“Pain is a more terrible lord of mankind than even death itself.”
— Albert Schweitzer, 1875-1965
Albert Schweitzer was a physician and theologian, best remembered for his missionary work in Africa. If you’ve experienced excruciating and unremitting pain, or felt helpless observing someone else in the throes of such torment, you know exactly what Dr. Schweitzer was talking about.
Pain is the alarm that tells us something is wrong. It is the main reason people seek medical care. When that alarm doesn’t turn off, such as with cancer, arthritis or especially with abnormal “short-circuiting” of the nervous system, soul-crushing despair takes over. That’s why Schweitzer’s immortal words motivated virtually every authoritative health, medical and human rights group throughout the civilized world to formally declare that relief from pain is a universal human right, including access to opioid analgesics if necessary.
Fortunately, most people with persistent or recurrent pain problems don’t require ongoing opioid therapy, especially when they have access to other effective treatments. But when non-opioid pain management strategies don’t work, opioids in combination with other medical, behavioral and rehabilitative therapies can be the only means of providing a livable, functional life.
Like cancer patients or diabetics who would give anything not to have to take chemotherapy or insulin, the patients I treat in my work as an academic physician at an interdisciplinary pain management center would give anything not to have to take pain medicines, including opioids. Nevertheless, for those who cannot obtain relief any other way, these medicines are life-saving.
As the “War on Drugs” ceaselessly continues in its attempt to curb the insatiable appetite so many in our society have for mind- and mood-altering substances, it threatens to turn back the clock on the fundamental human right of pain relief, making legitimate patients inflicted with torturous and physically debilitating pain the latest casualties. The Global Commission on Drug Policy released a critical report declaring, “The global war on drugs has failed, with devastating consequences for individuals and societies around the world.”
The heartbreak of drug abuse and addiction won’t be solved by preventing patients and their doctors from using and prescribing opioids appropriately, and only when necessary, as a component of interdisciplinary pain care. The interdisciplinary approach to serious unrelenting and life-altering pain, as practiced in my academic facility and similar centers around the country, has been shown to be the most effective way to sustain improvements in health-related and functional outcomes. It is a lack of insurance coverage, insufficient professional education at all levels, and an astonishingly low level of funding for pain research that has helped to drive inappropriate prescribing of opioids.
But there is much more to this century’s rapid rise in substance abuse than that. Coinciding with the tragic events of Sept. 11, 2001, we have witnessed an unprecedented acceleration of high-risk drug-use behaviors, especially with opioids, due to the ability of this drug class to immediately dull the constant anxiety, fear and insecurity of our unpredictable world, punctuated by random acts of terror, mass shootings, economic insecurity and other causes of social strife.
Combined with a 24-hour news cycle and a constant drum-beat of social media engagement, our individual and collective peace of mind has been eroded like never before. Without more healthy and adaptive means of coping, we’ve fallen into the trap of seeking immediate comfort with drugs.
Our national watchwords are that we are “…endowed with certain unalienable rights, that among these are life, liberty and the pursuit of happiness.” Each of the bedeviling conditions of intractable pain and drug addiction rob people of these “unalienable rights,” and so deserve our best attentions, starting by not blaming nor confusing the one for the other. We have a long way to go to prevent and more effectively treat these all-too-common crippling disorders.
We can and must do better. Albert Schweitzer most certainly would try if he were alive today.
| Courtesy Photo Perry Fine
Perry G. Fine, M.D., is a professor of anesthesiology at the University of Utah School of Medicine, Department of Anesthesiology, Division of Pain Medicine, Pain Research and Management Centers. He has been practicing medicine, teaching and doing research at the University of Utah Hospitals and Clinics for 32 years. The opinions expressed here are his own and do not necessarily reflect those of the University of Utah.
