When pain shouts, pay attention!

by Johnny Frem Dixon

If you try to ignore pain, my friend, it only shouts louder. Other voices call you elsewhere, but be still. We feel helpless, but physicians don’t. Training instills confidence that medication is the answer, but drugs only stop pain temporarily. Why kill it anyway? It only asks for awareness. It’s a sensation just like hot, cold, wet or dry. Is it good or bad? It simply exists.

A roofer I know is friends with many drug users in the park where he hangs. He says his friends are dropping like flies and lists a half dozen people I’ve met. Faces I know, who as my friend says, are “All dead now. Wasn’t always like this. But drugs aren’t the same anymore. No borders to cross. It’s all from labs: crystal meth and fentanyl are dirt cheap. No cocaine – just a mix of synthetics that produce similar effects. Fentanyl is the main ingredient in heroin on the streets these days, so it’s easier to overdose. Everyone’s switching over to hard drugs. The guys who used to sell pot, now sell hard stuff because they can’t compete with the pot dispensaries; $7 a gram in BC, half what you’d pay anywhere else. But street people don’t have ID. Pot stores demand it. Dealers don’t. And give credit ‘til welfare day.”

So how did we get to such a soaring use of opioids? “Fifteen to 19% of Canadian adults live with chronic non-cancer pain… [It] interferes with… daily living, [reduces] quality of life and is the leading cause of health resource utilization… and disability among working-age adults.”

In the 1990s, drug companies developed amazing drugs for pain relief, recognizing a potential gold mine. Drug companies and their organizations courted physicians and lobbied state governments for “the right to pain relief,” advocating an increased use of opioids, stating they were highly effective and the risk of addiction extremely small. But the studies they cited were for short-term, not long-term, use. The opioid crisis is largely attributable to over-prescription. More details of this campaign can be found in a 10-page article in Esquire magazine entitled, The Secretive Family Making Billions from the Opioid Crisis.

Do you know that the company that makes oxy and reaps the billions of dollars in profits it generates is owned by one family? The Sackler family, owners of Purdue Pharma, even went so far as to offer a patient starter coupon for OxyContin, giving patients a free, limited-time prescription for a seven to 30-day supply: “The first one’s free.”

I ask my sister, a family practitioner in Victoria, about opioid-prescribing today. “Sure, I prescribe pain-killers for post-operative pain. For childbirth, an IV injection of fentanyl. It wears off quickly and we don’t use it near delivery-time. Occasionally, I prescribe opioids for chronic pain – only for cancer patients – but otherwise, I don’t. My patients know not to ask me.” “Why not?” I ask. She laughs. “They just know they won’t get them from me. There was a time though, maybe 10 or 15 years ago, when oxycodone was a common choice for post-op’ pain. We didn’t understand how addictive it was. Doctors now realize it just doesn’t work.” “So what do you do?” I ask. “I refer them to a pain clinic,” she says.

A friend of mine, Heather Keith, along with her husband, an MD, opened a pain clinic in the 80s, long before pain clinics became recognized as a crucial component of healing and recovery.

“A lot of pain is a dysponetic loop,” she tells me. “When you have pain, your brain tells you to tense up. The tension causes more pain, which causes more tension. We have an emotional response to pain. We shrink away from it. With bio-feedback, we taught people to trick their brains into relaxing despite pain. We ran a six-week residential program. But follow-up is essential because relapse is frequent.”

The medical establishment was reluctant to endorse their work. Payments were slow. Bureaucracy was skeptical. They persevered. So, now, physicians like my sister realize the value of pain clinics. They use several techniques to teach people to manage their pain: autogenic training, a form of self-hypnosis via progressive muscle relaxation and then hooking up to a biofeedback machine; mindfulness-based stress reduction, which teaches you to sit with pain, notice it, acknowledge it, but how you react is in your control; and cognitive behavioural therapy. If we change how we think about something or how we act, we can feel better about it.

For people with opioid addiction, maintenance medications, such as methadone and suboxone, can ease or delay withdrawal symptoms, providing a better chance of recovery especially when paired with supportive and empowering psychological treatment.

Perhaps killing pain in the first place wasn’t such a good idea. There is no magic bullet, not bio-feedback, not mindfulness, not opioids. We need to learn some serious distress tolerance skills and accept that pain will always exist. We each have a responsibility. That is, an ability to respond. Pain can shout loudly. But, ultimately, we each choose our response. Learn to listen closely to pain, my friend.

The Chronic Pain Self-Management Program is a free, six-week, patient education program offered across BC. See www.selfmanagementbc.ca/chronicpainprogram

Johnny Frem organized “Bolts of Fiction” for six years and instigated the Vancouver Story Slam. johnny4em@gmail.com

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