We can’t feel their pain, but we can understand their fears

The editorial by Jessica Fulton¹ is admirable. She is an author who, in a scientific journal, looks at the issue of opioids for chronic, non-malignant pain from the point of view of the patient. It is refreshing to read of her ability to anticipate her patients’ fears in meeting a new physician who might have strong personal beliefs against a therapy upon which the patient depends. Patients are well aware of the terrible consequences of being cut off from their medications by an ill-informed physician, one who might also add a stern lecture based on personal philosophy rather than evidence.

Those who suffer from chronic noncancer pain have a poor quality of life, sometimes described as the lowest quality of life of any chronic noncancer disease. They have an increased risk of suicide and all-cause mortality.^2–6 However, when it comes to therapy, they often see the medical establishment as obstructive and antagonistic. It is disheartening to read that those of us who do try to mitigate our patients’ suffering are singled out as being in the highest quintile of family physicians and that our prescribing habits are somehow linked to mortality from opioids.⁷ It seems apparent to me that the physicians who do prescribe opioids are likely those with who have a chronic pain–focused practice and probably consult with the patients most severely affected by pain, who in turn have the highest mortality due to their respective diseases.⁶ None of the articles cited in Fulton’s editorial provides convincing data on causation of mortality, but rather promote the questionable assumption that the opioids themselves are responsible for the increased mortality in the most severely affected patients.^8,9 A climate of fear is created and physicians might be dissuaded from making correct medical decisions when treating these unfortunate patients.

Given the above, it is all the more reassuring that Dr Fulton can “sit on the same side of the desk” as her patients to discuss their prescriptions.

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