Wednesday, August 22, 2007

Paging Dr. Cox(ucker)

Imagine injuring your back and trying to get pain treatment from this guy. Dr Cox is a fictional character on the show "Scrubs" but his behavior and attitude are all too real. In Dr Cox's maniacal rant about drug addicts, he claims there are "millions" of them coming to the ER complaining of their "aches and their pains and their spasms and their cramps and their myalgia and their neuralgia and their otialgia and every other algia they can possibly think of just so they can get a fix." Unfortunately, his attitude is widely shared by far too many doctors, particularly ER docs, as a search for the term "drug-seeker" on Google will quickly reveal.

Of course, in this fictional example, the drug addict in question very conveniently manages to out himself just as Cox's beleaguered colleague is about to write out his script, but in reality, just about any behavior, no matter how innocuous, can get you labeled a drug seeker, even refusing pain meds or writhing in agony when no one is looking. Many doctors make the default assumption that pretty much anyone complaining of pain, looking for pain meds or especially asking for a pain med by name is a drug addict, and people in pain often find themselves guilty until proven guilty of drug-seeking no matter how much evidence they may have of a serious, causative factor for their pain.

Although there are certainly drug addicts who show up at doctor's offices looking for drugs, the reality is that narcotic abuse is relatively rare among chronic pain patients (3.8 percent using a very generous definition of drug abuse, which is not the equivalent of addiction), and in the general population as a whole (less than 1 percent). Given these facts, the idea that there are literally "millions" of drug seekers can only be based on bigotry and a lack of awareness of the realities of pain-related behaviors, which very often mimic those of drug addicts (a phenomenon know as pseudoaddiction). Dr. Frank B. Fisher, a Harvard-trained general practitioner and chronic pain advocate who has been prosecuted for treating pain patients humanely with opiate medications, describes pseudoaddiction thusly:

The term pseudoaddiction was coined in 1989 to describe chronic pain victims mistakenly diagnosed as suffering from opioid addiction after they were driven, by undertreated pain, to display certain drug-related behaviors. Simply stated, pseudoaddiction is a misdiagnosis that results from undertreatment of chronic pain. When this diagnosis is made, the medical system has erred. Recognition that patients are frequently harmed by misdiagnosis of addiction should prompt an aggressive search for undertreatment of pain. Unfortunately, this usually does not happen. Instead, when a patient displays certain behaviors, he is typically threatened with termination of his treatment, rather than questioned about its effectiveness.
All this should lead you to wonder where this horde of drug seekers the doctors are complaining about is coming from. Perhaps it's all in their heads?


Legend said...

Wow, don't I know it! There were two in particular, at my local hospital, who had me flagged, and all I could expect was a game of 'pin the tail on the junkie.' It got to where I believed them...I had every symptom, including attempts to stop, a crminal record, until-my PAROLE OFFICER,took notice of my marked difficulty in walking,and standing up straight...that she insisted that I find a pain specialist! It wasn't an overnight success, but, I'll never forget the time, when, in the office of one such doctor(who was helpful for the time, but planned on emigrating), I came upon a pamphlet, put out by the AMA, which described me almost perfectly...under the heading 'pseudoaddiction.'

I would have jumped,if I could. I just imagined those 2 ER sadists laughing their asses off, had I ever suggested such a thing to them! Ha!

Payne Hertz said...

You said it, Legend.

Unfortunately, there are far too many doctors and nurses who think it's some kind of a game to try and figure out who is and isn't a junkie, based on little more than personal ignorance, bigotry and pseudoscience. And if they guess wrong and destroy someone's life, so what? It's still a fun game to play. There is nothing quite so pleasing to some as the sweet sensation of self-righteousness. It's kind of like a, you know, DRUG, to these people.

BTW I am curious how you are doing with your pain management these days.If you're still down in the city, I know a few good pain specialists down there who might be willing to work with you despite your past problems, if you are honest and forthright with them about it. Send me an e-mail through the "About" link on the main page where there is a contact on the bottom if you're interested.

Anonymous said...

Seems to me the worst of it is the doctors are creating the addicts in the first place.

Inflicted with Chronic pain and other issues 2 years ago, all I can seem to get from my doctors IS pills!

I'm seeing many doctors, and maybe one seems interested in being my advocate, pulling the whole picture together, and tell me what I can do for help the problem and symptoms BESIDES popping pills!