As if chronic pain were not enough, some people have double the trouble. Some people are recovering addicts and have chronic pain. Some people have mental illness and have chronic pain. And some people have no insurance and have chronic pain. Yikes! All these additional problems add up to double the trouble when it comes to effectively treating chronic pain.
A recovering addict with pain creates a treatment dilemma for any physician who attempts to control pain with opioid medications (narcotics). The recovering substance abuser may be placed in harm's way if given access to the very chemicals that lead him/her onto the path of addiction; like an ex-heroin user that is seriously injured 20 years into recovery and needs pain medications. For this patient, the pain medications can become part of the solution, part of the problem or both. The potential for relapsing into addiction behavior is always there. And relapsing into the tenacious grip of addiction can result in death. In order to treat those with the double problem of addiction recovery and pain, a doctor must monitor very carefully and have very strict guidelines. In fact, some experts say that only addiction specialists should treat pain in those who are recovering from addiction. Complete honesty, family involvement, and support are also key ingredients for successfully, effectively treating pain in someone who has a preexisting addiction history. The risk of prescribing pain medications in this population that has double the trouble is very high.
A mentally ill person with chronic pain can be equally challenging. Recently, a twenty-one year old woman with low back pain came to see me. I was horrified to see amount of scars on her arms from self-mutilation. Is this someone who can be trusted to use medications responsibly? Serious mental illness in the face of chronic pain can be very risky and tricky to treat because, once again, pain medications in the wrong hands can lead to a deadly overdose. Mental illness with chronic pain is double the trouble, double the risk.
A person without health insurance has a different type of double trouble when a painful condition strikes. Treatment is expensive. Most people cannot afford medications let alone the potential benefits of physical therapy, bracing, massage, acupuncture, surgery or anything in between. Effectively treating pain can drain a person financially, especially if the pain prevents someone from working. Without a means to pay for proper treatment, the pain can be left unchecked and the bills can pile up quickly. Chronic pain is enough trouble without financial ruin to double the trouble.
Recovering addicts, the mentally ill, and the uninsured all have major problems accessing effective pain treatment for different reasons. The ex-addicts and the mentally ill get turned down by physicians who are not comfortable with the increased risk. The uninsured get turned away because many doctors cannot afford to offer services for free. Equal access to pain control for all is no easy task especially when dealing with special populations. For some, access to pain relieving medications could be deadly. For others, access to pain relief cannot come quick enough. Our society needs to ask some tough questions in order to find solutions. Should drugs be legalized and accessible to all? How should we address the needs of the mentally ill? Can we afford to insure everyone? Tough questions bring some tough answers. Is anyone brave enough to take these issues on?