We read with interest the article by Henry and Holt1 entitled “Frustrated Patients and Fearful Physicians”, published in JGIM. The authors commented on an earlier paper by Dr. Unger that emphasized our obligation as physicians to practice empathy when treating patients suffering from chronic pain and to maintain the stance of compassion over fear.1 We fully support their statements.
However, we would like to point out that the dilemma of “frustrated patients and fearful physicians” is driven, in part, by the swinging of the opioid pendulum and widespread media misconception about pain and pain management.
In a recent editorial entitled “Pain and Prejudice” published in JAMA Pediatrics, Drs. Fleegler and Schechter2 stated, “The general philosophy regarding the level of attention that should be paid to pain, as well as its treatment, has changed dramatically during the past 30 years, swinging wildly between extremes, and remains a moving target… Currently, most articles in the lay and even professional press highlight the problems associated with these drugs, as opposed to the significant benefits that may accrue from their appropriate use.”
Similarly, von Gunten3 opined, “During my professional life as a physician, I have seen the pendulum of attitudes about the role of opioids for treating pain swing its full arc and back again. I only graduated from medical school in 1988!… The newspapers are full of stories of the number of deaths from prescription opioids rising precipitously… I see the chilling effect on all prescribers every day. The meta-message to physicians is clear—be very afraid if you prescribe any opioids to anybody or you will cause them to be an addict and die. Better to let the patient suffer than be suspected of causing a rise in the number of addicts and opioid-related deaths. The pendulum is hurtling back to the place it had in 1940”.
Schatman4 opined that the media has deliberately focused on myriad opioid-related horror stories, ignoring the millions of Americans with chronic pain whose quality of life is actually enhanced through their appropriate utilization of opioid analgesics. The estimated 100 million Americans suffering from chronic pain was once again confirmed recently by the prestigious Institute of Medicine.5 Dzau and Pizzo indicated that a cultural transformation in how pain is perceived and judged by the public, including patients and health care professionals, is required to reduce the effects of pain and the associated morbidities.5
Funding
None.
Conflict of Interest
The authors declare that they do not have a conflict of interest.
Contributor Information
Xiulu Ruan, Phone: 251-583-5990, Email: drxruan88@gmail.com.
Jin Jun Luo, Phone: 215-707-3915, Email: jluo@temple.edu.
References
- 1.Henry SG, Holt ZB. Frustrated patients and fearful physicians. J Gen Intern Med. 2016:1–2. [DOI] [PMC free article] [PubMed]
- 2.Fleegler EW, Schechter NL. Pain and Prejudice. JAMA Pediatr. 2015;169(11):991–993. doi: 10.1001/jamapediatrics.2015.2284. [DOI] [PubMed] [Google Scholar]
- 3.von Gunten CF. The pendulum swings for opioid prescribing. J Palliat Med. 2016;19(4):348–348. doi: 10.1089/jpm.2016.0079. [DOI] [PubMed] [Google Scholar]
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- 5.Dzau VJ, Pizzo PA. Relieving Pain in America: Insights From an Institute of Medicine Committee. JAMA. 2014;312(15):1507–1508. doi: 10.1001/jama.2014.12986. [DOI] [PubMed] [Google Scholar]