Dancing Cheek-to-Cheek with the Rx Hex
October 30, 2003
Rush Limbaugh is dancing with a double-edged demon on a crowded floor. No, this isn’t another skirmish in the “Hate Rush/Love Rush” debate...if only it was that simple. As Limbaugh explained, “I first started taking prescription painkillers...following spinal surgery...the surgery was unsuccessful...I am still experiencing that pain.” He is one of over 50 million Americans suffering from some form of chronic pain.
The good folks at Lancaster General Hospital explain chronic pain, “...as pain that overwhelms all other symptoms and may become the problem. It may affect people so that often they cannot work, lose their appetites, and physical activity of any kind is exhausting and aggravates the pain.” When you break a leg, it affects your lifestyle; when you suffer chronic pain, it is your lifestyle.
Again from Lancaster General, “(sufferers) may become depressed, and irritable. This depression and irritability often leads to insomnia and weariness, which compounds the problem by causing more irritability, depression, and pain. This vicious cycle is called the "terrible triad" of suffering, sleeplessness, and sadness.” Chronic pain is like any other disability. The sufferer’s life is constrained by the affliction. The sufferer lives in a cross-fire between the bicameral debilitations of agony and addiction...a purely democratic Catch-22.
It is ideologically blind. Columbia University’s Dr. Peter Green makes this clear by remarking that former President John Kennedy’s, “Chronic back problems, due to osteoporosis resulted in several operations and required medications for chronic pain.” And worse...many of the sufferers don’t want to talk about it because, like any “handicap”, it can be viewed as affecting a person’s ability to perform. It can be an excuse for discrimination. Thus even the very popular Kennedy hid his suffering from the public.
Only those who have suffered from chronic pain can appreciate its torment. Most of the physicians who treat it have little understanding of its totality. While initially sympathetic, the families and loved ones of those who suffer eventually become weary of the complaints. And the sufferer is left with few choices; remain a bore, foolishly “grin and bear it” or attempt a “balancing act” around it.
The treatment for the management of chronic pain is a mixed bag that includes over-the-counter (OTC) medications, heat and cold treatments, prescription pain medications, prescription antidepressants, local electrical stimulation, brain stimulation, psychological treatment, surgery and acupuncture. To complicate matters even more, each patient has a different level of pain and a different pain threshold. It’s impossible to equate the level or nature of pain that different people experience from identical traumas.
Nobody except the sufferer can appreciate the hell of chronic pain. Imagine that every night you routinely awaken from severe lower back pain. Every morning the mere act of getting out of bed brings tears to your eyes. You are popping enough Advil to induce stomach bleeding but your alternative is immobility. You start your day with an exercise regimen that almost induces screaming. Again, your alternative is progressive immobility. And the remainder of your waking hours are haunted by distracting pain...it is a monkey forever on your back. At any moment, without warning or apparent cause, you can be totally immobilized by pain spasms that make even your next breath almost impossible.
You don’t want to be a burden and you wish to remain productive...so you start to play a balancing act. Maybe today I’ll give my stomach a break from the more effective Advil and try to cope with some less effective OTC medication. Or, maybe tonight I will give myself a break from 3 continuous months of sleeplessness and take a narcotic pain medication. And...the combination of pride and fear of ridicule makes you hide this like alcoholism.
Irrationally, American culture has stigmatized pain medication. In a society that consumes more OTC medications than candy, the mere mention of a “pain killer” spirals the public into paroxysms. When former President Clinton required knee surgery, the media was abuzz with a fear that he might need post-surgical narcotic pain medication. Of course the White House had to calm the panic with repeated statements that Clinton would only be taking non-narcotic medications. Should you really be more concerned about a President’s decision making ability under the influence a post-surgical Percocet than you would be about a President making decisions after a couple of martinis?
In the abstract, I’m not endorsing or condemning either of these behaviors. But, it just seems a bit hypocritical for someone sucking down a brew to pass moral judgment on a chronic pain sufferer taking a Darvocet. Especially when the Center for Disease Control lists alcohol as a top ten cause of mortality in America. Again, in the instance of chronic pain, medication is not recreational drug abuse...it most certainly is not a shooter of tequila! It is a vital component of treatment.
The more it is stigmatized, the more dangerous it becomes. The more the sufferer has to hide debilitating pain (and its treatment) for fear of persecution and discrimination, the greater the odds of losing the pain management balancing act and slipping, without intent, into addiction. And, if the present free-for-all created by Limbaugh’s situation centers only around condemning “addiction”, the sufferers will be further stigmatized and the illicit drug suppliers will prosper. Limbaugh’s problems are not about recreational drug addiction. They are about chronic human suffering.
There are millions of productive people in the U.S. who fear coming out of the chronic pain closet. In your teens, it might make a prospective date wonder if you are a “whole” person. In your professional life it might make your enemies seize the opportunity to attack you. Just look at the compassionate comment from Mike Hudson, editor of the Niagara Falls Reporter, regarding Limbaugh’s problems, “I hope he dies from cancer of the balls.” Hopefully Mr. Hudson will never suffer from testicular cancer and have to walk a tightrope between pain and addiction.
The time has come for a public understanding of chronic pain.
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