The People's Perspective on Medicine

Show 1178: Do We Need a Revolution in Managing Pain?

Opioids are an important tool for managing pain, but they are not the only option. Dr. Sean Mackey says we need a revolution in thinking about pain.
Sean Mackey, MD, PhD, Redlich Professor and Chief of the Division of Pain Medicine at Stanford University School of Medicine
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Do We Need a Revolution in Managing Pain?

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Pain is a difficult topic. To begin with, the experience of pain is completely subjective. There are no independent objective measures that doctors can use to assess a patient’s pain. They have to take her word for it. Second, pain has a very significant emotional component that must be addressed along with any physical causes. In addition, pain affects more than a single individual. Each patient’s pain affects his entire family and network of significant social contacts. That means managing pain has wide ramifications.

Managing Chronic Pain:

Sometimes, acute pain that has a discrete, observable cause lingers even after the cause is treated. How does chronic pain develop? When pain becomes a complex regional pain syndrome, it can be extremely difficult to treat. However, our guest, Dr. Sean Mackey, has a six-pronged strategy for managing pain.

The Problems with Opioids for Managing Pain:

Physicians often use opioids as a primary tool for managing pain, but the opioid epidemic has made many people leery of prescribing these powerful painkillers. This may leave some people suffering unnecessarily. When are opioids appropriate, and how can they be used most effectively? When opioids aren’t the right tool, how can doctors help people in pain?

A Revolution in Managing Pain:

Dr. Sean Mackey, Chief of the Division of Pain Medicine at Stanford University School of Medicine, says we need a revolution to change how we think about pain. Learn about his six-point approach for managing pain.

This Week’s Guest:

Sean Mackey, MD, PhD, is the Redlich Professor and Chief of the Division of Pain Medicine at Stanford University School of Medicine. He is Director of the Stanford Systems Neuroscience and Pain Lab and has additional appointments in the Departments of Anesthesiology, Perioperative, and Pain Medicine, Neurosciences and Neurology, by courtesy. Find him on Twitter: @StanfordPain and @DrSeanMackey.

Listen to the Podcast:

The podcast of this program will be available the Monday after the broadcast date. The show can be streamed online from this site and podcasts can be downloaded for free. CDs may be purchased at any time after broadcast for $9.99.

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    About the Author
    Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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    Now there is a DNA test to measure how you metabolize opioids and other medications. This would have shown up with the woman who took a lot of morphine yet it allowed her to function – to live! I had this DNA test done, and two doctors weren’t interested in looking at the findings which state I need more opioids then the average person to get the same relief. This is a DNA test! How can intelligent doctors ignore a DNA test of his patient? It is unethical, and it’s destroying lives.

    I’m a CPP with lupus and psoriatic arthritis. I’m also an RN on disability due to my diseases and the inability to walk most days. I have a house to run. I have a 12 yo son to raise. I have a carpool to shuffle kids back and forth to basketball, musical practice, etc. Without pain medication, I wouldn’t be able to live or carry out my family duties that I love. Every day of my life is centered around pain and how far I can push myself. Take away my lifeline, and I won’t be able to live.

    Thank you very much for the informative discussion. It is greatly appreciated!

    I have consulted with several pain “specialist” who have differing opinions on treating chronic pain with little compassion. I was an RN for 33 years and had to retire due to back problems. After three back surgeries, arthritis and fibromyalgia I had to find “my” solution to living a fairly normal life-one without the help of pain specialists! My orthopedist lets me use two small doses of codeine daily, meditation and aquatics to “carry on” my activities of daily living. So far so good.

    When you start looking for compassionate physicians you must be careful of “doctor shopping” accusations. Pharmacies can intimidate with papers on addiction included with your prescriptions also. I advise all those with chronic pain to be your own advocate!

    I never hear of the use of spinal cord stimulators as a viable option when the subject of pain management is discussed. Why is that? Mine has been a lifesaver and enabled me to leave opiods behind.

    People assume you use it for only pain. But it also works great for a horrendous cough due to exposure to fragrances. 1/2 a pill, and I can go out into the public!

    I am a nurse working in Southwest Missouri in a hospital setting. Twenty years ago I was working in a peri op department where we covered PACU, (recovery room), pre and post op care for outpatients and we staffed the newly developing procedure area for the anesthesia run Pain Clinic. The anesthesiologist who started our Pain Clinic brought in a Pain Management Doctor from MD Anderson for a seminar. The name of the seminar was, “The Ethics of Pain Management”. I attended, and my view on pain and pain control was forever changed.

    There were several case studies of patients treated at the Pain Clinic at MD Anderson. I remember specifically a lady who was being treated for a degenerative nerve and muscle disease. She was in a wheelchair and prior to coming to the pain clinic was completely debilitated. At the pain clinic she was started on extremely high doses of morphine. I remember thinking, that’s enough morphine to kill an elephant. She was a keyboard player for a gospel singing group. With that morphine she was able to return to the group and participate in life.

    The gist of the conference was, “It is unethical to have the ability to relieve someone’s pain and not do it. There are and always have been all sorts of value judgements made in treating pain. I too, have been touched personally by opioid addiction and the destruction it brings to individuals and families. It is unethical to withhold pain relief when we have the ability to do so.

    Insurance companies should be required to fully cover alternative pain relief measures such as therapeutic massage and acupuncture. Physical therapy should be covered a 100% as well, with no copay.

    Like so many others with arthritis and fibromyalgia, I fight pain every day. The cost of acupuncture, massage, and the copay for physical therapy puts those treatments out of reach. Pills are much cheaper, $8.00 a month for generic Tramadol versus $800.00 a month for those alternatives.

    Hopefully there will be changes in light of the opioid epidemic and these alternatives will have complete coverage.

    Kratom is an old botanical that has been used for centuries in Asia for pain, anxiety and energy and is now used in Europe and the US legally. Read the scientific research on it. US is doing research fighting the FDA and they have been winning cuz it’s safe and effective. Scientists and researchers backed by the Kratom Assoc. have been closely looking at it due to its effectiveness. Personally I have used it for 3 years, 3 tsp in orange juice. I am a 68 year old retired teacher born with hip dysplasia and also have spinal stenosis. It greatly decreases pain, anxiety plus gives an energy boost without the jitters or side effects and is effective for up to 5 hrs. It also gives a subtle feeling of pleasure increasing your desire to be sociable. A friend, who has fibromyalgia and anxiety, took it during her whole pregnancy and there were no negative effects. Her daughter is incredibly healthy, cognitively, emotionally and socially. I have written about kratom several times but Peoples Pharmacy have not written about it. People have the right to know about kratom. It’s a leaf from a tree related to the coffee plant. There are different strains just like there are different kinds of maple trees. The red strains are best for pain. The Maengda, Bali and Borneo strains are the most effective for pain. Please tell readers about it so they can try it for mild to moderate (maybe severe?) pain, anxiety and energy. Thank you.

    100% correct.

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