Therapies of the Heart
The National Institutes for Health (NIH) published a Request for Information (RFI) seeking input from “stakeholders throughout the scientific research and medical education community and the general public regarding the Centers for Excellence in Pain Education (CoEPEs) educational content regarding treating pain and opioid misuse or use disorder.”
You can see the RFI—Guidance on Current Education Curricula for Health Care Professionals Regarding Pain and Opioid Misuse and Use Disorder here. The link includes an email address to use to contribute your thoughts, and the deadline for submission is September 1, 2019.
In a recent blog, I noted that I would share my thoughts with the NIH. I did so. A slightly edited form of my letter to the NIH follows. In the original, I included a formal bibliography. In this version, I have used hyperlinks for your convenience.
My Response to the RFI—Guidance on Current Education Curricula for Health Care Professionals Regarding Pain and Opioid Misuse and Use Disorder
August 22, 2019
National Institute on Drug Abuse
Office of Science Policy and Communications
Public Information and Liaison Branch
6001 Executive Boulevard
Room 5213, MSC 9561
Bethesda, MD 20892
Dear National Institute on Drug Abuse:
This is in response to your Request for Information (RFI): Guidance on Current Education Curricula for Health Care Professionals Regarding Pain and Opioid Misuse and Use Disorder.
I am board certified in Anesthesiology, pain medicine, and addiction medicine. In addition to practicing medicine for 30 years, I have conducted hundreds of clinical studies. My primary research focus has been on trying to identify the risk factors for opioid abuse, addiction and overdose. This has shown me what is needed for appropriate education to prevent harm from opioids when they are prescribed for pain.
I have given hundreds of presentations to providers on pain management and risks associated with opioids. I have co-authored a book titled, Avoiding Opioid Abuse While Managing Pain – A Guide for Practitioners (North Branch, MN: Sunrise River Press; 2007), and I contributed to the content for the provider education that was associated with about a 30% reduction in opioid overdose deaths in Utah from 2008 – 2010. The core educational content that led to the reduced overdose deaths is summarized in Eight Principles of Safer Opioid Prescribing.
In 2005, I published a study, Predicting Aberrant Behaviors in Opioid-Treated Patients: Preliminary Validation of the Opioid Risk Tool (ORT). The ORT has been used to help assess risk for developing aberrant drug-related behavior and was recently further validated by a large NIH-funded study.
My experience has provided me with a unique window into what health care providers need to know when they treat people with pain, either with or without opioids. I have learned that, above all, pain therapy must include compassion.
A genuine personal relationship with patients may not be considered mainstream medical treatment today, but it is a crucial part of pain management. It includes acceptance, compassion, listening, respect, encouragement, trust, kindness, patience, and being fully present.
I call these the “therapies of the heart” in my book, The Painful Truth: What Chronic Pain Is Really Like and Why It Matters to Each of Us (Oxford University Press, December 2016). To some, this may sound Pollyannaish, but it isn’t. These are simple, yet vital, components of a broad-based approach to treating the whole person.
Education should convey that pain isn’t just physical. It is psychological, social, and spiritual. A health care professional who treats pain must internalize this concept to provide the most humanistic treatment possible.
In addition, educators who discuss opioids must make clear the differences between addiction and withdrawal. Providers must learn that a person who experiences withdrawal is not necessarily addicted. Misdiagnoses of addiction stigmatize patients and can lead to inappropriate treatment.
Travis Rieder’s TED Talk about the agony of opioid withdrawal should be required viewing by all physicians and a topic of discussion. Also, the curricula should make it clear that babies cannot be born addicted. The fact that the media and some physicians commonly use the phrase “addicted babies” in place of “babies with neonatal abstinence syndrome” only reinforces the misunderstanding of what clinical withdrawal means and unfairly stigmatizes babies.
Additionally, education should address misconceptions about people in pain, and how chronic pain affects families and other relationships. Educational content should include a discussion of the losses that accompany chronic pain—for the person in pain, and also for their family members.
Providers need to be trained to understand that pain is personal and treatment must be individualized. What works for one person may not work for another.
In summary, health care professionals’ education regarding the treatment of patients with pain, or with opioid use disorder, should:
- Use the Eight Principals for Safer Opioid Prescribing
- Train providers on how to treat opioid withdrawal
- Use Travis Rieder’s TED Talk to illustrate the failures of the health care system in treating pain with opioids
- Teach how to treat withdrawal from different types of opioids
- Acknowledge the differences between withdrawal and addiction
- Recognize that babies cannot be born addicted
- Convey compassion
- Express empathy
- Develop a trusting relationship with patients
- Know that pain is psychological, social, and spiritual as well as physical
- Internalize the “therapies of the heart”
- Recognize the losses associated with chronic pain for patient and family
- Emphasize that access to effective pain treatment is a human right
I am pleased to be able to share my deeply-held beliefs about pain education with you. Thank you for taking the time to read and consider them.
Sincerely,
Lynn Webster, MD
Vice President Scientific Affairs
Neurosciences
PRA Health Sciences
Salt Lake City, Utah
Dr. Webster,
Thank you for providing us the compassionate and comprehensive model and considerations to address the concerns of people with chronic pain and addiction. Equally important, your body of work lights the path to restore their and their providers individual and collective dignity.
Once again, Dr. Webster, you have been our “Beacon of Light” in this universal fog of the well-intended, but horribly misguided CDC efforts to lessen Opioid overdoses, with only more overdoses, plus the increase of suicides within the group of us. The group no one wants to be a member of; Chronic Pain Patients. I too drafted a letter to the NIH when the request went out, but after writing it, I thought ‘why bother?’ No one involved with this travesty that has taken place for nearly four years now, gives a damn about the actual pain patients all of this has affected. I tried desperately to get into the National Summit on Opioids some months ago, as it was in my own hometown, but even at a price of some $250 just to get in, there was already a ‘waiting list,’ by the time I found out about the Summit. I wrote the organizers, but of course, no response. I found it interesting, and relayed such to the organizers, that not a single one of their Keynote speakers was a Chronic Pain Patient, to tell our side of how we’re all being affected, including the increase in suicides over and above the increase in opioid overdoses since the CDC started this entire mess. I’m so happy that you wrote them Dr. Webster, as your credentials will carry a lot more weight with the NIH than anything I would have written. No one but you, seems to give a damn about us.