It is clear that chronic pain is a significant medical problem. It is also clear that in many cases, chronic pain is inadequately treated. Many factors contribute to this. These include, but are not limited to: Lack of an objective assessment tool for pain, abuse potential for many pain-relieving medications, "chilling effect" of diversion control regulation on doctors, a history of substance abuse in some patients with chronic pain, suboptimal number of pain specialists, the complex nature of pain management itself, etc. Due to at least some of these factors described above, chronic pain patients are often viewed as drug seekers and/or malingerers. Since the most effective pain-relieving medications are potentially addicting, the health care providers and the chronic pain patients often find themselves in a catch 22 situation. Some patients may not want to go through the "hassles" of getting pain medication from a doctor and resort to buying heroin or similar substances, which are widely available, on the streets. It is note-worthy that certain subgroups of patients such as ethnic minorities, the elderly, children, the developmentally delayed, patients with cancer/HIV, etc. are more likely to be under treated. This phenomenon is most likely due to the societal biases towards these groups, which may be viewed by healthcare providers as misrepresenting the intensity of their pain either purposely or due to the reasons unrelated to the pain itself. Finally, there is a good correlation between inadequate treatment of pain and seeking heroin and similar drugs on the street.
The purpose of this article is for educational purposes only. It is not intended to diagnose or treat any medical or psychiatric issue. Dr. Rakesh Ranjan is a practicing psychiatrist and a researcher. He is the CEO of Charak Center for Health and Wellness, an outpatient mental health and substance abuse center. For more information, or if you would like to make an appointment, please check out our website at charakcenter.org.