Pain Crisis

Hello Readers

I have just read a tweet – enough to break a person’s heart – from someone suffering from pancreatic cancer and other chronic conditions. She is struggling with pain and can’t find the help she needs.

Today has been another day where the crisis we are in has been reinforced. First a consult patient who presented with severe neuropathic pain. He was taken off Methadone and a breakthrough medication and had to suffer for far too long in pain. And then this tweet – pancreatic cancer is one of the most painful cancers. Pancreatitis is bad enough, but when the pancreas is affected by cancer, it can even need a Celiac plexus block to control the cancer pain.

Thank goodness we live in Canada. I learned from our cancer specialists in Vancouver that pancreas cancer will often only respond to triple opioid therapy. I had a patient with this cancer who was on Methadone, Fentanyl and Hydromorph. He lived longer, I believe, because he didn’t have as much stress from severe pain. And his quality of life was improved because he had less pain. This helped his family cope with the trauma of his illness and death. He was able to live out his life and die at home.

I discussed with a patient the difficulties doctors have when it comes to prescribing opioids. Some docs work 80 to 100 hour work weeks, especially if they work in rural areas. The work is terrifying – so easy to make mistakes – I understand the knee jerk response to avoid opioids. If it wasn’t that I’d stopped doing emergency calls and cut my work week down to 50 hours, I would never have managed to change my way of managing chronic pain. The time I had to spend studying and working on different approaches took a huge chunk out of each week.

Sometimes I also think that, as doctors, we are faced daily with so much pain and suffering that we become blunted. We shut ourselves out to the real effects of pain and disease. Maybe that is necessary to continue to work. I know that I have done that to cope. If you stop to consider the suffering coming through your door every fifteen minutes, it becomes overwhelming.

This doesn’t help the patients who deal with pain day in and day out too. Patients are now suffering because many are not getting the medication that has previously helped them. There has been more than a doubling of deaths from illicit opioid use since the new guidelines in B.C.

Probably a bit too much rambling. Long day today and stress seeing the one particular patient in so much distress. I am just reaching out to you to hope that we can all work to reach out to each other, spend time with people in pain, reach out for help to family and friends. The more people who can support a person in pain the better. Go with a person in pain to the doctor. It helps improve communication.

Good Luck

Signing off for tonight


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