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DHS news release

April 16, 2004

This guest opinion is by Carol Misrack, R.N., pain management coordinator in the Oregon Department of Human Services. For a photo of Misrack, please call (503) 945-5738 or e-mail jim.sellers@state.or.us

Length: 561 words

Chronic pain: Encouraging signs in getting doctors to treat it


By Carol Misrack, R.N.

Some people have trouble believing this: Thousands of Oregonians suffer from a chronic condition for which most doctors still won't prescribe medication and insurance companies often won't pay.

The condition is called chronic pain.

I remember speaking about chronic pain several years ago to a group of physicians and having one of them stand up and say to me, "This is bunk."

Although attitudes are changing, too many physicians still won't treat chronic pain even though it afflicts millions of Americans.

Recently, a 50-state University of Wisconsin report crossed my desk that rated the states on the quality of pain care. Oregon got a C+ and, to illustrate that this is a serious national issue, that put our state among the 20 "best" states. The researchers gave no state an A.

The good news for pain sufferers is that 85 percent of chronic pain can be successfully managed in a primary care doctor's office. Probably as little as 10 to 20 percent is, however.

I understand. Although chronic pain is my job, I've also experienced it. After cancer-related chemotherapy treatments, I was in pain for a year and a half, at times so severe that I could not work. For people in such circumstances, pain is real.

It is so real, in fact, that chronic pain is every bit as much a disease as diabetes or heart disease, for example.

If you or someone you know is experiencing chronic pain, I urge you to consider these tips:

• Find a physician you can talk to. If she says something you disagree with, address it.

• Work with your doctor as a team. Develop a workable treatment plan that gives both the doctor and you a role in managing your pain.

• Be factual. Be able to tell your doctor when and under what circumstances you experience pain, what medications you're taking, the pain's 1-10 intensity.

• Learn as much as you can from credible resources in magazines, Web sites and resources in your local library.

• Identify community resources such as local water-aerobics, low-impact exercise and nutrition classes; find out about alternative strategies such as yoga, acupuncture and massage.

Some physicians fear state Board of Medical Examiners and federal Drug Enforcement Agency sanctions. But they can address these concerns by following BME requirements such as accurate recordkeeping, having contracts with patients, and advising patients of potential risks. My office offers tips to help doctors spot drug-seeking behavior, and particularly those wanting opioids.

Statistics also show that opioid addiction is a smaller concern than some news coverage suggests, and should not be confused with dependence. Those in pain become dependent on medication - just as a diabetic becomes dependent on insulin - but if the pain disappears, in most cases they lose their need for the medication.

There's cause for encouragement on this front. Nurses working on the front lines are on board. The Pain Society of Oregon is active. And a new state law will require all physicians to enroll in pain-related continuing medical education beginning in 2006, although the bill passed by a single vote.

The legislator who cast the deciding vote said, "I've seen too many people die in pain. I vote aye." My hope is that more medical professionals will "vote" that way, too.

Carol Misrack, a registered nurse, is pain management coordinator in the Oregon Department of Human Services.