Every Pain Experience is Different

Every pain experience is different. It’s all too easy to try to compare. To try to look at two people with the same health issue and judge one as being dramatic or over-sensitive because they may need more help. But, we can’t judge or compare pain.

I was just reading through the HHS Pain Management Task Force Report on Pain Management Best Practices in preparation for Fibromyalgia Advocacy Day. Overall, I found it to be an evenly presented document that really addressed some major issues in how pain is managed in the US. The final section discussed the CDC’s recommendations for opioid treatment of acute pain.

“The CDC Guideline recommends that opioids prescribed for acute pain be limited to three or fewer days and that more than a seven-day supply is rarely necessary.”

“Various health insurance plans, retail pharmacies, and local and state governments are implementing the CDC Guideline as policy, limiting the number of days a patient can receive prescription opioids even when the seriousness of the injury or surgery may require opioids for adequate pain management for a longer period. A more even-handed approach would balance addressing opioid overuse with the need to protect the patient-provider relationship by preserving access to medically necessary drug regimens and reducing the potential for unintended consequences.”

I’d say overall this is my take-away from the HHS report. It really should come down to a balance and a discussion between the healthcare providers and the patient. The two together know what is best and can evaluate based on the individual need of the patient, because no two pain experiences are the same.

In 2013 I had the first of (so far) three laparoscopic surgeries for endometriosis. That surgery was intended to be exploratory. Neither myself or my gynecologist expected to find much. However, that was not the case. When I awoke from that surgery, I had a button in my hand to push for pain medication. A button that I could push every five minutes. It did hurt that bad.

Thankfully, I don’t remember the worst of it. When I went in for surgery, we expected I’d go home that same day. However, my doctor told me that when I initially woke up I was SCREAMING in pain. I did go home the next day with a prescription for pain medication. And, in case you are curious, yes they found and removed a lot of endometriosis (and one of my fallopian tubes that was twisted and tangled in endometrial tissue).

The initial prescription for pain medication was for about five days. It wasn’t nearly enough and I ended up back in my doctors office the day before Christmas begging for more to get me through the holiday. Of course, my doctor was out of the office, so that request was a bit of a struggle.

I had my second and third surgeries with an endometriosis specialist. In both cases, my recovery was far easier than that first surgery. However, that doctor also took a little extra care. He planned to keep me overnight for both (primarily because he’s two hours from my home so he wanted to give me a little extra time before sending me down bumpy roads). He also sent me home with a week’s worth of pain medication each time.

Fast forward to 2017 and my third surgery for endometriosis. While in the hospital I was on intravenous pain medication. I was given hydrocodone before leaving the hospital, along with a script for a week’s worth of pain medication. When I arrived home I applied a CBD pain patch and as a result never needed the prescription pain meds.

CBD and medical marijuana is one area where the HHS document was severely lacking. They addressed this lack as a result of varying degrees of legality and lack of research into the effectiveness of the products. I don’t have an answer for that.

I agree that more research needs to be done, more scientific studies to show how CBD helps and what strains of medical cannabis are beneficial for pain relief. At the same time I strongly feel that this more than all the other alternative and integrative treatments available for pain could be the answer to the “opioid crisis.”

I put “opioid crisis” in quotes primarily because I feel the crisis has been created as much by the inaccurate and inappropriate application of the CDC guidelines as any existing misuse by patients. We have simply gone from one crisis to another. A crisis of over-prescription and abuse (which has largely been solved by creating prescription drug monitoring programs that can be easily accessed by providers, emergency departments and pharmacies) to a crisis of inadequate patient care and refusal to treat.

In this current crisis everyone loses. Patients are unable to get the treatment they need. And, at the same time, providers are being punished (or in fear of being punished) for providing that care.

All in all, I do feel that the Dept of Health & Human Services has done a service with this Pain Management Best Practices Document. As did the CDC by coming out publicly that their guidelines were being misinterpreted. If only the latter had occurred sooner. It’s not like we didn’t all see it happening as soon as those guidelines were released. First do no harm seems to have been forgotten. But, hopefully, we are moving back in the right direction of a balanced approach to pain management.

Related Posts:

• Medical Marijuana and Chronic Pain
• Legalization of Medical Marijuana and Opioid Overdose
• Marijuana for Fibromyalgia: Does it work?
• Within My Control: 5 Lessons in Pain Management