The Realities of Pain Management

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Life has its dramas.   Its heroes, its villains.  Its victims.  In fairy tales and comics, in books and movies, in most things meant to entertain, this tends to be clear cut.  In real life, unfortunately, this is rarely the case.  Take the drama currently playing out in the medical world around pain management.  Not at a theater near you, but in this very clinic and places like it.   Every single day.  With patients who are deeply suffering, many with legitimate complaints and honest intentions about finding relief, whose efforts and endurance can take on heroic proportions, at times. With others who may have addictive tendencies, with profound complaints that can generate sometimes desperate needs, to the point where integrity gets compromised.  Where danger becomes a possibility.  Where the victim can take on villainous qualities, at least according to some, who may lack some degree of compassion and understanding. 

To distinguish between these types of victims – and the variations are infinite – can be extremely difficult, fraught with ambiguity.  This often impossible task falls to the provider.  Usually the hero on the TV dramas, and also – in far more complex ways – in real places like this clinic.  Providers who, in the eyes of the patient depending on them for relief and failing to have their expectations met, begin to take on villainous aspects, no matter how caring or expert they are.  In such cases, the providers endure their own kind of suffering – the complaints, the pleading, the suspicions – and in their way can feel like victims themselves.  Politicians are also players in this drama.  In their role as protectors of their constituency, they must respond to threats to the public health.  One such threat currently links pain management to the “drug scourge.” 

Politicians, sometimes heroic, can also act rashly, or under poor advisement, or in response to some constituencies at the neglect of others.  They are also known to act primarily to garner votes, where being “tough on drugs” still has much currency in this society.  Providers can feel victimized by this, so there are organizations like the Massachusetts Medical Society, currently opposing strict proposals to limit narcotics use.  On the patients’ side, we have the U.S. Pain Foundation doing the same thing.  Looming in the background, barely mentioned, is Big Pharma.  Is it a hero, here?  A villain?  Rarely a victim, at least in the long run.  If all the world truly is a stage, as the man said, this is certainly one of them.  Not the stuff of dreams, or of fiction, but of real life, with real players, and real consequences.  It’s our world, and it can get pretty messy at times.  

John Dabrowski , LICSW

Neponset Health Center and Geiger Gibson Community Health Center

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