Pubdate: Fri, 27 Nov 2015
Source: Boston Globe (MA)
Copyright: 2015 Globe Newspaper Company
Contact: http://services.bostonglobe.com/news/opeds/letter.aspx?id=6340
Website: http://bostonglobe.com/
Details: http://www.mapinc.org/media/52
Author: Judy Foreman
Note: Judy Foreman is the Globe's former Health Sense columnist and 
the author of "A Nation in Pain: Healing Our Biggest Health Problem."

BAKER'S OPIOID PLAN GETS IT ONLY HALF RIGHT

Governor Baker's plan to increase opioid education, which he 
announced on Nov. 9 with the deans of the state's four medical 
schools, gets it only half right.

It's wonderful to teach future doctors how to prescribe opioids 
safely to reduce abuse and addiction. But the United States is 
actually caught in the middle of two colliding epidemics, not just 
one: the well-publicized problem of opioid abuse, and the 
under-publicized epidemic of chronic pain, which affects 100 million 
American adults, according to the Institute of Medicine.

Unfortunately, medical schools not only fail to teach students how to 
prescribe opioids, they also do an abysmal job of teaching about 
chronic pain itself. Chronic pain is not just acute pain that doesn't 
go away after three to six months. It is now known to be a disease of 
the nervous system in its own right, and not just a symptom of 
something else. It is the main reason Americans go on disability, and 
a leading reason people go to doctors.

Yet during four years of medical school, American medical students 
get a median of only nine hours of pain education, according to a 
2011 study by Johns Hopkins. Even veterinary students get more - 87 
hours, other research shows.

In the laboratory, pain researchers have discovered a lot about 
chronic pain: how the nervous system transforms itself as acute pain 
shifts to chronic pain; how microglial cells derived from the immune 
system help with this transformation; how a handful of genes play a 
major role in a person's susceptibility to chronic pain; how hormones 
such as testosterone and estrogen influence pain sensitivity.

But doctors on the front lines don't know this because medical 
schools don't teach it.

Doctors themselves are fully aware of how ill-prepared they are to 
help people in chronic pain. One survey by Harvard Medical School 
researchers found that half of doctors in primary care positions felt 
only "somewhat prepared" to counsel patients on pain management. 
Because they learn so little about pain in medical school, few young 
doctors have any desire to become pain medicine specialists. When 
professors at one medical school asked graduating medical students 
what they would do when faced by a pain patient, one student spoke 
for many: "Run!"

Indeed, chronic pain appears to be an important driver of the rising 
suicide rate among white, middle-aged Americans, according to a study 
published last week by Princeton economists.

There are no hard data on how many people with chronic pain die by 
suicide every year. But it is known that people in chronic pain are 
significantly more likely than those not in pain to commit suicide. 
Given that there are about 41,000 suicides every year, according to 
the National Center for Health Statistics, this suggests by inference 
that more than 20,000 Americans a year with chronic pain kill 
themselves. That would be more than the government's figure of 16,235 
deaths per year involving prescription opioids.

The other tragedy in all this is that because of time and 
reimbursement pressures, doctors on the front lines get only a few 
minutes with each patient. That's not enough time to address the 
other issues in a person's life that may be adding to the distress of 
chronic pain. Nor enough time to advise about nondrug treatments such 
as acupuncture, massage, exercise, meditation, or alternatives such 
as marijuana.

The governor's plan pays lip service to teaching medical students how 
to evaluate a patient's pain. But lip service is not enough. The 
state government has declared that substance use disorder is a 
"chronic, progressive, relapsing disease."

So is chronic pain.
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MAP posted-by: Jay Bergstrom