Doctors are now suggesting that eliminating the pain of their patients is not only impossible, but an unnecessary course of action of a medical treatment, a commentary in a new study published on Tuesday says.
In the past, doctors have always supported suppressing the pain of the patient as much as practically possible. This view led to a surge in the sale of opiate painkillers, such as OxyContin and Vicodin.
As a result, the surging rates of opiate addiction and deaths in the United States have been attributed to the popularity of opiate medications for the suppression of pain.
"Zero pain is not the goal," Dr. Thomas H. Lee, chief medical officer of the healthcare consulting firm Press Ganey, wrote in a commentary published Tuesday in the Journal of the American Medical Association. "The reduction of suffering is - and that is something more complex than analgesia alone."
According to the Centers for Disease Control and Prevention, more than 165,000 people in the U.S. have suffered fatal overdoses of prescription painkillers since 1999, and about 1.9 million patients are addicted to or abusing prescription painkillers.
The Centers for Disease Control and Prevention has now issued new guidance advocating that doctors only prescribe the opiate pain relief medications to patients suffering from acute cancer pain, those receiving palliative care and those in the last stages of their life.
The guidelines also recommended that doctors prescribe Tylenol, Advil or other non-addictive therapies for the treatment of chronic pain due to conditions like arthritis and back problems.
Dr. Tom Freiden, the director of CDC, said that the benefits of opiate painkillers for most patients were "unproven and transient" and inversely, the drugs could be "just as addictive as heroin".
Frieden and Dr. Deborah Houry, director of the CDC's National Center for Injury Prevention and Control, noted in the commentary that several studies conducted on post-surgical patients and menopausal women with chronic pain conditions suggested that long-term opioid use not only fails to provide relief, but instead may actually worsen patients' pain and lower their capacity to function.
Lee noted that when doctors communicate and show compassion for their patients, the suffering of the patients is reduced, even if the patients still have pain.
"Quality does not mean the elimination of death," Lee wrote. "And compassion for patients does not mean the elimination of all pain."
Dr. Mitchell Katz, director of the Los Angeles County Department of Health Services, said that he places emphasis on the capacity to function, when he sees his chronic pain patients.
"When a patient tells me that the opioid enables them to sleep at night, get out of bed and do their usual activities, I feel much more reassured than I do by the patient report of any pain score," he wrote in JAMA Internal Medicine.
