Editor's Message: Perspective
I have had some incredibly memorable shoes throughout my life. In middle school, my parents provided for me a pair of Red Wing hiking boots. At the time, these boots represented an incredible expenditure for my parents, but they allowed me to experience fantastic and foundational adventures such as hiking throughout the Badlands, Black Hills, and Isle Royale. In my senior year of high school our basketball team was outfitted in matching North Carolina blue Nike Air Max shoes. In these shoes, our group of 12 felt like we could take on the world. At the time, I was fairly convinced that there would be multiple NBA teams clamoring to draft an unathletic 6’ forward with questionable shot range. The shoes that I am most connected to now are my Brooks Transcend running shoes. These size 13 land cruisers don’t go anywhere incredibly fast, but they glide over the miles and the years have been marked by a number of great runs with friends and family.
It is my hope that you emerge equipped to view patients experiencing chronic pain with increased empathy while considering their shoes and the journey that has led them to you.
The thing about all of the shoes that I have worn out into the world is that each of them has brought me somewhere positive – nature, hard court glory, country roads, and marathon courses. While wearing these shoes, I have been unburdened by constant and consuming pain or the need to consume opioids or other substances of abuse. I grew up in a house with fantastic parents (thank you Lucy and Bill) where we did not have all of the money in the world but where we were unquestionably loved and supported. While not universally true, members of our profession frequently benefit from these same generational blessings that largely grant us immunity from poverty, household settings where drug abuse is normalized, or suffering in situations where we might need to overcome painful conditions without an adequate social support structure or available healthcare resources. While mental health disorders are ubiquitous, our patients may not always enjoy access to treatment pathways designed to improve their ability to achieve a highly functional status or cope with unforeseen stressors. Our collective lack of familiarity with the tribulations and suffering of our patients is occasionally difficult to remedy and may impair our ability to connect with these patients and develop an effective encompassing analgesic treatment plan.
While the central tenet of our career as pain management physicians is the alleviation of patient suffering, it would be incredibly disingenuous to not acknowledge the challenges associated with the treatment of some of our patients suffering with chronic pain and opioid requirements or abuse disorders. While many of these patients are incredibly gracious for our commitment to their plight, there are certainly some that can be difficult, manipulative, deceitful, abusive, dismissive or disengaged. There are times when treating these “chronic painers” can seem incredibly unrewarding and call into question the utility of attempting to treat their pain or tailor an analgesic regimen.
In those challenging clinical moments where it seems that there is no appreciation for your efforts emanating from the patient or their family, I would encourage you to take a moment to consider where they may be coming from and assist your colleagues in attempting to do the same. Is the patient’s perspective on the healthcare system clouded by an adversarial experience in the emergency department where legitimate pain was labeled as opioid-seeking behavior? Does the patient have persistent pain resulting from an unwarranted procedure or unanticipated adverse surgical outcome? Does the patient with difficult to control inpatient pain have a home situation that is potentially unsafe, or are they solely responsible for providing care for others? Is the patient on elevated opioid doses simply because it was easier for a previous healthcare provider to continue to escalate the opioid dose than work to determine and diagnose an etiology for the pain or consider nonopioid analgesic alternatives?
Ultimately, our healthcare system is likely the cobbler for many of the opioid related issues currently afflicting our healthcare system and our patients. It is therefore incumbent upon us to consider these patients and their situations carefully and continue to work toward addressing their unique circumstances and analgesic needs. In this edition of the ASRA News, we intensely focus on how the opioid epidemic has impacted our patients and the role that pain physicians must now assume in addressing this catastrophe. Following a review of these articles, it is my hope that you emerge equipped to view patients experiencing chronic pain with increased empathy while considering their shoes and the journey that has led them to you.