KANSAS CITY, Mo. — More than 25 million Americans suffer from chronic pain.
But as the country grapples with opioid use and misuse, those affected and their doctors are working to balance how to find relief safely.
KSHB 41 went 360 on the topic, speaking with a:
- Woman struggling with chronic pain
- Pain management doctor
- Drug and alcohol recovery agency
- Insurance company with a patient advocacy expert
Brief timeline
In November 2022, the Centers for Disease Control and Prevention updated its guidelines for doctors prescribing opioid medications.
The changes provide physicians more flexibility as the CDC eases off of dose limits set in 2016, which chronic pain patients and other experts criticized as too strict.
An increase in opioid prescriptions started in the 1990s, followed by a rise in heroin overdose deaths in 2010 and a surge in synthetic opioid deaths in 2013, per the CDC.
Since 1999, the CDC reports drug overdose deaths have quintupled.
Woman struggling with chronic pain
Patrisha Gillette says living with chronic pain is a struggle.
“I take like 30 pills a day,” she said. “I don’t look to the future. I try not to because it’s too depressing.”
Her reality is similar to other Americans who suffer chronic pain.
“It’s like this burning pins and needles sharp pain in my feet all the time. It never goes away,” Gillette said.
Doctors have diagnosed Gillette with fibromyalgia, lupus and degenerative back disease.
Over time, chronic pain has not only robbed her of mobility but also her self-esteem.
“I’m hoping to make it through my kids graduating high school to where they’re in college or have families and don’t need me anymore. But you always need your mom, and that’s why I can’t think about it," Gillette said as she broke down in tears.
Her medical bills are covered by Medicaid. And while she feels fortunate to have that option, Gillette understands without a customized care team and insurance, the reality is grim for many others.
“I think that’s a travesty,” she said.
Pain management physician
Dr. Fei Cao is a pain management specialist at University Health.
“Chronic pain is not that simple,” he said.
Years of chronic pain can lead to secondary consequences such as anxiety and depression, according to Cao.
Physically, chronic pain can cause high blood pressure and increased heart rates.
Despite patient complaints, the Social Security Administration does not consider chronic pain to be a disability.
“It’s so subjective,” Cao said of a lack of protocol surrounding chronic pain. “It’s really hard.”
University Health uses a multidisciplinary approach to healing. Doctors consider a patient's history, physical examination and various imaging, along with training from pain psychologists.
“Pain psychologists use basic coping skills to let you become your own MD,” Cao said.
Cao says medication, especially opioids, is just one small part of a holistic treatment plan.
“Opioid itself is not a bad drug, it just depends on when you use it, how you use it and who uses it,” he said.
Drug and alcohol recovery agency
Megan Fowler is the director of recovery services at First Call, a Kansas City, Missouri-based drug and alcohol recovery agency.
As a recovering addict herself, Fowler says she understands the cyclical nature of the opioid crisis.
“It goes from being, feeling good and euphoric to feeling you’re just trying to get by and survive because the withdrawals from opioids are brutal and very physically painful,” she said.
The National Institutes of Health reports about 2 million Americans are addicted to opioids, and fatal overdose rates have risen more than 20% in the last 20 years.
Fowler says patients who don’t have, or lose, their insurance can lead to issues of addiction.
“It's not uncommon for people to turn to illicit ways of getting those substances, so what we see is people turning to heroin, plus pills on the street,” she said.
At First Call, staff says it’s important not to judge the substance or the person who might be struggling. Instead, the agency's goal is to help people toward recovery and offer education for prevention.
“What we would love to see at First Call is anybody who is prescribed pain medication also get Narcan,” she said.
Narcan is a medication that quickly reverses an opioid overdose.
Insurance company with patient advocacy expert
Blue Cross Blue Shield of Kansas City's Chief Health Officer Dr. Greg Sweat informs patients and advises doctors in his role.
"You’ve got a lot of physicians out there ... I think they are conflicted,” he said.
Last fall’s updated CDC guidelines shift focus to a patient’s individual needs. Sweat believes the solution can only be found if doctors work together with their patients.
However, he says physicians must strike a delicate balance between overprescribing and cutting patients off.
“Sometimes doctors are leary and weary of — it’s a bad term — but drug-seeking behavior. Drug-seeking patients,” he said. “[But] when people get into this cycle of pain and they’ve escalated and continued to escalate their need and then they get cut off, that’s inappropriate, too.”
Sweat proposes two potential solutions that may help with prescription opioids. First, he thinks there should be a national database of patients.
“Before Missouri enacted their monitoring program several years ago, people in Kansas, they would just go to Missouri,” Sweat said. “You should be able to see a patient’s name, every pharmacy they’ve been to, quantities of narcotics they’ve gotten, types of narcotics they’ve gotten and the date that they got them. That’s what's needed, ‘cause then the doctor could make an informed decision.”
His second proposal is a contract signed by both parties before administering opioids. It would outline the responsibilities of the doctor to inform and the patient to be transparent.
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As part of KSHB 41 News' commitment to providing context and depth in our reporting, we've excited to share our latest project, which we're calling 360. This project takes stories and topics that our communities are talking about and explores different perspectives on the issue. You can be a part of the process by e-mailing your ideas and thoughts to us at 360@kshb.com.