Are patients qualified to determine whether or not opioids help in treating their pain? Pain Medicine Advance Access published a study that was conducted at the Back and Pain Center, University of Michigan, in Ann Arbor, MI. The Back and Pain Center is an outpatient tertiary care pain clinic where patients are evaluated for a range of chronic pain conditions.
Study Asks Patients to Describe Pain
Patients were asked about key clinical factors including pain, functioning, mood, and opioid use history. The researchers wanted to evaluate patients’ beliefs about opioids. Their goal was to find out, from the perspective of patients, whether the difficulties associated with opioids (such as anxiety and depression) outweighed its benefit (that is, pain relief).
“The recent opioid guidelines from the US Centers for Disease Control (CDC) state that if the benefits of opioids do not outweigh the harms and there is not sufficient evidence of sustained improvement in pain and functioning, physicians should work to taper patients to lower doses or encourage complete opioid cessation,” according to Pain Medicine Advance.
In evaluating the answers they received to a questionnaire, the researchers concluded: “72.4% of patients reported less than a 30% reduction in pain severity since starting opioids. Out of the 84 current opioid users, 27.1% reported no pain relief after taking opioids.”
How to Interpret Pain Patients’ Responses
Some people might interpret the data to mean that, for nearly three-quarters of the patients who use opioids, there’s minimal pain reduction and the benefit probably does not outweigh the risk of harm. However, there’s more to the story.
Although the report states nearly 3 in 4 people say they do not get 30% or more pain relief, it should not be surprising. This has been my clinical experience as well. Relieving pain is not easy, even with opioids.
Why Pain Study Results Are Open to Interpretation
In assessing pain and the effect of medication on pain relief, we usually ask the patient about the change in pain intensity. But asking just about a change in pain intensity can be misleading for several reasons.
Pain intensity is not linear. What I mean by this is that the difference between a 9 and a 10 pain intensity, on a scale of 0-10, is much greater than the difference between a 3 and a 4 pain intensity, even though the difference in both situations is only 1 point. In the former case, it is a 10% difference, but in the latter example, it is a 25% difference. For most patients, the 10% reduction in pain from 10 to 9 has more meaning than the 25% decrease from 4 to 3.
Only a patient can determine the meaning of their pain reduction. Two out of three people surveyed expressed an overall positive experience with opioids, even though the patients reported no more than 30% pain relief. Still, it was a meaningful difference in pain to those patients.
Few Real Alternatives for Treating Pain
We must remember that, for many patients, there is no other option for treating pain. Opioids are the most affordable, effective treatment available for many people. Therefore, to suggest that opioids have no value, or that the risk outweighs the benefit unless there is at least a 30% relief as proposed by some, means that patients can unnecessarily be sentenced to suffer from intense pain just because they don’t reach the 30% bar.
It is important that we understand there is tremendous variability in response to painful stimuli. One person may feel a pain intensity of 5, while another person may experience the same stimulus as a pain intensity of 8. There’s no intent to be dishonest or manipulative. There are just individual differences in response to pain.
Sometimes, the unfair assumptions we make about people with chronic pain are as debilitating as the pain itself. Pain is what a patient says it is. And no, you cannot feel someone else’s pain.
Purchase my book, The Painful Truth: What Chronic Pain Is Really Like and Why It Matters to Each of Us (available on Amazon), or read a free excerpt here.
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