To be honest, this has me sort of speechless. I will be the first to admit that I can be a bit irrationally biased when it comes to the topic of pain management, but that’s in large part because nights like tonight, while not common, are also not very rare: I’m laying on a heating pad, have targeted heat strips on several key pain sites, and am both counting down when I can take my next short acting pain control medication, and contemplating doubling the dose of my longer acting pain medicine.
In short, I’m hurting. And I get very cranky when I see people making recommendations that, were they followed when I was first diagnosed with a chronic pain issue, would have kept me in pain for months while we ran through all of the American Heart Association guidelines.
According to this release,
Patients should be treated first with nonmedicinal measures such as physical therapy, hot or cold packs, exercise, weight loss, and orthotics before doctors even consider medication, said the AHA scientific statement published in the journal Circulation.
Patients who get no relief after those measures have been exhausted can be considered for drug therapy, but doctors should try drugs only in a certain order, the statement said:
“In general, the least risky medication should be tried first, with escalation only if the first medication is ineffective. In practice, this usually means starting with acetaminophen or aspirin at the lowest efficacious dose, especially for short-term needs.”
While most patients are likely to be helped by those drugs, a smaller number may need to try a drug such as naproxen. Patients who require additional help should be given other nonprescription painkillers such as ibuprofen, and only after that option has been exhausted should physicians consider Cox-2 inhibitors.
Oh, where to begin? By the time I finally saw my doc for the pain I was experiencing in my arm, I was in significant discomfort. I was taking 2400-3600mg of ibuprofin a day, barely sleeping, cranky, and had already damaged my posture because I was “sheltering” my injured area. Touching my arm often resulted in me screaming involuntarily. The gust of the fan across my skin brought tears, and I would occasionally run from wherever I was to the shower to let hot water run over my arm and shoulder – the only thing that would bring even a bit of relief.
To even be able to tolerate physical therapy, I had to be drugged to almost unconsciousness. A single woman, I needed to arrange for people to be able to escort me to and from therapy, or have a taxi waiting.
As is, it took my fabulously responsive doctor four months to diagnose me to the point I could be shipped off to a pain management doctor. If, during that time, she hadn’t liberally prescribed a variety of pain medications – including Cox-2 inhibitors – until we hit on a combination that worked for me, I honestly don’t know what I would have done. There were times – there are still times – where the pain gets so intense, so bad, that I become almost consumed by the idea of cutting the arm off, of permanently relieving the pain. I might have broken a limb – left hand, arm, or foot, just to get temporary relief from the fiery pain burning up my right arm. I might have harmed myself worse than that.
And speaking of pain management docs – did AHA even consider consulting any before making these declarations that affect the profession?
I realize I’m rambling a bit – like I said, I’m actually in significant pain tonight, and I’ve had very little sleep the last few days. But I am just aghast that this statement by the AHA presumes to tell another specialty what and how to treat, as well as presumes that there are either NSAIDs or Cox-2 and nothing else.
There are many ways to treat chronic pain problems, and how the treatment happens should depend on the individual scenario. While it would have been perfectly fine for the AHA to come out and say “look, there are some serious risks associated with both the Cox-2 and NSAIDs, and here they are, and this is how we’d recommend using them” – well, okay, that’s one thing. But that’s a far cry from recommending not how to use medication but to treat patients, and from declaring that no chronic pain patient should receive painkillers until after they’ve jumped through a long and potentially detrimental (without relief) series of hoops.