In this book, I will argue that lack of adequate pain control is one of the most urgent health problems in America. In my research over the last five years, I have interviewed nearly 200 scientists and physicians, as well as countless patients, a few lawyers, and a handful of government officials. I have amassed a roomful of books on pain and hundreds upon hundreds of scientific papers.
I have found that there is an appalling mismatch between what people in pain need and what doctors know. Pain is the main reason that patients go to doctors, but most doctors know almost nothing about it, much less how to treat it. Doctors get only a few hours of pain education throughout four years of medical school. Even veterinarians get more.
The government, specifically the National Institutes of Health, the country’s premier research establishment, isn’t much better. It spends only about 1 percent of its vast budget on pain research, despite the fact that chronic pain is now considered a disease in its own right and is a bigger problem than heart disease, cancer, and diabetes combined. Indeed, federal spending on chronic pain is actually going down.
Culture wars over prescription pain relievers play into all this, too. I discovered that opioids (narcotics) are like airplane food—not great, but hard to get enough of when you’re in need. But opioids are all too easy to get if you are a street abuser. Tragically, politics still means the government is focused more on punishing abusers than helping patients.
Nor does our healthcare reimbursement system get it right. It skimps on things that take a doctor’s time—like talking to patients— and rewards interventions like surgery and injections that may or may not help.
I got into all this the hard way, with excruciating neck pain that came on, seemingly out of the blue, a few years ago. Like other pain patients, I trekked from doctor to doctor looking for help—and once, in desperation, to the emergency room, where I felt I was viewed more as a potential drug-seeker than as a person in severe pain.
I am better now. I tried much of what you’ll read about in the second half of this book—opioids, NSAIDs, physical therapy, exercise (lots), meditation, acupuncture, massage, steroid injections, and Botox— pretty much everything except surgery and marijuana. I learned that nothing really cures pain, but that lots of things can help a little, and that adding them all together can decrease it a bit more.
Today, I count myself lucky. I am no longer living in pain. But I have come to believe that the failure to better manage pain borders on “torture by omission.” Many people—some of whose stories you will read in the coming pages—are still living in pain, though, as you’ll see, some manage to live extremely fulfilling lives.
Whatever your pain now—or the pain of someone you love—I hope this book will help you to better understand your pain and fight for the care you need.
Judy Foreman
Cambridge, Massachusetts
June 2013