Read the full article at The Guardian.
Twenty-two years ago, in 1996, the influential American Pain Society introduced the concept that pain should be treated as a “fifth vital sign”, alongside the normal things doctors routinely check in their patients – body temperature, blood pressure, heart rate and breathing. America’s medical profession broadly welcomed the idea and began to ask patients routinely how much pain they were in.
The same year, the US drug company Purdue Pharma began aggressively marketing a new type of prescription narcotic painkiller, OxyContin, that it claimed was less prone to abuse or dependency than the morphine it mimicked, because it came in the form of slow-release pills.
But these events set the stage for the opioid crisis that unfolded – and persists – currently killing more than 60,000 Americans a year.
Prescriptions began flying off pads in doctors’ offices all over the country, as a class of drug traditionally associated with war wounds, post-surgical acute pain or patients dying of cancer became a routine treatment for chronic conditions like back pain or osteoarthritis.
Pain accounts for more than half of primary care visits in the US, according to the Department of Health.
The problem, APS leaders told the Guardian this week, is that opioids merely block pain without treating its source. Many experts now recommend a multi-disciplinary approach, such as physical and sometimes psychological therapies, before turning to prescriptions.
But as medical experts shrink from opioids, “there’s no rationality” to the way that is being implemented, says the outgoing APS president, David Williams, a psychologist at University of Michigan. And that drives people to the black market and street drugs like heroin and fentanyl. “Are we throwing the baby out with the bathwater?” asked Mark Sullivan, a psychiatrist at the University of Washington in a January research article.
Opioid painkillers , such as OxyContin or the many other brand and generic versions that also became bestsellers, do nothing to alleviate the underlying cause of the pain, says Dr John Loeser,an APS member, also at the University of Washington.