Kentucky Doc Spring 2016 - Page 20

20 doc • Spring 2016 Kentucky From the Cover A Paradigm Shift in Pain By Danesh Mazloomdoost, MD Not long ago, even palliative care patients struggled for pain relief, prompting the World Health Organization among many other organizations to focus on pain care access. What started in the late 1980s as an effort to encourage compassionate care for terminal conditions evolved into the largest iatrogenic epidemic in history; the US is now the largest consumer of global opiates. While less than 5% of the global population, we utilize 80% of the global opiate supply and 99% of the available hydrocodone1. In fact, hydrocodone is the most prescribed medication in America at 131 million scripts, beating out the next most prescribed medication, by over 37 million scripts2. In spite of this dramatic reliance on opiates, quality of life or functional indicators do not reflect improvement in health. Rather, opiate initiation more often correlates with future disability and worsening conditions3. Many factors have contributed to the evolution of the opiate epidemic. Most efforts to address this multifaceted epidemic are narrowly focused on issues such as abuse deterrence, compliance monitoring or egregious pill-mills. But the problem rages on and metastasizes to other concerns like the growth in heroin. Introspection into our field poses risks of triggering defensiveness and denial. Nonetheless, solutions start with accountability and it involves challenging longbelieved myths about pain management. acute injury or palliative care. The focus of these efforts hinged on liberal access to opiates – an excellent solution for some of these problems, but short-sighted for others. Pain became a dump-bucket diagnosis which no longer differentiated situations and conditions for which opiates are not the ubiquitous solution and may even cause harm. The zeal of these efforts shifted patient focus from the nuances of coping and valuable therapeutic workup to an entitlement of a painfree existence no matter what. Pain was made into the Fifth Vital Sign and a metric for reimbursement. No other field is held to a zero-tolerance standard, nor is it fair to promote the illusion of its possibility to patients. Regulatory & patient advocacy groups Patients: Starting in the late 1980s, wide-scale advocacy platforms focused on pain, identifying many undertreated scenarios like Sedentary lifestyles and poor nutrition have made the populace vulnerable to obesity and degenerative pathologies that culminate in pain. The mantra of opiate initia-