Why IS It So Difficult to Find Better Methods of Chronic Pain Management?

Most of the social framework surrounding pain has to do with acute pain; the sharp snap of a broken arm and subsequent fiery wave of pain that follows, the jab of a needle, the sear of a burn. The rapid, emergency signal the body sends when something is going very wrong and it would like attention immediately. Lesser understood is the phenomenon in which the body keeps sending those signals, even when nothing is happening, telling the brain over and over again that something painful is going on, and leaving the actual person in a constant state of pain.

Chronic pain is associated not just with random pain signals that happen with no cause, but also with medical conditions that cause long-term pain, of which there are a large number. People of all ages can experience chronic pain, but strikingly, it tends to be a medical problem encountered more in women, which is an important fact to keep in mind. Chronic pain is also one of the most poorly-managed medical issues, with limited treatment options available to patients. And the options that are available both don’t really work, and come with hefty side effects.

Most of the treatments available are opiates and other narcotics. And many members of the public assume that people with chronic pain take these drugs, get high, and find them enjoyable, leading to commentaries about addiction (about which more in a moment). In fact, here’s what happens when you experience chronic pain and you take, for example, fentanyl: your pain decreases. It doesn’t go away, and you don’t get high. Your pain decreases, that’s all. It might go from a nine to a six or seven, and that makes a big difference in your quality of life, but you’re still in pain.

And you experience delightful side effects like brain fog, constipation, fatigue, nausea, and difficulty concentrating. It’s hard to work, you can’t drive, and you can’t perform tasks of daily living. When you’re in pain, you have to choose between taking the medication and being more comfortable, or not taking the medication and being in even more pain because you need to be able to do something. Even though the pain clouds your mind too, and even though you know numerous studies have documented that chronic untreated pain can actually cause serious medical complications.

As patients debate over whether to take their meds, they’re also caught in the trap of ugly narratives about addiction. Many chronic pain patients consistently undermedicate and do not control their pain well because they’re afraid of becoming pillheads, and they’re constantly second-guessing their doses and how they respond to them. If you’re having a good day, does that mean you’re high? If you feel poorly, does that mean you’re addicted and you’re getting withdrawals? Is it okay to take one vicodin a day, but not two? Where do you draw the line?

The systemic and persistent association between addiction and drugs used in pain management is horrible for chronic pain patients because they abuse themselves over their medications, and they are abused because of the medications they use. Doctors, friends, family, and complete strangers may hassle them about the medications they need to function, in a way that people who rely on many other medications for survival don’t experience as much; for example, the use of insulin in diabetes management is widely accepted (though some diabetes patients are informed, of course, that if they ‘just ate right’ or ‘exercised’ or ‘did yoga’ &tc, they wouldn’t have diabetes or wouldn’t need insulin).

And it’s bad for people with actual addiction problems, who need access to support services rather than ostracisation. It’s hard to get treatment for addiction when society treats you like something dirty, filthy, and disgusting, making it readily apparent that addiction is horrible and nasty and addicts just need more self-control and should be ashamed of themselves. For people with addictions involving narcotics, whether those addictions stemmed from abuse of initially legitimate medications or other means, the stigma surrounding pain management drugs creates yet another barrier to treatment.

What’s obvious here is that we need more effective drugs for pain management. For one thing, patients need drugs that reduce pain even more effectively, that are less likely to create a tolerance (which forces patients to take higher doses, which can become a health risk—narcotics cause nervous system depression and the more you take, the more complications they cause), that allow patients to function while on medication, and that are less likely to be habit-forming, ideally. People shouldn’t have to choose between ‘burning agony’ and ‘not being able to read.’ Yet, right now, these are the options for people with chronic pain conditions, medical conditions like cancer, or impairments associated with chronic pain.

So what’s the deal? If chronic pain affects so many people, it seems like something that would be of immense interest to pharmaceutical companies, who are always questing for new ways to make money. Improving pain control or developing new methods of pain management could be a major money maker, and yet, we’re not seeing a lot of applications for new chronic pain management options hitting the market.

One aspect of the problem, I suspect, is that chronic pain patients are still highly stigmatised, and there’s a wide belief that they’re all drug-seeking addicts. There’s also the issue that so many of them are women, and women historically have been underserved by medicine, which focuses on developing drugs, treatments, and standards for men. Medicine is based on a mythological standard white cis male body, and women just aren’t considered a major concern, which means that women are always at a disadvantage. They don’t receive the same attention and the same quality of care, especially when they belong to minority groups. Thus, a Black woman with fibromyalgia will be abused by the medical system, while a white man with bone cancer causing agonising bone pain will not be. One has a ‘legitimate’ condition and is accepted within the establishment; the other is obviously just a drug-seeking liar.

This is why shifting cultural attitudes about bodies in medicine is so important, because this is about people of all genders, living in all kinds of bodies. This is not just about people living with chronic pain, but about people living with a huge number of other conditions that present radically differently than they do in the ‘standard patient’ used in medicine. We need to understand the differences in anatomy and physiology that make bodies diverse, and we need to use that knowledge to improve medicine.