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Our latest book delves beneath the usual narrative about greedy pharmaceutical companies and lax oversight to explore clinical and cultural misunderstandings of opioids and pain that represent the deep roots of the opioid epidemic.
The Right to Pain Relief and other deep roots of the opioid epidemic
We now understand pain as a medical problem with impersonal and mechanical origins in our body. This has separated pain from the rest of human suffering and laid the basis for a right to pain relief. We have sought to provide that relief through opioid prescriptions. This is based on the mistaken belief that these are targeted “painkillers” that reduce pain but leave the person alone.
Review from the USASP Newsletter
David Morris’ review of Drs. Sullivan and Ballantyne’s new book: The Right to Pain Relief And Other Deep Roots of the Opioid Epidemic
This timely and valuable book offers a clear picture of what medicine knows and doesn’t know about pain, particularly chronic pain. It also, methodically, sets pain within relevant historical and cultural contexts showing how the modern world has redefined pain as a medical problem. Medicine meanwhile often remains in the grip of inadequate (biological) models of nociception. In practice, even biopsychosocial models tend—as reflected in the order of terms—to privilege biology. The problem that drives the book is how pain and pain relief stand in relation to the current opioid crisis, which the authors call an epidemic. The approach to this knotty problem is largely to contextualize it.
The authors, distinguished clinicians with extended careers in pain medicine, layer up a thick, helpful explanatory context. The eight chapters discuss 1) the transition of pain from a religious to a medical context, 2) the birth of anesthesia and pain medicine, 3) the emergence of a right to pain relief, 4) chronic pain as a disease, 5) a persistence of biological understandings and treatment, 6) the harmful results from a medicalization of pain, 7) the selling of opioids, and 8) the right to pain relief in relation to causal and moral theories. The book concludes with a retrospective meditation on pain and the future of pain relief.
It is a big, wide swath—some terrain familiar, some refreshingly new—covering the opioid crisis and its relation to modern medicine. The running engagement with clinical practice helps set medical judgments about pain and pain relief on a more solid footing.
The heart of the book—as reflected in the title—is the chapter on the right to pain relief. It shows how this worthwhile principle can entail hidden, harmful, unintended consequences. Opioids temporarily relieve pain, but—beyond the clinical and moral questions raised—they also make money, and money, like power, corrupts. Also, in a setting where malpractice litigation and the pharmaceutical industry are hard to ignore, pain raises multidimensional problems and questions for clinicians who must struggle not only to understand an individual patient’s hard-to-intractable pain problems but also the (sometimes confounding) recent concept that every patient has a right to pain relief.
Contextualization is a useful instrument for analysis, and the authors use it skillfully, but it runs up against the inherent paradox that it can’t explain what it can’t explain. The opioid crisis is not only about pain, but also about the desire of many people to get high. “The one thing which we seek with insatiable desire,” Ralph Waldo Emerson wrote in 1841, “is to forget ourselves….” Drugs rank among his chief routes to “counterfeit” elevation and self-forgetting. A second edition of this book might expand the brief section on addiction. It might ask—from multiple perspectives including race, gender, and biology—why so many addicts wanted to get high, how opioids figured in this new avalanche of desire, and what clinicians might do about its unintended consequences.
—David B. Morris, PhD author of The Culture of Pain (California, 1993)
Mark Sullivan, MD, PhD is Professor of Psychiatry and Behavioral Sciences at the University of Washington. He is also Adjunct Professor of Anesthesiology and Pain Medicine and or Bioethics and Humanities. He is the author of The Patient as Agent of Health and Health Care. He has also written over 300 peer-reviewed articles, many on the interaction of physical health and mental health in patients with chronic illness.
Jane Ballantyne, MD, FRCA is Professor of Anesthesiology and Pain Medicine at the University of Washington. She is Secretary of the International Association for the Study of Pain (IASP) and a Section Editor of PAIN.
Dr. Sullivan shares the latest news about pain and health care.
Sullivan MD, Vowles KE, Powelson EB, Patel KV, Reid MC. Prioritizing patient values for chronic pain care: a path out of the pain reduction regime?
Fam Pract. 2023 Jan 19:cmad002. doi: 10.1093/fampra/cmad002. Epub ahead of print. PMID: 36656068. Conclusion Rather than assuming that patients desire pain reduction first and…
Continue Reading Sullivan MD, Vowles KE, Powelson EB, Patel KV, Reid MC. Prioritizing patient values for chronic pain care: a path out of the pain reduction regime?