We need to redefine pain and hold everyone accountable

We are currently in the midst of the worst drug crisis in American history. A crisis that killed more than 33,000 people in 2015. Currently, an estimated 2.6 million people are addicted to opioids.

As an internal medicine doctor, I deal with pain, addiction and opioid overdoses on a routine basis. The current epidemic that is sweeping across our nation, is deeply concerning.

The U.S. Surgeon General recently spoke about the epidemic and asked health care providers to view addiction as a chronic illness and not as a “moral failing.” I completely agree with this approach but while everyone is talking about addiction, I think we need to take a step back and talk about pain.

Pain was first recognized at the fifth vital sign in the 1990s. The other vital signs include blood pressure, heart rate, respiratory rate, and temperature. I always had a hard time accepting pain as a vital sign. To me, it does not fit the objective canvas of the other measurable signs. It is a subjective feeling that a patient reports and is more convoluted than a number on a scale of 1 to 10.

Treating pain appropriately is absolutely critical, but unfortunately, the definition of pain is not that simple. Pain is an extremely complex phenomenon and we do it injustice by reducing it to a mere number on a scale.

Pain in an end-stage cancer patient with bone metastasis may be very different from pain in a young patient who recently had routine surgery. Both of these patients can tell me that their pain level is a 5 but the number can be interpreted in several different ways. Pain level of 10 in a patient with chronic pain and a high tolerance is very different from a pain level of 10 in a patient who has never experienced severe pain before.

Redefining pain is essential to the current crisis and the education needs to start early in training. At present, primary care physicians are not well trained in addressing chronic pain and addiction. We need a multidisciplinary approach to the problem with involvement of psychiatry, pain management and addiction medicine specialists.

We also need to hold our patients accountable. Yes, physicians may have contributed to the crisis by overprescribing, but physicians are not the only ones at fault.

I often meet patients who deny the concept of addiction and demand strong narcotics without negotiation. They offer me no scope for education and partnership and are usually my most challenging patients. Patients need to be open to a dialogue when it comes to pain management.

Lastly, I believe that we need to move away from bureaucracy in order to address the opioid crisis.

Bureaucracy has introduced the concept of customer service in our hospitals. When your patient becomes your customer, the outlook for a partnership dissolves. The focus shifts from education to satisfaction. When surveys and scores take precedent, the scope for open dialogue gets diluted.

Our country is in a public health crisis. We need to act. We need to employ a multidisciplinary approach. We need to redefine pain and hold everyone accountable. Physicians need a louder voice in regulations and policies. Most importantly, we need to restore the heart of medicine in the physician-patient relationship for change to occur.

Neha Sharma is a hospitalist.  This article originally appeared in the El Paso Times.

Image credit: Shutterstock.com

View 20 Comments >

Most Popular

KevinMD logo - transparent