The Right (and Wrong) Way to Treat Pain

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After three days of contentious discussion, an FDA advisory panel last week recommended that the COX-2 drugs Bextra and Celebrex remain on the market but with certain restrictions. Most panel members favored "black box" warnings on the packages indicating that the drugs raise the risk of heart attack and stroke and are therefore inappropriate for many patients. If the FDA adopts this strategy, it would mean the end of ads like the once ubiquitous "Celebrate!" spots for Celebrex, as black-box drugs may not be advertised directly to consumers. But there was tantalizing news for Rickhoff, Dobbs and other Vioxx devotees. By a narrow vote, the panel okayed the idea of bringing the discontinued drug back to market, and Merck, its manufacturer, said this was under consideration.

Is that good news? Rickhoff isn't so sure. "I definitely feel at the mercy of the pharmaceutical companies and the FDA," she says. "It's terrible that they've scared people so much. All drugs have side effects, and some probably have much worse risks than Vioxx." Studies suggest that roughly half of Americans with chronic or recurrent pain simply do not find a good solution, and the news out of the hearings is not going to make their choices any easier. In fact, chronic pain is a leading cause of lost workdays. It costs the nation an estimated $100 billion in lost productivity and increased health care, not to mention immeasurable suffering.

Doctors who specialize in managing pain say this need not be so. Perhaps the biggest reason so many patients suffer more than they should is the tendency among doctors and patients alike to see pain as a mere sideshow--a vexing side effect of arthritis, a herniated disc, cancer or trauma--rather than what it is: a serious and consequential health issue in its own right. A long-suffering Michigan physician and mother of three, who asks that her name not be used, knows this both as a doctor and as a patient whose life has been compromised by severe neck pain stemming from a 1999 car accident. "I know all too well how most doctors really feel about people with chronic pain who don't get better: disdainful and contemptuous," she says. "There is a real sense of the patient as a failure and a weak person who can't pull him- or herself together and cope."

The second big reason for the widespread failure to find adequate pain relief is that most of us seek it entirely in a pill bottle--or two or three. The quest for pharmaceutical salvation is misguided to begin with, say doctors at the nation's most sophisticated pain-management centers. The lesson they have to teach us all is that chronic pain must be attacked on many fronts. Drugs are important, but they are just one weapon in the arsenal.