Reckoning with Addiction: Pain and the way we hurt by John Inscore Essick

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Recently I spoke with Drs. Donna and Damon Gatewood about pain and how opioid abuse is changing the way they practice medicine.
They are both family doctors who see patients of all ages (Donna in Crestwood and Damon in Campbellsburg) and regularly provide medication-assisted treatment of opioid addiction at a clinic in Louisville.
The Gatewoods routinely see patients who are seeking relief from acute and/or chronic pain.
Acute pain is the body’s signal that we need immediate medical attention for a broken bone or kidney stone. In time, acute pain will go away.
Chronic pain, in contrast, persists for months or even years. Chronic pain can be difficult or impossible to cure, so physicians work with patients to develop long-term strategies for living with severe pain.
Most patients do not experience the kind of chronic pain for which legal opiates such as oxycodone, hydrocodone, morphine, codeine or fentanyl might be prescribed.
Many patients do need one of those powerful drugs to function, however, and doctors like the Gatewoods were originally trained by hospitals, pharmaceutical companies and the larger medical field to eliminate pain as quickly and completely as possible.
In a society increasingly committed to, and capable of, instant gratification, instant downloads and next day delivery, we have come to expect that pain relief can and should be handled in like fashion. But chronic pain is not so easily erased.
“Complete elimination of pain is not a realistic goal at all,” the Gatewoods said. “You do your best, but you shoot for tolerable or livable.”
The use and misuse of opiates is complicated by the fact that we experience pain differently.
“The problem with pain is that it is subjective,” said the Gatewoods. “No one can really know what the other person really feels.”
Thresholds for pain vary and are impacted by factors such as mental health, anxiety, stress and mobility.
One’s circumstances compound and complicate physical pain, and thus pain management is rarely simple or perfect.
“In medical science we definitely don’t know how to fix everything,” the Gatewoods said, “and sometimes in trying to we make it quite a bit worse.”
Opiates are a prime example of unintended consequences in the medical field.
The pharmaceutical breakthrough to control chronic pain is too often bringing about a new and equally powerful pain of addiction.
For some people, though, opiates are considered an unavoidable, if risky, last resort.
The Gatewoods prescribe opiates in such cases. At the same time, opiate abuse is making it more difficult to treat those patients for whom well-regulated narcotics are deemed necessary. The Gatewoods report that legislation passed in the last few years requires patients to visit their office regardless of condition, complete narcotic contracts and undergo regular urine screenings that can cost as much as a hundred dollars and are often not covered by health insurance companies.
Because of the stigma around opioids, we are now at a point where it is more difficult to assist those in real need of the relief opioids can reasonably provide.
I put off writing this column because of how complex and sensitive the subject of pain is. But I also worry that by not talking about pain we avoid the deeper undercurrents of our life together which often gives rise to and exacerbate pain and hurt in our community.
I suspect that our thinking is fuzzy around the limits of medicine, the capacities of the human body and how to climb appropriately the ladder that leads to the prescription of powerful painkillers.
The Gatewoods’ approach to medical care has evolved as our understanding of addiction has evolved. Donna Gatewood is “a little more direct” in her conversation with patients who may need an opioid prescription. They also point out that “physical pain is one thing,” but most of the young addicts they work with “started it and continued to do it to treat their anxiety and their restlessness.”
This is a critical insight, I believe, because it points to a deep pain and untouchable hurt among us that is not quantifiable and for which there is no lab test. It is, I think, an existential and non-physical wound seeking a chemical, capsuled relief.
My biggest take away from talking to these two Henry County doctors is that reckoning with addiction involves talking more openly and transparently about not only where we hurt, but how we hurt.
From there, we just may get a glimpse of what health looks like.
Rev. Dr. John Inscore Essick is co-pastor of Port Royal Baptist Church and associate professor of Church History at Baptist Seminary of Kentucky in Georgetown. Feedback is welcomed by e-mailing hopeinhenry@gmail.com. He also welcomes conversation with those willing to share their stories.