Not Taking Pain Meds Isn't Always A Choice. Dependency On Pain Meds Is Not The Same As Addiction.
Addiction
-Mental & physical factors
-Withdrawal symptoms prevent tapering medication
-Poor mental health drives addiction as a way to escape mental pain
-In most cases, symptoms will resolve following longstanding refrain from use of medication/substances
Dependency
-A physical need
-Pain symptoms return when meds are tapered regardless of withdrawal symptoms
-Mental health is poor as a result of suffering physical pain and stigma
-If medication is withheld for long periods of time symptoms will not resolve and likely get worse
Both
-Chemical tolerance to frequently used substances may require higher doses
-Face undesirable side effects from use of medications & substances
-Face stigma from doctors & community
-Doesn't make you a bad person
-Deserve compassion and APPROPRIATE* treatment
*The appropriate treatment for addiction is community and mental health support targeting the reasons someone abuses substances, accompanied by careful tapering of substances including informed use of less harmful or addictive options. The appropriate treatment of chronic pain dependent on medication management is continuing to provide pain relief using whatever balance of medication provides the best overall quality of life.
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Two Scenarios
Imagine if someone paid you to put your hand in boiling water. You might be able to put it there, but you would probably not be able to hold it in the boiling water no matter how much money was offered. Your body would force you to pull your hand away.
Now imagine you are have a chronic pain condition and it is flaring. It is causing you as much acute pain as having your hand in boiling water. You have medication in front of you that you know will stop it, but you have already taken the prescribed dose.
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In the first scenario, most people would not say the person chose to give up the money by pulling their hand out of the water. They would say they were forced to by extreme pain, or by bodily instinct. So why do we so often label the second scenario as a "choice" to be "medication non-compliant"?
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In a study on chronic pain by the US Pain Foundation, 1 in 4 patients said that no side effect would stop them from trying a medication to control their pain.
When patients are in extreme pain and medication is available to them in any way, they do not have a real choice of whether to take it.
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Should we be trying to offer the least harmful pain control option? Yes.
Should be put protections in place so that patients do not accidentally overdose in an attempt to control their pain? Yes.
But can we blame patients for an innate human response to take action to stop unbearable pain? No. We cannot.
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If you acknowledge the basic truth that chronic pain can be just as severe as the acute pain of a hand in boiling water, then you must acknowledge the truth that controlling that pain is not a choice, it is a basic human reflex.
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Obviously, not all chronic pain is as bad as holding a hand in boiling water. Most is less severe. Some is more. Most patients with chronic pain do make the choice every day to take less pain medication in order to avoid social stigma, cost, side effects, and so on.
But for those who are truly dependent on pain medication, this metaphor is not an exaggeration.
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Following this logic, to deny pain relief is to force someone's hand into the boiling water. It is torture. It is cruelty. It is traumatizing. Yet it is an experience almost every single chronic pain patient has suffered.
Is it any wonder that so many doctors deny that chronic pain patients are truly in severe pain? If they accepted the truth they would be forced to acknowledge the true cruelty their profession perpetrates.
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The true risk to any chronic pain patient is not addiction. It is suicide.
Physical need for painkillers is not addiction. It is self-preservation.
Providing stable ongoing medication to chronic pain patients is not enabling anything besides their lives.
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Medication Dependency is not the same thing as addiction. While both chronic pain and addiction patients deserve compassion and respect, it is essential that we understand that these are very different scenarios.
Severe Pain is no less worthy of relief simply because it is chronic. Fibromyalgia, CRPS, Neuropathic Pain, Trigeminal Neuralgia, Migraine, Cluster Headache, Sciatica, and Arthritis, all of these patients' pain matters. While the #OpioidCrisis is real, #chronicPainPatients are not the problem and they have become the victims of policies that do nothing to stop the actual abuse of #opioids.
Using pain medication is morally neutral. When that medication is used as an unhealthy coping mechanism in addiction that is bad. But when it is used to relieve life-threatening physical pain that is most definitely good. And make no mistake, severe chronic pain is life-threatening.
The greatest threat to chronic pain patients is not addiction. It is suicide.
Quality Of Life is life giving. Palliative Care is a Human Right.
Until doctors come to understand that taking pain medication for severe pain is a human reflex they will never be able to see the true cruelty they perpetrate through forced tapers, cutting of patients from life giving medication, and denying pain relief to those in severe pain.
Medical Gaslighting must end. Just because a patient can be trained not to complain about pain doesn't make the pain stop. You Didnt Cure Us
Pain medications and opioid medications aren't the answer to all chronic pain. But for some people, they are the answer. For some people, they are the difference between a fulfilled life and a miserable living death. To deny these people's life is nothing but cruelty. The only thing they are addicted to is life.
