The Stigma of Chronic Pain

Most of the patients I treat who have chronic pain are distressed by stigma and the ignorance behind it. They are often judged by relatives, friends, doctors, nurses and others as being weak, addicted, defective, "not tough enough," "not motivated." Worst of all is the epithet: "Drug Seeking." Drug Seeking is a judgment impersonating an objective clinical observation. Drug Seeking implies asking for ("seeking") pain medication for non-legitimate purposes, such as getting high, "being a chemical coper," or other reasons not related to pain control. These judgments are almost always made by people who have never experienced unrelenting severe pain. Pain wears you down. No matter how good you are at coping, it pushes you to the edge. If you have other problems such as chronic physical or mental illnesses, it's just that much harder. The more chronic illnesses you have to manage the harder it is to manage any of them very well. When one illness recurs it upsets all the others. I have had patients who stopped taking opioid (narcotic) medications for pain, even though it improved their quality of life and function substantially, because they were stigmatized and criticized by health care providers, families members, and others. They subsequently are condemned to reduced quality of life and reduced personal and employment function in order to not be labeled "drug seeking." The level of knowledge about the management of pain by most clinicians is minimal at best. Chronic pain frequently goes untreated, leading to considerable suffering and disability because of this stigma.

Bottom line: medication that 1) improves overall quality of life, and 2) improved function in the absence of 3) serious side effects should be regarded as life saving, not as a way to escape reality.

MW