20
doc • Spring 2016
Kentucky
From the Cover
A Paradigm Shift in Pain
By Danesh
Mazloomdoost, MD
Not long ago, even
palliative care patients
struggled for pain relief,
prompting the World
Health Organization among many other
organizations to focus on pain care access.
What started in the late 1980s as an effort
to encourage compassionate care for terminal conditions evolved into the largest
iatrogenic epidemic in history; the US is
now the largest consumer of global opiates.
While less than 5% of the global population, we utilize 80% of the global opiate
supply and 99% of the available hydrocodone1. In fact, hydrocodone is the most
prescribed medication in America at 131
million scripts, beating out the next most
prescribed medication, by over 37 million
scripts2. In spite of this dramatic reliance
on opiates, quality of life or functional
indicators do not reflect improvement in
health. Rather, opiate initiation more often
correlates with future disability and worsening conditions3.
Many factors have contributed to the
evolution of the opiate epidemic. Most
efforts to address this multifaceted epidemic are narrowly focused on issues
such as abuse deterrence, compliance
monitoring or egregious pill-mills. But
the problem rages on and metastasizes to
other concerns like the growth in heroin.
Introspection into our field poses risks
of triggering defensiveness and denial.
Nonetheless, solutions start with accountability and it involves challenging longbelieved myths about pain management.
acute injury or palliative care. The focus
of these efforts hinged on liberal access to
opiates – an excellent solution for some
of these problems, but short-sighted for
others. Pain became a dump-bucket diagnosis which no longer differentiated situations and conditions for which opiates
are not the ubiquitous solution and may
even cause harm. The zeal of these efforts
shifted patient focus from the nuances of
coping and valuable therapeutic workup to
an entitlement of a painfree existence no
matter what. Pain was made into the Fifth
Vital Sign and a metric for reimbursement.
No other field is held to a zero-tolerance
standard, nor is it fair to promote the illusion of its possibility to patients.
Regulatory & patient
advocacy groups
Patients:
Starting in the late 1980s, wide-scale
advocacy platforms focused on pain, identifying many undertreated scenarios like
Sedentary lifestyles and poor nutrition
have made the populace vulnerable to obesity and degenerative pathologies that culminate in pain. The mantra of opiate initia-