If you have been following the messages coming from experts in the pain field in recent times, you will notice one clear resonating message. Pain management is complex. There are often no silver bullets, and short cuts in the management of pain often lead to longer, and harder pathways for everyone involved.
We have seen this unfold in a myriad of ways, most painful of which perhaps has been the so called ‘Opioid Crisis’. It’s hard to see how a class of drugs that have become synonymous with the phrase ‘pain-killer’, may actually be doing everything but. The overwhelming evidence now shows us that in the long run, opioids are ineffective for the management of long term chronic pain. In fact there is substantial evidence now that they have a significant potential for harm: from nausea and constipation to physical dependence and neuropsychological problems. However, we know that there may be people with chronic pain conditions and their practitioners who will still consider them a useful part of their treatment regime and we know there are exceptions to any hard and fast rule of thumb especially in a complex area.
There is now a general reluctance across the medical community to prescribe opioids, even in instances where it may be a clinically viable and necessitated option. Anecdotal evidence from consumers in our networks shows that even consumers for whom opioids have often been the last resort of treatment are now facing increasing resistance to ongoing prescribing, with reports of some doctors issuing blanket ban notices on prescribing of opioids, as well as reports of forced tapering.
Painaustralia has also heard from GP’s who practice predominantly in the aged care sector who have been scrutinised for their prescribing of opioids in a palliative care context. Clearly in the context of aged and palliative care, we need more effective and timely pain management strategies, and using a broad brush approach that limits all opioid prescribing will have some serious, unintended consequences.
In the US, we can see the devastating impact that similar punitive regulatory responses have had on the very cohort who rely most on both regulation and effective pain management: people living with chronic pain.
We must recognise that pain management is a nuanced discussion. There is no one size fits all pathway here. While we do have a problem with excessive opioid prescribing, we must invest the time and effort to improve understanding and awareness of best practice pain management among both consumers and health professionals. This requires a long- term approach. It is also important that we invest in the range of treatments and services that can assist people to manage their pain condition. We should not expect this to be a quick and easy road.
I hope that we can learn from the American experience and return to a more considered discussion around appropriate, well-informed pain management supported by regulation that won’t inflict further harm on people living with pain.