Freedom to Feel Pain: Quinones and the "Sunday Review"

I think we may find a few responses to The New York Times "Sunday Review" of Sam Quinones book Dreamland very informative.

Response #1

“As a psychiatrist who treats opiate addicts and as a patient who was once given a week supply of hydrocodone for acute pain, I have seen both straightforward and problematic use of pain medication," JN in New York wrote. "It made me feel groggy and stupid and tired. … Yet I have seen hundreds of people who experience euphoria when they take certain opiates, the effects vary from drug to drug and person to person."

Response #2

“Pain has been declared ‘public enemy number one’ and elevated to ‘the fifth vital sign’ in hospitals,” Mikhailalexandrovich wrote from Madison, Wisconsin. “Considering the competition among surgeons for their share of the market, unrealistic expectations about post-operative pain are frequently created in order not to scare the customer away.”

Response #3

“The real villains are the ones who profit: Big Pharma,” David X. wrote from New Haven, Connecticut. “But our doctors need to protect us from this profit machine.”

(Marie Tessier. Reader responses to "Serving All Your Heroin Needs" by Sam Quinones.

"Sunday Review" in The New York Times. April 20, 2015)

We abhor pain. Not only do we do everything to avoid it invading our own body, but also we suffer great empathy as we see others we love experience any hurt. It is no wonder medical researchers keep searching for the ultimate pain relief, no matter the source of our discomfort. Yet, feeling and understanding pain is necessary for our survival. Pain is both an invaluable tool and a teacher.

Pain is defined as "an unpleasant feeling that is conveyed to the brain by sensory neurons." The discomfort signals actual or potential injury to the body. However, pain is more than a sensation, or the physical awareness of pain; it also includes perception, the subjective interpretation of the discomfort.

Perception gives information on the pain's location, intensity, and something about its nature. The various conscious and unconscious responses to both sensation and perception, including the emotional response, add further definition to the overall concept of pain.

When something is wrong, pain alerts us to the problem, gives us vital information about the nature of the discomfort, and this important interpretation leads us to seek proper treatment, be the pain normal, acute, or chronic in nature. Without pain, we would have no ability to avoid danger nor to pinpoint life-threatening damage.

The etymology of the word pain leads us to the Latin poena meaning "punishment, penalty, retribution, indemnification." If we look at the root meaning, we may better understanding that, in most cases, pain is not some mysterious, evil force that randomly descends upon us as cruel fate bent upon our excruciating destruction.

Instead, pain usually arrives because of something we do to ourselves -- we have an accident; we become careless; we take risks; we encounter unforeseen distress. Then, in that respect, pain is an unkind penalty for simply living life as a human being. And, the "pain penalties" associated with normal living become essential lessons for using caution and avoidance.

Even the best "scientific" measures of pain -- numerical ratings, comfort scales, and the like -- are subjective and often based on self-reporting. Due to different pain tolerances and vastly different biological, psychological, and social factors, treatment is anything but a precise technique. Still, today nearly everyone follows the zero-tolerance policy for enduring the slightest pain.

But ...

Deficits in knowledge and skills by health care professionals and poor pharmacological management have led to millions of people becoming addicted to pain relievers. Couple bad practice with insatiable greed, and we can trace an opiate epidemic from its inception -- a pain epidemic that resulted from dangerous prescription drugs like OxyContin and illegal substances such as heroin.

The incredible highs, the dependencies, and the addictions -- all of the stories in this painful saga comprise a complicated but well-documented history, a past with some well-meaning intentions that jumped the track when certain covetous conductors took the throttle and carelessly caused an enormous train wreck.

People eager to cure whatever ailed them scooped up the falsely touted relief by the handfuls, ingested it, and paid the ultimate price, many knowingly taking great risks and others innocently sold on the safety of a physician's scripts.

All for the relief of pain.

So, look at the responses again and consider the knowledge imparted:

1. "The effects of opiates vary from drug to drug and person to person."

2. “Considering the competition among surgeons for their share of the market, unrealistic expectations about post-operative pain are frequently created in order not to scare the customer away.”

3. “The real villains are the ones who profit: Big Pharma, but our doctors need to protect us from this profit machine.”

I believe we must stop living with unreasonable expectations of pain relief. Granted, the pain pill and the pain injection and the anesthetic are vital. Thank God, they are merciful medical tools. We must have them available and consistently employ them in times when pain should never be endured.

Yet, to escape all pain that naturally occurs because we are creatures of flesh and nerves is a lesson drilled into our being by profiteers. The smiling mask hides the real intention of dealers of death and destruction. Take your Soma and be controlled. There is nothing but enormous pain in criminal pain relief.

"And if anything should go wrong, there's Soma .... Take a holiday from reality whenever you like, and come back without so much as a headache or a mythology."

--Aldous Huxley,  Brave New World, 1932

Thank you, Mr. Quinones for making us think and respond and learn from our own history.