MEDIA FAILURES ENABLE CONTINUING LETHAL MEDICAL MALPRACTICE FOR CHRONIC PAIN
The change required to start saving lives is unthinkable, incriminating: expose the lie that generated and perpetuates lethal crisis as fiction – that common chronic pain is a medical or physical condition
by Clark Miller
Published January 15, 2023
Here’s some news!
That’s a relief, and sure to help with all that continuing overprescribing of opioids, and overdose, and deaths.
How could it not help?
Here’s what the law says, as described in the silive.com report:
REQUIRES DOCTORS TO CONSIDER NON-OPIOID TREATMENTS
The last piece of legislation, S.4640/A.273, requires doctors to consider non-opioid alternative treatments for patients experiencing pain before prescribing a patient opioids.
“This will require both parties to discuss the alternatives before choosing an opioid prescription. Because opioids have become a common solution to pain treatment, one in four primary care patients experience some form of an opioid use disorder. By exploring all the options, such as physical therapy, chiropractic care, acupuncture, massage therapy, or occupational therapy, the risks of opioid prescription, dependence, and overdose can be avoided,” the state said.
requires doctors to consider
That’s got some teeth in it doesn’t it!
Because doctors haven’t been very good at all – as lethal misprescribing continues decades into America’s increasingly lethal epidemics – at practicing competently and ethically to avoid dangerous prescribing, required or directly mandated, or encouraged.
The law – and in any case it’s distorted messaging and predictable implementation – lethal and in any case redundant in prediction for harm.
Predicting continued harm because the “non-opioid alternative treatments for patients experiencing pain”, the “physical therapy, chiropractic care, acupuncture, massage therapy, or occupational therapy” are not treatments for common chronic pain – almost all common pain – and never have been, no more than opioids ever have been. They don’t work, are not supported by research as working, just as opioids never were.
But let’s go back. Because that’s actually not what the bill states, that, By exploring all the options, such as physical therapy, chiropractic care, acupuncture, massage therapy, or occupational therapy, the risks of opioid prescription, dependence, and overdose can be avoided,” the state said.
Here, from the bill, is what it actually states –
9 (A) WHEN A PATIENT SEEKS TREATMENT FOR ANY NEUROMUSCULOSKELETAL CONDITION THAT CAUSES PAIN, WHERE A PRACTITIONER CONSIDERS AN OPIOID TREATMENT, THE PRACTITIONER SHALL CONSIDER, DISCUSS WITH THE PATIENT, AND, AS APPROPRIATE, REFER OR PRESCRIBE NON-OPIOID TREATMENT ALTERNATIVES, BASED ON THE PRACTITIONER’S CLINICAL JUDGMENT AND FOLLOWING GENERALLY ACCEPTED NATIONAL PROFESSIONAL OR TREATMENT GUIDELINES, AND CONSISTENT WITH PATIENT PREFERENCE AND CONSENT, BEFORE STARTING A PATIENT ON OPIOID TREATMENT. FOR THE PURPOSES OF THIS SUBDIVISION, NON- OPIOID TREATMENT ALTERNATIVES INCLUDE, BUT ARE NOT LIMITED TO: ACUPUNCTURE, CHIROPRACTIC, MASSAGE THERAPY, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, COGNITIVE BEHAVIORAL THERAPY, NON-OPIOID MEDICATIONS, INTERVENTIONAL TREATMENTS AND NON-CLINICAL ACTIVITIES SUCH AS EXERCISE. THE PRACTITIONER SHALL INFORM THE PATIENT THAT SOME TREATMENTS MAY NOT BE COVERED BY THE PATIENT’S HEALTH COVERAGE.
ACUPUNCTURE, CHIROPRACTIC, MASSAGE THERAPY, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, COGNITIVE BEHAVIORAL THERAPY, NON-OPIOID MEDICATIONS, INTERVENTIONAL TREATMENTS AND NON-CLINICAL ACTIVITIES SUCH AS EXERCISE
That’s what the bill states.
Oddly, the media account included, as explained here, the “treatments” not supported as effective based on research (acupuncture, chiropractic, massage therapy, physical therapy) and excluded the therapies supported by strong evidence to provide lasting benefit, at the end of the list: cognitive behavioral therapy (CBT) and exercise, also (not on the list) keeping active, returning to work.
Even more oddly
(or not), that distortion – that places patients at risk of vulnerability to initiation or return to use of opioids by provision of ineffective but privileged “treatments” for their chronic pain – accurately reflects the practices of American doctors, as in this study that “tracked treatment patterns for millions of patients struggling with limb, extremity, joint, back and/or neck pain”.
Over the two-year period, patients under the care of doctors for common chronic pain:
were referred to and provided at high rates the “treatments” not supported by research as effective for chronic pain
were not referred to or engaged in treatments established as effective for chronic pain including CBT and motivational support for physical exercise
with a conclusion that the incompetent and malfeasant medical practices “could lead to a worsening of the opioid epidemic, researchers suggest.”
Right. Here it is –
Wow. That’s interesting. Let’s compare eTAble 4 to the table of research results explained above in this post outlining what current research says about the medical/biophysical interventions versus psychological/psychosocial = CBT, Cognitive behavioral therapy. The numbers link to the peer-reviewed research/review articles cited in the post linked to.
For massage, acupuncture, physical therapy – “Weak evidence” with benefit, if any “short-term”.
Now look back at eTable 4: those interventions favored, in apparent referrals, by orders of magnitude, that is, more frequently by factors of 100 times to more than 1,000 times greater, over use of CBT by their patients with chronic pain. But that doesn’t quite capture it, does it? Use of the one therapy evidenced as providing real, lasting relief from common chronic pain – Cognitive Behavioral Therapy – was never used more than a tiny faction of the time, and was extinguished to no use. And no mention of the pain-controlling value of regular physical exercise, constituting the effective provision of CBT experientially.
Do not treat that condition any more than does alcohol, both effective
as temporary anesthetics for chronic pain, in the same way: both affecting neurotransmitter activity in the brain resulting in numbing, “forgetting”, otherwise moderating emotion-laden awareness of pain. The research on alcohol as providing this effect is clear and established.
But alcohol is generally not recommended for daily, regular dosing to manage chronic pain, for sound reasons. That can lead to psychological dependence, with risk of overuse and well-known associated problems including problems with judgement; diminished mental acuity, “fogginess”; increased risk of a variety of physical problems including disease states; impaired functioning; and risk of accidental death.
Wait . . . that sounds familiar, or should. Long-term use of opioids, as prescribed, poses essentially the same risks. In a 10-year retrospective cohort study, long-term opioid use among patients with chronic non-cancer pain (CNCP) compared to patients with CNCP and not using opioids increased risk of all-cause mortality by a factor of 1.21, (hazard ratio: 1.21, 95% CI: 1.13, 1.31; P<0·001) with a database of more than 19 million patient records. Mortality risk was also higher specifically for cancer (HR 1.19, P = 0.041) and circulatory disease (HR 1.26, P<0.001).
The two temporary numbing agents are comparable, with similar and slightly different risk profiles: for opioids development of dependence, misuse, infectious disease, accidental overdose; for alcohol liver and other disease states, accidental physical injury.
Both provide a temporary cognitive and emotional deadening of the experience of pain, the pain reliably returning after the effects wear off, and often worsening over time. Because, of course, the source of that pain is not treated or addressed in any way. Instead, patients are diverted and disincentivized from engaging in the evidence-based treatments for the cause of chronic pain – psychotherapy and therapy support for changes in activity and movement – diverted by the effective, concerted efforts of medical and pharmaceutical industries instilling in them the lie that a medication can treat chronic pain. With lethal epidemic as outcome.
Opioid provision for chronic pain makes no more sense and is no more clinically and ethically responsible than recommendation for daily use of alcohol to numb chronic pain.
Common chronic pain = “centralized” pain
(not cancer or tied to findings of tissue pathology or injury), constituting almost all chronic pain, is psychogenic, psychological, established for decades as such, never as a medical condition. Like compulsive substance use, depression, and other conditions, its medicalization is malignant malpractice and cultural pathology that has harmed and killed vulnerable, trusting millions while securing and controlling $billions in public healthcare funds for the professionals, systems and centers of power that control cultural capital to generate the mass-messaged fictions that perpetuate it.
That’s how it works, the predictable lethal epidemics and illness an operational cost for those systems.
And the cowardly army of useful idiots spinning their necessary lies.
Take the power back.
To save the planet, change how you live on it.
To stop problem substance use, change how you treat your kids and each other, and let a therapist help with the emotional pain driving it.
To manage depression or common chronic pain, find a qualified psychotherapist.
“Crisis is a necessary condition for a questioning of doxa, but is not in itself a sufficient condition for the production of a critical discourse.”
– Pierre Bourdieu Outline of a Theory of Practice (1972)
In Bourdieu’s Theory of Practice, heterodoxy is dissent, challenge to what “goes without saying” – the accepted, constructed doxa, “knowledge”, reality, that goes without saying precisely because it “comes without saying”, without real scrutiny, untested, unquestioned. The function of doxa is not knowledge or truth or promotion of the collective good, but to protect and serve the interests of those with the power, the cultural capital, to create it.