Having lived with someone who suffered chronic kidney stones, at least within the US, a huge problem in recent years has been the over-reaction to the so-called opioid crisis. The result has been a decreased willingness to actually treat what we might call chronic acute pain, like the kind that comes from kidney stones.
This is a somewhat technical distinction I’m making here. Kidney stone pain is acute in that it has a clear cause that can be remediated. However if someone produces kidney stones chronically (let’s say at least one a month), they are chronically in acute pain. This creates a problem because standard treatment protocols for chronic pain don’t always work because this is a continuous level of pain above what’s normally experienced by chronic pain sufferers, perhaps with the exception of migraines. But since migraine pain is best treated with non-opioid drugs, they don’t run into the same problems as chronic kidney stone sufferers do who need repeated access to opioids to deal with pain that can break through maintenance pain medications.
The result is people left in agony who suffer from chronic kidney stones that are resistant to treatment because of restrictions on opioid drug use in the name of curbing abuse. To make matters worse, treatment can become a catch-22: chronic pain doctors won’t treat such pain because it’s “acute” and at some point other doctors will stop wanting to treat repeated kidney stones because they are “chronic”. The incentives are aligned perfectly to get doctors to not treat these patients since they can risk losing their license for improperly prescribing opioids. It doesn’t matter if it’s valid, all that matters is that it looks suspicious in a database, and doctors would rather avoid that attention than risk it to treat patients (but of course not all doctors are like this, just that there’s a lot of them who follow the incentives rather than work against them in the name of patient care).
Having lived with someone who suffered chronic kidney stones, at least within the US, a huge problem in recent years has been the over-reaction to the so-called opioid crisis. The result has been a decreased willingness to actually treat what we might call chronic acute pain, like the kind that comes from kidney stones.
This is a somewhat technical distinction I’m making here. Kidney stone pain is acute in that it has a clear cause that can be remediated. However if someone produces kidney stones chronically (let’s say at least one a month), they are chronically in acute pain. This creates a problem because standard treatment protocols for chronic pain don’t always work because this is a continuous level of pain above what’s normally experienced by chronic pain sufferers, perhaps with the exception of migraines. But since migraine pain is best treated with non-opioid drugs, they don’t run into the same problems as chronic kidney stone sufferers do who need repeated access to opioids to deal with pain that can break through maintenance pain medications.
The result is people left in agony who suffer from chronic kidney stones that are resistant to treatment because of restrictions on opioid drug use in the name of curbing abuse. To make matters worse, treatment can become a catch-22: chronic pain doctors won’t treat such pain because it’s “acute” and at some point other doctors will stop wanting to treat repeated kidney stones because they are “chronic”. The incentives are aligned perfectly to get doctors to not treat these patients since they can risk losing their license for improperly prescribing opioids. It doesn’t matter if it’s valid, all that matters is that it looks suspicious in a database, and doctors would rather avoid that attention than risk it to treat patients (but of course not all doctors are like this, just that there’s a lot of them who follow the incentives rather than work against them in the name of patient care).