chronic pain: help is there but …

i just came across a petition regarding the use of narcotics for people with chronic pain that i drafted for the canadian RSD network ten years ago. looks like things haven’t changed much. even all the links are still alive. skip baker’s story is particularly chilling.

here is the petition:

dear ………:

we are people who live with persistent, often intractable pain. in the u.s., there are 34 million of us. many of us have lived with this for decades. but even a few months of constant pain is enough to wreck terrible havoc in anyone’s lives.

imagine the pain of childbirth, of an abscessed tooth, of kidney stones – or even just the headache from a hangover. in fact, nobody would want to imagine such a thing. for many of us, however, such pain is something we live with constantly. we suffer from arachnoiditis, reflex sympathetic dystrophy, systemic lupus, headaches, arthritis, fibromyalgia and many other conditions.

the constant pain means that many of us lose valuable work time or cannot work at all; it means that we might have to plan our whole day around pain management (often resulting in a non-existent social life); it means that our health is further affected by the consequences of constant pain – therefore, many of us suffer from insomnia, depression, and anxiety.

it also means that our families suffer: we often feel inadequate as parents, spouses, friends; we cannot contribute to the circle of our loved ones as much as we want – we cannot contribute to society as much as we would want to. and some of us are driven to despair by this and commit suicide – thousands of us, every year.

what is the economic impact of chronic pain? back pain, migraines, and arthritis alone account for medical costs of $40 billion annually, and pain is the cause of 25% of all sick days taken yearly. in the u.s., the annual total cost of pain from all causes is estimated to be more than $100 billion.

our doctors often do not know what causes the pain. other times, we have a diagnosis, and it just promises more pain.

but what makes our situation even more difficult to bear is that at least for some of us, there is a solution. opiates. opiates are not the perfect answer – in fact, many of us do not want to or cannot take opiates. to others, however, it offers hope for something that we all yearn for: an almost normal life. for some of us that means that we can go to work, for others it means we can participate in family life, for others yet it decreases the pain to a point where we do not constantly think of suicide.

unlike other freely prescribed medication, such as prozac, many opiates have been around – tried and true – for a long time. morphine is one such example. and, contrary to commonly held beliefs, opiates can be quite safe if used in a controlled manner, by people like us, who use them for pain control, not for recreational purposes. let us look at a few myths:

myth #1 – addiction
physical dependence is not the same as addiction. for example, a diabetic is physically dependent on insulin – not addicted. “addiction” means loss of control, compulsive use, and continued use in spite of harm. this is not the case for most of us – indeed, a 1980 survey by the boston collaborative group found only 0.03% patients became addicted to an opioid.

myth #2 – tolerance and “non-responsive pain”
absence of pain relief to increasing doses of opiates is very uncommon. research supports the use of opiates for chronic nonmalignant pain (e.g., nonneuropathic musculoskeletal pain, pain resulting from chronic regional pain syndrome, etc.).

myth #3 – disability
according to dr. portenoy, an internationally recognized expert in pain research and the use of opiates, regular, careful monitoring can easily forestall potentially detrimental effects of opiates. this monitoring should include questions regarding pain severity, adverse physical or mental effects, the patient’s social status and support network, etc.

these and many more myths have long been debunked by many researchers, physicians and patients. however, the u.s. war on drugs, which has spilled over into other countries, especially canada, has created a climate of fear and misinformation among patients and health professionals alike. even when they know that opiates would be the answer to pain relief, health professionals often do not prescribe or endorse opiates for fear of regulatory authorities who have the power to withdraw their licenses.

the world health organization, unlike the US, endorses the use of opiates when indicated. indeed, its “ladder of pain control” is very similar to the one indicated by dr. portenoy and other workers in the field. according to this “ladder”, when regular painkillers, such as aspirin, do not relieve pain, an opiate should be added to it; if the results are unsatisfactory, higher doses of opiates and non-nsaid painkillers should be used, etc. (here is another myth debunked: more people die annually of an overuse of our “regular” nsaid painkillers than from the use of opiates for pain).

international researchers and politicians have formed the resolution for a federal commission on drug policy to align along the scientific and compassionate guidelines of the who to petition with the u.s. president to reconsider their war on drugs. not only is this war deadly for us, resulting in a war on people with chronic pain, it also has other catastrophic consequences, such as thwarting the fight against aids, using scarce resources for the war on drugs instead of fighting against poverty and illiteracy, and empowering the drug lords.

we appeal to your intelligence and compassion. please, follow the intelligent lead of the resolution for a federal commission on drug policy and consider your stand on opiates in a sober, unbiased and scientific light. please, understand the terrible suffering people with chronic pain and help us regain at least a modicum of a normal life.

thank you.


moulin et al: lancet 1996;347:143-7
canine, craig: worth. march, 1997: 79-82, 151-157
liebeskind, j.c.: pain, vol. 44, no. 1, january 1991:3-4
american academy of pain medicine and american pain society: clinical journal of pain, vol. 13, 1997: 6-8

portenoy on
skip baker and the ASAP
drug library

isabella mori
counselling in vancouver

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