Killing pain--or maybe painkillers

You are probably tired of hearing about the opioid epidemic, but I was surprised to learn a few new tidbits from a book written by the chief of addiction medicine at the Stanford University School of Medicine. To begin with, the majority of the misused prescription drugs come directly from doctors. Only four percent are obtained from a drug dealer or stranger.  One of the chief culprits is Purdue Pharma, the manufacturer of OxyContin and other addictive painkillers. For many years, this company misled doctors about the dangers of opioids and promoted them heavily. Now they're being sued by the state of Massachusetts. (Recently, internal emails were brought to light in which their strategy was to “hammer abusers in every way possible” calling them “reckless criminals.”) But the damage has been done.

To promote their products, Purdue helped to fund the educational materials for a nationwide pain management program under the aegis of the Joint Commission on Accreditation of Healthcare Organizations. For one thing, the commission added “pain” as the fifth vital sign—something that hospitals must measure. Of course, pain can’t be measured objectively. Hence, The Visual Analog Scale of pain. 

You’ve all seen the posters. Purdue helped to fund their production and dissemination. It turns out that the posters helped Purdue’s business: research shows that the use of these scores increases opioid prescribing and use.

In the past, pain was viewed as part of the healing process—something to be endured. Today we think of pain as intolerable—something that must be eliminated. In fact, the Federation of State Medical Boards urged state medical boards to punish doctors for undertreating pain, such that doctors now live in fear of disciplinary action.

Maybe hospitals should substitute their little face posters with the slogan, “no pain, no gain.”

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