NFL players reveal nation’s poor treatment of chronic pain
By DR. LYNN WEBSTER August 26, 2014 4:34PM
As America’s most popular sport kicks into high gear, NFL fans will know about, follow closely and fret over player injuries. Yet, even with so much attention, pro football players experiencing some form of chronic pain will say they feel alone and that no one is listening.
Such is the case for Chicago Bears legends Jim McMahon, Richard Dent and Keith Van Horne, who recently stepped forward with a lawsuit against NFL. At issue is the claim that the NFL distributed powerful painkillers to players as recently as 2012 without disclosure of risks. While these claims deserve investigation and adjudication, precious little is said about chronic, oftentimes debilitating, pain that affects McMahon, Dent and Van Horne. They are not alone.
According to the Institute of Medicine, chronic pain plagues more than 100 million Americans. Because of its growing prevalence, much of medical community no longer sees chronic pain as a symptom, but a disease. Those suffering from that disease will do anything to escape it, including abusing painkillers and taking their own lives, a trend growing at an alarming rate.
In many ways, the chronic pain crisis is fueling another serious problem in America, the prescription drug epidemic, which claims more lives than illegal drugs, car accidents or gun violence. At the heart of the epidemic is a class of painkillers known as opioid narcotics — highly addictive psychoactive medications and the types of painkillers former NFL players used.
Unfortunately, many of the policy choices we’ve made as a society have unintended consequences and actually do more harm to pain patients like McMahon, Dent, Van Horne and millions of others. The pressure to do something about painkiller abuse and overdose deaths has led to “solutions” that are far worse than the problems they were supposed address:
Under regulatory pressure, Walgreens adopted a “Good Faith Dispensing” policy requiring pharmacists to call physicians’ offices to confirm anything from patient contact information to medical appropriateness whenever a prescription for painkillers is received. The American Medical Association (AMA) criticized the policy as “disruptive” and one that would “seriously delay” patient treatment.
A Des Moines pain physician recently stood trial on criminal charges for “recklessly” prescribing powerful medications, some of which were opioids, when his patient died of an overdose. After a high-profile trial, the physician was acquitted but remains professionally ruined, an outcome that local physicians undoubtedly have noted.
In a Pulitzer Prize winning investigation in 2012, the Seattle Times found that Medicaid and workers’ compensation patients were moved from safer pain-control medication to methadone, a cheaper but extremely powerful opioid that contributed to about 2,100 deaths – of largely the poor — over an eight-year period.
What’s wrong with this picture? For starters, the pressure to act is causing us to cede management of the health-care delivery system to those who enforce, make or practice the law rather than those who practice and research medicine. Moreover, our policy on opioids has become a patchwork quilt; on one hand, opioids are branded as “too addictive” to be tolerated, but on the other, they are accepted as the preferred painkillers for low-income patients. Worse still is that we are working to deny relief to people in extreme pain.
To be sure, we cannot continue to rely on opioids over the long-term and must replace them as a treatment method. But opioids that are safely prescribed and monitored by a trained medical professional must not be eliminated as a treatment option. While opioid medications are neither the best nor the only therapy for all patients or all conditions, they are known to be effective for a subset of the population. Administered and taken properly, opioids allow these patients to work, sleep at night, read and take care of their families – activities most of us take for granted.
Most important, we need to accept that curbing painkiller abuse and overdose deaths requires us to address the chronic pain crisis directly. Requiring insurance coverage for lifestyle modification, alternative treatment modalities such as exercise and physical therapy, interventional therapies, and behavior health counseling by a qualified psychotherapist would likely yield far better patient outcomes than the status quo.
Before his suicide, Chicago Bear Dave Duerson talked about his helplessness living with chronic pain. Part of the reason for this feeling is that people in pain rarely find relief, let alone someone who is willing to believe them. Society must not mimic this same sense of helplessness in treating the chronic pain crisis. We need to find a better way.
Lynn Webster, M.D., is the immediate past president of the American Academy of Pain Medicine, based in Chicago. He lives in Salt Lake City.