Ending the stigma


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Chronic pain patients tell pharmacists: we don’t want to be treated like addicts

Kevin James had to give up his career as a full-time registered nurse due to crippling lower back pain.

“I had an unknown condition in May 2009 that caused lower back pain,” he tells AJP.

The 55-year-old from Brisbane was eventually diagnosed with Facet disease, a degenerative disorder of the lower spine that causes neuropathic pain.

It took seven years for him to be prescribed adequate pain relief in the form of low-dose opiates.

“I struggled for seven years,” he says.

“I had to retire because I can no longer drive effectively, I cannot sit or walk or stand or lie for long periods of time.

“Chronic pain can a make people terribly depressed, isolated and there’s a terrible anxiety that comes with chronic pain… a lot of people suffer terribly from anxiety or fear of the pain worsening.

“I had to give up a career in occupational health nursing. I’ll never be able to work again full time because my condition is degenerative and it gets worse every year.”

Pharmacists need to be able to differentiate between short-term and chronic pain patients to reduce stigma, he says.

“A lot of the time the pharmacist may not be aware of their background for the patients who have chronic pain. They look at it more of, you have short term pain, here’s a solution, and sometimes they’re not looking at what is the population of chronic pain patients,” says Mr James.

“And this is not just pharmacists but the general public have a view, in my opinion, that people who are chronic pain patients are addicts,” he adds.

“I’m very passionate about talking about chronic pain in terms of management and effective relief of low-dose opiates. Post-surgery, some people only need it for two or six weeks, but chronic pain patients need pain relief for longer than that and pharmacists should understand what that entails.”

Feeling judged, not understood and not listened to by healthcare professionals remains some of the biggest barriers Australians living with chronic pain face in the management of their condition, says Chronic Pain Australia National President Jarrod McMaugh.

“Pharmacists are often worried about the harms medicines can cause, including dependence, but the actual incidence of dependence is lower than most pharmacists realise,” Mr McMaugh tells AJP.

“We need to do a better job of weighing up risk of harms in a manner that doesn’t cause more harms through stigma.

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“Start by actually believing the person’s account of their pain, then think about the fact that people feel horrible when a health professional acts like their experiences are exaggerated or catastrophised or made up.

“Pain is horrible, and yet there are people willing to put up with pain rather than speak to their pharmacist about it due to the manner in which we are dealing with people who seek our help for pain. When putting up with pain is preferable over speaking to a health professional, then we know things need to change.”

He suggests that pharmacists can start by asking questions that are relevant and guided by the conversation, rather than robotic or rote-type questions.

National Pain Week runs this week, from 22-29 July.

The National Pain Survey 2019 of more than 1200 Australians released today found:

  • 71% visit their pharmacist monthly or more about their chronic pain, but 21% don’t visit their pharmacist at all
  • 68% said they would benefit from more education and knowledge on medicinal cannabis
  • 96% felt the government should provide a full or partial rebate for accessing allied health professionals to manage chronic pain
  • 91% of respondents were not aware of the Pain MedsCheck trial program

Many respondents said they want to minimise their use of medication, often due to unwanted side effects, but require the support of a multidisciplinary team to do so, which is commonly out of their reach.

“Whilst the majority of respondents utilise a range of allied health professionals to help manage their pain, 84% do not find them affordable and 96% felt the government should provide support in the form of a partial or full rebate,” says Mr McMaugh.

“On the other hand, responses to the survey also tell us that medication regularly plays a very necessary part of person’s treatment plan, yet people living in pain are all too often labelled as drug seekers for requiring assistance to simply get out of bed in the morning.”

Mr James found huge relief in medicinal cannabis, especially in combination with low-dose opiates.

In October last year he began taking medicinal cannabis through the first clinic set up in Queensland, and since then has been able to wean off half of his slow-release opiates.

“For the last three years [since being on low-dose opiates] I’ve been getting better and better. And for the last six months in particular the medical cannabis oil has been fantastic and that’s what I talk about so much now which is really good for chronic pain overseas and proving so in Australia,” he says.

“The medical cannabis has allowed me to wean off 50% of my slow-release opiates, which is good news for me. But I’m still on some pain relief and I do exercise and other things because I’ve had it for 10 years now.

“My objective in life is to deal with my remaining physical abilities as best as I can.”

Mr McMaugh says people living with pain want to know more about medicinal cannabis but they are facing a range of hurdles when it comes to accessing treatment, including a complicated approval process and the cost being out of reach for most people.

“What we are hearing very clearly is that they feel there is stigma being attributed to medicinal cannabis which is not necessarily placed on other treatment options,” says Mr McMaugh.

“Chronic Pain Australia would like to see medicinal cannabis treated in the same way as any other legal treatment option, subject to the same regulatory standards and evidence as all other medications used in the treatment of pain.

“Barriers such as regulatory burden, stigma, lack of investment in research, and low uptake of opportunities for professional education by health professionals need to be overcome to ensure that everything is being done to better the quality of life of people in pain.” 

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