as defining pain itself.
The International Association for the Study of Pain has defined pain as
An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.
So maybe success in treating chronic pain with opioids could be defined as:
A regulatory and emotional experience associated with actual or potential benefit, or described in terms of such benefit.
And I’ll offer the other side this definition of failure:
A regulatory and emotional experience associated with actual or potential harm, or described in terms of such harm.
Take home point: All three definitions are subjective.
So, as I prepare for another day on the front line of chronic pain care my inherent duty is to:
Follow the regulations, but
Find the truth contained therein, and use it to
Facilitate my patient’s journey to success.
Success is a journey. Not a destination.
New England Journal of Medicine, consider this my open invitation to any researcher interested in exploring the possibility that one might be able to successfully prescribe opioids for chronic pain.
The doctor will see you now.
Will you see the doctor?
*
Success is counted sweetest
By those who ne’er succeed.
To contemplate a nectar
Requires sorest need.
– Emily Dickinson
*
Confluential Truth 
From a chronic pain success story (from average days of pain at level 6-7 to working again, driving, taking care of myself and enjoying life) I thank you, Dr. Murphy, for persisting with my care and that of others, and especially for continuing to do so in a viciously discriminating society and against all odds. Your commitment and integrity far surpasses that of those with a blind determination to see only one side of the truth.