Reporter focuses on chronic pain for series on opioid use Date: 02/14/14
By Lisa Bernard-Kuhn
Like many media outlets, The Enquirer has reported at length on the societal costs of the deadly opioid crisis.
Early on, we observed a troubling reality of the stories of addicted and overdosed people in our community – so many began with pain.
• The pill-popping mother whose addiction was touched off by a Percocet prescription for lower back pain.
• The teens sent home from surgery with powerful painkillers that leave them hooked to the drugs.
• The construction worker who turned to cheap easy-to-find heroin when his $70-a-day OxyContin habit (originally prescribed for a busted knee) became too expensive.
Story after story pointed to pain – a vital sign that physicians are required to treat.
And evidence suggested, given the skyrocketing sales of prescriptions, painkillers – the go-to treatment to quell the suffering is often a powerful opioid – the same controlled substance that causes nearly 17,000 deaths a year.
So we began wondering: What happens between a patient and doctor before an opioid is prescribed?
How does the doctor measure pain?
What are patients told about the drugs they are prescribed?
How effective are opioids for chronic pain?
What are patients’ expectations?
Clearly, we had a lot of questions when we began our reporting in late March. It took us more than eight months find at least most of the answers.
Divide and conquer
Reporter Mark Curnutte and I were tapped to tackle the topic. Curnutte was asked to examine the Joint Commission’s role in America’s approach to treating pain, and the pharmaceutical industry’s influence. My job: Examine pain – not opioid addiction. The latter issue was central to our reporting, but we wanted to stay focused on pain and, more specifically, chronic pain. What’s the science behind long-term pain? How is it different than acute pain, and how are physicians trained to treat it?
Cast a wide net
We knew we needed doctors – primary care and pain management physicians – who would speak candidly about their opioid prescribing habits, their biggest challenges and concerns.
And we needed patients to share their stories.
We cast a wide net to get both.
We reached out to all of the big health systems in Greater Cincinnati and Northern Kentucky, and at least a half a dozen pain management physicians. We also hunted for national experts on the topic. I asked every doctor I heard back from if they had patients I could reach out to. We found some success with that approach. A few patients also responded after I posted a request on Facebook (Something like: Have problems with chronic pain? I’d like to hear your story) And I got permission from one pain management doctor to ask patients in his waiting room if they would be OK if I followed up with them “for a series of stories I’m working on about chronic pain.”
Top three tips, lessons learned
1) Be prepared for pushback
While some of the physicians I interviewed were incredibly candid, they had press representatives who insisted on being present during our discussions.
At one point, a press representative asked to cut-off of the interview when the doctor began complaining about unscrupulous opioid prescribing by other physicians in the community. At that point, I asked the doctor for his personal contact info, he agreed, and I finished the interview through email and cell phone chats. Likewise, several patients were concerned about sharing the fact they take opioids every day with the public. I was extra sensitive to their concerns and I let patients know exactly what we planned to print about them. I had one patient who, after the first interview, decided he didn’t want to be included.
2) Pain is very personal
What struck me most as I spoke to patients suffering from chronic pain is the emotional toll they pay for their suffering. It’s so much more than a blown-out back, busted hip or excruciating migraine. It’s time away from the things they love. It affects their family, their relationships and their job – everything they do. Patients taking opioids and those who weren’t had emotional stories to share about the way their pain impacted their life. Some just wanted the pain to go away. Others told me they understood they needed to find ways to live with it. As I listened to their stories, I began to better understand the dilemma physicians face when these patients come to them seeking relief.
3) Give yourself plenty of time
Every interview for this series was incredibly time-intensive and required multiple follow-ups.
Many patient interviews lasted for two hours or more. And just getting on a doctor’s schedule can take weeks. I also spent months researching chronic pain and I asked every physician I interviewed what medical research, studies, data they relied on to inform their opioid prescribing practices. Here are a few that I found most helpful:
Long-term opioid treatment of chronic nonmalignant pain, Brigham and Women’s Hospital, Harvard Medical School, Boston
Ballantyne JC, Shin NS. Efficacy of opioids for chronic pain: a review of the evidence. Clin J Pain. 2008;24(6):469-478.
Noble M, Treadwell JR, Tregear SJ, et al. Long-term opioid management for chronic noncancer pain. Cochrane Database Syst Rev. 2010(1):CD006605.
Institute of Medicine report: Relieving Pain in America
Lisa Bernard-Kuhn is a health care reporter at The Cincinnati Enquirer.