Chronic Pain and COVID-19: Why Is Treating One Disease More Noble Than the Other?
/By Dr. Lynn Webster, PNN Columnist
During the coronavirus pandemic, our frontline healthcare providers have put their lives on the line, and many have paid a price. Their sacrifice is quintessentially noble, and we feel boundless respect and gratitude for their work.
Similar compassion is felt for COVID-19 patients. We are moved by the tireless efforts made to provide them with proper care, medication and life-supporting equipment.
This outpouring has led me, as a pain and addiction medicine physician, to reflect: When is healthcare noble? And why is some healthcare noble and other healthcare suspect?
There is a stark, bittersweet disparity between the esteem and appreciation we rightly bestow on COVID-19 frontline providers and the suspicion we direct toward chronic pain physicians.
Our frontline heroes in the coronavirus crisis -- regardless of patient outcomes -- are viewed as inherently noble and courageous. Conversely, those who treat people with chronic pain -- especially in cases with an adverse outcomes -- are often threatened with harsh judgment, loss of medical licenses and even incarceration.
Recently passed federal legislation provides “broad immunity” from legal liability to providers treating COVID-19 patients. Pain physicians have no such immunity.
This disparity is also mirrored in patient treatment, sometimes involving the same drug. There is a shortage of injectable fentanyl and other painkillers ventilated coronavirus patients need. The Drug Enforcement Administration recently increased the production quota for those drugs so manufacturers could produce more of them. But DEA-ordered cutbacks in the production of other opioids remain in place.
People in pain -- whether they have the coronavirus or not -- deserve the same effective and humane treatment.
As a pain physician, I have watched people with chronic conditions who are forced to live with undertreated pain for years. I have seen them fight to get through each day as the medications they need are tapered due to governmental regulations and cultural biases, rather than their physicians' decisions. I have observed their struggles with desperate options, including suicide, in the face of daily, oppressive and almost unimaginable pain.
Even as I recognize the heroism of the frontline practitioners caring for people with COVID-19, I have to wonder: How did patients with chronic pain end up on the wrong side of the empathy divide?
Pain patients feel this empathy inequity. It's not uncommon for some healthcare providers to treat them like exiles from society, as drug-seekers, malingerers or even criminals. But these "criminals" are people who have a disease that saddles them with long-term pain. Does their suffering matter less than coronavirus patients’ pain?
How must they feel about society’s outpouring of love for COVID-19 fighters and victims compared to the suspicion, derision and slander they receive?
An Opportunity for Reflection
I submit that the heroic and selfless medical response to those afflicted with COVID-19 should prompt valuable reflection by all providers on empathy and equitable treatment for all patients.
What is it about certain medical conditions that results in unprecedented concern, a willingness to muster all resources, and an outpouring of selflessness from practitioners and the public alike? Why are healthcare professionals willing to risk their lives for coronavirus patients, but not their reputations to treat chronic pain?
Some may argue that it is the immediacy of the threat and risk of death that makes the difference. But that’s a false argument. All pain is immediate and, despite what is commonly thought, people with severe chronic pain have dramatically shortened life expectancy.
Providers on the frontlines of the lengthier, more widespread and complex pain crisis are as noble as those fighting the current pandemic. They often take on patients that others don’t want to treat. They show open-mindedness, concern and great courage in risking the respect of their peers, running afoul of misinformed authorities, or being persecuted by misguided legislation. They put aside their professional well-being to serve a seriously oppressed and underserved population.
We need to find a way to professionally restore belief in the nobility of those providers who may not cure patients, but who do offer comfort and relief. These are professionals who are willing -- often for months and years -- to fight wearying and risky battles for their patients.
If such battles received the respect they deserved, there would be nothing bittersweet about watching all members of the same profession going above and beyond the call of duty for all.
Lynn R. Webster, MD, is a vice president of scientific affairs for PRA Health Sciences and consults with the pharmaceutical industry. He is author of the award-winning book, “The Painful Truth,” and co-producer of the documentary, “It Hurts Until You Die.” You can find Lynn on Twitter: @LynnRWebsterMD.
The opinions expressed in this column are those of the author alone and do not inherently reflect the views, opinions and/or positions of Pain News Network.
