The fibromyalgia stigma: When law enforcement, not pain management, wins
VIRGINIA, July 8, 2014— A patient who mentions the “F” word, or fibromyalgia syndrome (FMS), to most primary care physicians, hospital residents, specialists and even pain management clinics, is liable to be labeled as a ‘drug seeker’and not a serious patient.
The truth is, those who are diagnosed as having FMS are seeking drugs, but not for recreational use. They want medication to relieve the agony that FMS brings to their health table.
READ ALSO: Fibromyalgia: The stigma and the truth
So why are health care professionals (HCP) ducking FMS victims? Is it because the Drug Enforcement Agency has cracked down so hard that a reasonably prescribed narcotic (opioid) will bring them to the pit of government hellfire?
No it is not, and no one should accept this response to a request for pain meds. What is more likely is an HCP is unwilling to take responsibility for their patient in a manner that they cannot totally and completely control.
What HCP’s often do is refer to a pain management clinic and it may take a month or two for an appointment and meanwhile the explanation of quite a few doctors is “the pain won’t kill you.”
HCP’s interviewed for this article all, in each and every case, admitted they have never experienced the type and pain that requires an opioid.
One family doctor in his late 30’s said ‘I don’t prescribe opioids until I’ve known the patient for at least two years. I don’t trust them.”
Would this same doctor delay treatment for an infection for two years? Hopefully, no.
The only true means of an HCP to establish levels of pain is patient self-reporting. There are no universal means to for diagnosing pain levels-yet. Some HCP’s use blood pressure readings as a measure but this is not a reliable tool. One can have great pain but not at that particular moment.
When some HCP’s hear a patient report a ‘10’ on a pain scale that is ‘1’ for lowest and ‘10’ the highest, it raises suspicions as does request a particular opioid but some people have had enough experience to know what does and work and they may be in what they perceive as a value of ‘10’.
The opinion of some is pain management doctors (PMD) are control freaks that found an outlet for their personal disorder. One must sign a ‘pain treatment contract,’ get treated as either criminals or drug abusers by having to count their pills or called in for surprise pill counts and urinalysis.
Some well-respected universities with pain management clinics are known for keeping patients waiting for up to four hours for their appointment because as one pain management doctor said-“they’ll (patients) wait for as long as it takes to get their drugs.” The same doctor said “all users of narcotics are losers.”
He too, in his 56 years, has never felt the bite of real pain but in one breath mentioned the patient may wish to resign himself to accepting he will be on addictive opioids for life then in the next breath rejected a suggestion of what the patient knew from years of experience to be an effective opioid because “it’s addicting.”
HCP’s can take blood, urine and a host of other tests to determine what and if a particular med is working and if not, alter the dosage. When pain is a problem they lose control of measurable, scientific means of determination and are loath to surrender control to the patient.
One emergency room doctor said he had broken two ribs and the non-opioid analgesic Tramadol relieved his pain so based on his experience ‘I will never prescribe anything stronger.”
This Maryland doctor, like all doctors, should know that no two people are alike in regard to biological function. There are far too many variables to apply a blanket policy.
Shame on him.
Many doctors are now using Tramadol in lieu of true opioids but Tramadol was not designed for long term prescribing and can cause seizures, and irreversible kidney damage.
A huge issue is the US Pharmacopeia (USP) that decides which medication should be safely prescribed at which dosage. Unfortunately, the USP has not updated the body weight criterion which stands at 170 lbs.
This means a 97 lb. 60 year old will get the same 5 mg. Vicodin a 20 year old 350 lb. person will get. In fact, this issue is so pervasive, recent studies have proven overweight cancer patients are dying earlier or not recovering as well or as quickly as their thinner counterparts because of chemotherapy dosage that is insufficient for heavier folks.
Efficaciousness does not always translate to effectiveness.
The same applies to opioid analgesics but try to get an HCP to admit to it. In fact, try to get an HCP to prescribe opioids for FMS without pulling teeth or traveling from one doctor to the next in search of relief.
Of course, doing so assigns a label as a ‘doctor shopper.’
The entire issue gets mired yet again when ‘X’ mgs of an opioid which is prescribed for regular and continuous daily levels of pain turn into, say, a three-day period of extreme pain that requires a bit more analgesic help, one may label as an abuser.
If you run out of opioids prematurely because of long periods of discomfort that are not figured into the daily dosage for relief of daily levels of discomfort, you may be under suspicion of selling opioids to others then labeled a criminal.
Then there are the doctors who upon losing trust for their patient, abruptly discontinue prescribing, making patients go into withdrawals and left ill, vomiting and not sleeping for up to a week. As many doctors for this article said; “opioid withdrawal won’t kill you” but again, they never experienced it themselves.
Many times, drugs for various health issues need to be increased to be effective but try to get an increase in opioid mg or strength and out comes the labeling or if you suggest alternating from one opioid to another and back so the body does not get too accustomed to a particular opioid requiring increasing levels, the argument is again the DEA or the ‘boss’ or ‘panel of review’ that will frown on this.
It is an effective tool but scares the dickens out of HCP’s as they again, surrender the all-important control over a patient with oftentimes, little regard to what the patient is saying.
The deaf ear to FMS is again assigned to the lack of HCP control and compounded with less control as the patient requests help for pain.
Pain and FMS fit the definition of disease by virtue of the disease being and abnormal, pathological condition which affects a part or all of an organism.
The modern version of the Hippocratic Oath states in part: “I will apply, for the benefit of the sick, all measures that are required, avoiding those twin traps of overtreatment and therapeutic nihilism.”
This part of the Hippocratic Oath calls for balance and to reject the now proven disease of FMS and chronic pain can be construed as “therapeutic nihilism.”
The time has come for patients to report doctors as not being advocates for their patients as their oath demands. If a large number of patients report doctors who are unwilling to understand FMS is real and realize most patients are likely overweight, out of shape and live in a world growing older and require pain meds, perhaps this trend of pain relief avoidance can be reversed.
Granted, in the USA, prescription drug abuse is a growing problem, compounded by unscrupulous physicians, but HCP’s should not violate their oath and neglect their responsibility as an advocate for their patient because of reasons truly out of control of the medical fraternity.
The world of those seeking to live comfortably and improve their health and quality of life should not be the victim of an irresponsible segment of society and HCP’s should not assume the role of law enforcement.
Paul Mountjoy is a Virginia based psychotherapist.