To Better Treat Pain, We Must Understand It

The recent passage of federal legislation to address the nation’s opioid abuse problem is an important step not just for reducing opioid addiction, but also for helping better understand, treat and manage pain. The Comprehensive Addiction and Recovery Act (CARA) directs the National Institute of Health (NIH) to intensify pain research into new treatments and opioid alternatives. It also bolsters efforts to combat opioid abuse through effective prescription drug monitoring programs and the establishes a new interagency task force to improve opioid prescribing standards. This approach is essential to balancing patient access to effective pain treatment with efforts to reduce prescription drug abuse.

It is well documented that unrelieved pain continues to be a serious public health problem in the United States. According to the Institutes of Medicine, an estimated 100 million Americans suffer from chronic pain, including millions of cancer patients and survivors like Evelyn Lopez of New Jersey. At 51, Lopez expected pain when she was diagnosed with Stage 3 non-Hodgkin’s Lymphoma. What she didn’t expect, after enduring months of bone-damaging chemotherapy and radiation, was how much pain would remain after her treatment.

“I thought once I was in remission, I would be able to function as I did before. This wasn’t the case,” she says. Instead Lopez could hardly sleep and awoke every morning to extreme, relentless pain. She was among the 60 percent of cancer patients and 30 percent of survivors who experience pain. The only thing that helped were prescription opioid medications.

“I’m all too aware of the opioid epidemic in our country,” says Lopez. “My father was a heroin addict and eventually took his own life. I swore I’d never go down that road.” Yet for Lopez, as is the case for many cancer patients and survivors, opioid-based pain medications were one of the few effective options available. There simply isn’t enough understanding of the basic biologic causes of pain to offer many alternatives, which is why CARA’s focus on research is so essential.

Left untreated, pain can devastate patients’ quality of life and, in many cases, interfere with basic daily tasks. Overly restrictive drug policies can cause similar devastation. Increasingly, states trying to get a handle on prescription drug abuse are passing well-intentioned laws with serious unintended consequences. For instance, drug dosage, and refill limits on opioid medications may seem reasonable. However, if you are a cancer patient the impact of these policy changes can be significant. The same goes for the effort and cost of requiring in-person monthly doctor visits for prescription refills. These policy changes, and a host of other restrictions that have been implemented across the country, have the goal of reducing drug abuse, but can also negatively impact cancer patients’ access to essential medications.

A more effective means of curbing abuse while preserving patient access is prescription drug monitoring programs. These statewide programs collect, monitor, and analyze certain prescriptions to deter abuse and help identify those who may need addiction assistance.  CARA expands and strengthens these programs by requiring state systems to communicate and share data across state lines.

Additionally, the legislation establishes an interagency taskforce of researchers, physicians, patient advocacy groups, and others to review, modify and update pain management and patient medication prescribing standards. With better informed guidelines and care standards providers can better understand and treat pain.

There is no single solution to the public health problem that exists today as a result of the misuse and abuse of opioids nationwide. However, by focusing on research, boosting prescription drug monitoring programs, and seeking broad input for provider standards of pain care, CARA offers a balanced start and acknowledges the need for thoughtful policies that curb abuse without harming patient access. For Evelyn Lopez and the millions of other patients and survivors like her, such balance is essential to enjoying the life they fought so hard to preserve.

Christopher Hansen is the President of the American Cancer Society Cancer Action Network (ACS CAN), the advocacy affiliate of the American Cancer Society. ACS CAN works across the country in support of laws and policies that help save lives from cancer.

Morning Consult