A doctor in the New York Times today writes about the difficulty in treating pain. He's caught between a pain rights movement that pushes for more humane treatment and the prescription of needed medications, and the dangers of users and addicts. He frames his article with a patient of his who has a history of substance abuse, and seems to be malingering. I have no doubt that this is a serious concern for doctors, who don't want to feel like they are being taken advantage of. Yet how much of a problem is this, and how many genuine sufferers of chronic pain are living in misery because of overly cautious doctors?
I recently had a horrible experience in finding a new doctor. After 20 years of chronic neck pain, and having tried nearly everything - from physical therapy to chiropractic to rolphing to wacky supplements, and ultimately a suicide attempt - A pain specialist covered under my previous insurance finally got things manageable. Unfortunately, aside from effexor, and over the counter ibuprophen and acetaminophen, the one pill that was a real breakthrough was the sleeping pill temazepam, which ended years of agonizing, restless, painful sleep.
Two doctors, after a brief consult, determined that I shouldn't be taking it, and that I simply had "insomnia". The first didn't want me taking anything at all, and the second told me that "people in the 3rd world didn't have the luxury of taking pills to get to sleep".
Great, now looking for my 3rd doctor made me feel like I was doctor shopping. Well, I was, but I simply wanted to get back to the treatment that I had been on for a few years and had been very effective.
My current doctor has no problem with temazepam for my neck pain, thankfully. But in looking for a doctor who would prescribe what I wanted I can't help but feel like I was manipulating the system, subverting skilled, trained authorities in favor of my own lay judgement. Of course, it is my body and I have 20 years of experience with what has and has not worked.