Doctors must listen to patients about their pain – and if that means prescribing opioids, so be it

James Moore

I’m writing this column earlier than usual this week because I’m excited to say I’m going into hospital on Friday. It’s for a pain treatment in which I will have capsaicin (chilli pepper extract) patches placed on an agonisingly painful foot.

You might at this point be wondering why on earth I’m looking forward to having a procedure that will temporarily turn that part of my body into a firecracker. The reason is that it works. It burns out the pain fibres in a part of my body that I can’t move, but fibres which I sure as hell know are there. It doesn’t eliminate the neuropathic pain from which I suffer, but it does have a significant impact on it.

After the treatment I am, for example, able to tolerate wearing socks for longer than half an hour or so, and to cover my foot with a duvet at night, which is kind of helpful at this time of year.

However, I have to admit to having put off approaching my (first-rate) consultant about the latest procedure until agony forced my hand, partly because of the very real pain that resulted from the interrogation I was subjected to last time I had it. “What number do you rate your pain at on a scale of one to 10? What number do you rate it after the treatment? Answer me! Don’t you know I have a clipboard here?”

I found it impossible to do that, because the chronic pain I experience varies throughout the day (it usually gets worse as the day progresses), and putting a number on it would be entirely arbitrary. One person’s eight is another’s 10, and some of us like to underplay how much we’re feeling because of the good soldier thing. When I made that point, I got a lecture from the nurse about how they needed the information so they could assess the effectiveness of the treatment. Sigh. Chronic pain is unpleasant enough as it is without enduring this sort of crap.

Which brings me to the question of opioids, which are still widely prescribed but increasingly under fire because of issues of addiction and effectiveness.

The backlash against them is gathering momentum, maybe with good reason. While we don’t have a US-style opioid crisis, opioids have arguably been over-prescribed, and Public Health England found a link between the numbers being doled out and levels of deprivation in a report published last year.

Dr Michael Mosley, in an intriguing episode of BBC’s Horizon, said opioids were effective in less than one in 10 cases of chronic pain, and he presented alternatives. I’m willing to give anything a go – but I have to admit, I started to feel some scepticism when Dr Mosley presented the idea that you could talk chronic pain away with the aid of a course. And opioids are effective, albeit in a minority of cases.

This brings us back to where I started out, and the nurse’s insistence that I put a number on my pain, instead of listening to the evidence I was providing them with. Socks, dammit, socks!

As a long-time consumer of NHS care, medical professionals aren’t always as good at listening as they might be.

I’m lucky. My pain consultant does listen; so does my GP. But I’ve experienced the flipside, too.

Sometimes doctors have to impart hard truths – I get that. Those may include telling people who are popping morphine with wild abandon that it’s time to cut down.

At the same time, it’s also important for medical professionals to listen to their patients, and particularly in the midst of a backlash, that doesn’t always happen. I fear people will suffer as a result.

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