It hurts to sit here writing. There is a weather front passing through. I had a hard time carrying my coffee cup from the kitchen to the table where I'm sitting. My hands can hardly bend and my joints throb. When I stand up I have to stand still for a few moments to allow the wave of sever pain that passes through every joint in my body to return to its dull achy pain. What causes many falls resulting in broken hips, etc., is a person with chronic pain - especially from arthritis - standing up and trying to move too quickly. Even after allowing the wave of pain to pass I must be careful taking that first step. Moving is a very conscious act and I will be honest, I attempt to look as "normal" in my movement as possible. And to think I'm one of the lucky ones. I can actually still run a bit. I hike, climb mountains, bike, kayak and scuba dive, but I do these things very carefully and with a great deal of pain. I do them despite the pain because I love to do them and I know that if I don't keep my painful joints moving I will not be able to move at all and I will die.
I know. I did a Facebook post some time ago about how angry I was when I went to an orthopedic clinic and a 20-some year old PA flippantly said "It's just arthritis." Just because it isn't the direct cause of death doesn't mean that it isn't a monster disease that can destroy the victim's quality of life and leave them in almost unbearable pain. To many who suffer from severe arthritis death is preferable to years of unimaginable pain.
Arthritis is far from the only disease causing chronic pain but in addressing the topic of chronic pain it is my personal point of reference. There are also as many ways of describing the pain experience as there are people who experience chronic pain. I heard one person describe it as like being kicked by a horse. I was kicked by a horse many years ago. That's a pretty good description. I've never been hit by a car, but I've heard that analogy. The ice pick and baseball bat are common. Very honestly the best analogy for those who have not experienced chronic pain is to imagine the worst pain you have every experienced in your life and imagine having to suffer that pain day in and day out for the rest of your life. The best a person with chronic pain can expect is a dull ache or pain that is at least tolerable so they can sleep or rest.
Having spent my entire practice around the elderly and those with chronic debilitating disease I did notice that medical practitioners have a tendency to say "just ...." because chronic pain is not considered terminal therefore how bad can it be? Chronic pain can be a killer. My field was psych. People have an inclination to avoid anything psychological including trying to understand why a person would kill or try to kill themselves just because of pain. If you don't experience chronic pain I can't blame you for not wanting to try to imagine what it's like. Just trying to really imagine it is psychologically painful in itself. But what if you couldn't escape that pain? If you can comprehend that then you can understand why you would see death as the only escape. The problem is that death isn't an option because it would bring great guilt on the society and the society will not allow that. At the same time the society is not permitting the victim to end their life and threatening the victims with such boggy man stories as going to hell it is not providing any relief to the victim. How would that make you feel? Angry? Desperate? Terminal?
I'm not saying that there are not those who are trying to find cure or relief for the various causes of chronic pain. However, I see three problems. First, most practitioners have no concept of the pain we are asked to endure. Well-meaning medical practitioners give us mild analgesics because they've been told by some pharmaceutical chemist or advertising agent that it will control the pain of arthritis all day. Then they wonder why we return complaining of no relief. Secondly, they give us anti-inflammatory medications in lieu of strong pain killers because they're no longer allowed to give us opioids without sending us to special pain clinics that are really inefficient but supposedly keep us from becoming addicted to the medications that only partially reduce our pain. Thirdly, western medicine is exceptionally arrogant. It calls anything other than it's forms and techniques "alternative" medicine or even more disrespectful names. Many of these other medical approaches are older than western medicine and often just as successful. A good example are the eastern medicines. They focus on prevention as opposed to western medicine which is reactive. They have an excellent track record. They aren't as arrogant and will use western techniques when they appear better. We don't do that. In Indiana, for example, it is almost impossible to get an acupuncture license because Indiana AMA just doesn't want it around.
So what can be done about chronic pain? Since I just mentioned western medical arrogance and other successful medical models, the first thing which could be done would be to explore what those systems have to offer to the management of pain and make them available by having them covered by insurance, Medicare and Medicaid.
I don't think any of us who suffer from chronic pain want to become addicted to opiate pain killers. Addiction would just add another problem and complication to our pain, but let's be honest. If you were hurting so much each day that you had no quality of life, which is more important - managing the pain or worrying about the risk of addiction? The important thing to remember is that we don't take these potent drugs to get high. There is no pleasure use.
Countless websites want to tell you about the dangers of pain medications, and there are those dangers. The problem with those sites is that they fail to talk about what happens if one's pain goes un-managed. What happens to the body when you go days without rest? What happens to the body if you become so depressed that you don't eat? I could go on at great length but suffice it to say that in my 47 years of practice I have seen many people come very close to death because they did not receive pain management. I wonder how many died because we didn't get them into care. Then there are those I've seen attempt suicide.
We must also consider the cost. I mentioned being required to go to a pain specialist in pain clinics. I will avoid the temptation to talk about their efficacy but let's talk about their cost. Put the word "specialist" behind a practitioner's name and you multiply the cost many times. Then government requirements force such "pain specialist" to do monthly drug screening which can cost the patient or an insurance company as much as $700. That is $8,400 a year not counting the cost of the specialist, medication and any other requirements or treatments. The drug screening is nothing more than treating the victim of pain like a drug addict. We must stop treating victims of chronic severe pain like drug addicts. Pain medications need to be available and affordable.
Who knows how Coca-Cola got its name? It contained cocaine. John Pemberton, the inventor of Coca-Cola in 1886, claimed that Coca-Cola cured many diseases, including morphine addiction, dyspepsia, neurasthenia, headache and impotence. Cocaine was not removed from Coke until 1902. So let's stop be puritanical. A great deal of modern research has been done on cannabis - and I'm not talking about smoking pot. Smoking marijuana just delivers the cannabinoids more quickly but it isn't as effective as pills. So we're not talking about becoming "pot heads".
Those who think the treatment of arthritis with cannabis was thought up by those long haired, new age hippies wanting to legalize pot should read some history. Four thousand years ago the Chinese called cannabis a treatment that "undoes rheumatism". Cannabis tinctures were common in American drug stores in the 19th century because aspirin didn't become common until the early part of the 20th century.
Marijuana provides two chemicals - called cannabinoids - that have been found to be exceptionally efficient in the treatment of arthritis: CBD and THC. CBD, cannabidiol, is helpful for autoimmune conditions like rheumatoid arthritis. THC, tetrahydrocannabinol, is an anti-inflammatory and analgesic (pain killer). As an added benefit THC is also known to reduce anxiety and depression "that commonly accompany severe diseases, especially those that affect one's mobility." (1)
We use opiates medicinally in all 50 states. There isn't a hospital in the USA that doesn't use morphine pumps. With these very highly addictive and popular street drugs used so commonly why do only 22 states permit the medicinal use of the non-addictive CBD and THC for the treatment of arthritis?
From this you can see why, even though I'm a pacifist, I am sorely tempted to do bodily harm when someone says "it's just arthritis."
What can you do? Be thoughtful to those who suffer from chronic pain. Don't patronize us. Help us make our case, bring attention to the road blocks that keep us from getting the good and proper pain management that we deserve as human beings. Don't let us be treated like drug addicts because the only medications that come close to dampening our pain are strong and highly addictive. Help us push legislators and others to stop putting legal blockades in front of possible sources. And lastly, donate to the American Arthritis Foundation or other organizations that are seeking to find cures for the diseases that cause chronic pain.
FOOTNOTES:
(1) https://www.whaxy.com/learn/best-cannabis-for-arthritis
Russell E. Vance, III, PhD
30 March 2016
30 March 2016
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