I just finished reading a fascinating piece (and the one comment submitted thus far) on the Pain News Network website. The article discussed the need for an official definition of ‘legitimate pain’ in order to continue allowing doctors to prescribe opioids while at the same time fighting against opioid misuse and abuse. Here is my question: is there any such thing as ‘legitimate pain’?
At first, the answer seems like a no-brainer. But think about it. If we can define legitimate pain, that would imply that there is also illegitimate pain. You cannot have one without the other. As the commenter to the post pointed out, pain is highly subjective. How do you tell one patient their pain is legitimate but another patient that theirs is not?
A Lack of Medical and Legal Definitions
The post in question makes a compelling case that a lack of medical and legal definitions creates difficulty for doctors who believe prescription opioids are appropriate for some patients. Before they can prescribe, they must believe they have a legitimate medical reason for doing so. They also need to be able to back up the decision should the feds ever come calling.
This creates a tenuous situation for medical providers. But it also creates uncomfortable circumstances for patients. The lack of medical and legal definitions puts the responsibility on doctors to make a decision that may come back to haunt them later on. And when doctors need to work this way, patients are at risk of not getting the care they need.
Pain Is Generally Symptomatic
Historically speaking, the medical community has defined pain as generally symptomatic. It has been understood that pain is not a condition in and of itself. Rather, it is a symptom of underlying disease, injury, or illness. Doctors have been encouraged to look for the underlying cause rather than just treating the symptom of pain.
According to the experts at Texas-based Lone Star Pain Medicine, that’s exactly what pain doctors are trained to do. They look for the root causes of pain so that appropriate treatments can be offered. Unfortunately, there is no shortage of cases for which pain is considered non-specific. If a doctor doesn’t know what is causing the pain that plagues a patient, does this make the pain illegitimate?
A Bigger Question to Answer
The retired doctor who wrote the previously mentioned piece makes a good point: without medical and legal definitions for pain, doctors wishing to prescribe opioids are in a precarious position. But I think there is a more important question at hand: should prescription opioids even be on the table?
The doctor pointed out in his post that modern medicine now has the technological means to verify pain. Through imaging and neural analysis, it is possible to observe pain signals being sent to the brain. We cannot yet measure the intensity of pain – and perhaps that will never be possible – but we can at least observe the presence of pain.
Likewise, we have the technological means to relieve pain without having to use opioid medications. Procedures like radiofrequency neurotomy, spinal cord stimulation, and kyphoplasty have proven highly effective for certain types of pain.
Perhaps it’s time to develop medical and legal definitions of legitimate pain. But if we do so, we also need to accept the existence of illegitimate pain. Such definitions should help both medical providers and their patients as they seek adequate pain relief. Yet in the end, none of this should be about promoting opioid prescriptions. We should be looking to get rid of opioids as soon as we can.
