A website specializing in Lifestyle Modification of Chronic Non-Cancer Pain

“In the land of the blind, the one-eyed man is king. And, in 5+ level chronic non-cancer pain, whoever can consistently restore functionality according to patients’ priorities, controls chronic pain as we know it.” Grand Rounds, Scripps Memorial Hospital Campus, Schaetzel Conference Center, 2004

Around the world, those who study chronic non-cancer pain agree on the following:

That patients with moderate to severe (5+) pain have had their pain, on average, for 7½ years before they find the qualified multidisciplinary treatment that is the gold standard for restoring the functionality that most patients want restored. Furthermore, functionality is a clearly observable, measurable, objective standard, so why do so many studies talk about increased “quality of life” in regards to chronic non-cancer pain? It’s interesting semantics that patients need to understand lest their treatment objectives be changed without their awareness.

Medications are “licensed” by the FDA for specific uses. Therefore, medications intended strictly for cancer pain can only be legitimately marketed to cancer patients. And, the language of cancer pain must be used to stay on the safe side of the FDA, who can be pretty strict about misapplications of a licensed drug. Now, a key outcome in cancer pain is increased “quality of life,” meaning that someone who is facing life and death – and for whom going back to work, socializing, doing housework and getting a higher degree to improve one’s chance of promotion on the job is pretty irrelevant stuff – and is just happy to get an “increased quality of life,” which really means “suffering a bit less from cancer pain.”

However, once the drug is on the market, any physician can choose to use a medication “off license,” or for some other use than the use that was “licensed” by the FDA. Therefore, a drug company wishing to increase use of its cancer drug would be wise not to directly challenge the FDA by changing the wording of its key outcome – or its “improved quality of life” claim – and just put the advertising out there in the right journals and hope that general physicians, who are the majority of those who prescribe “off license,” will think that “improved quality of life” might be what their chronic non-cancer pain patients could benefit from, without worrying about splitting hairs over what cancer and non-cancer pain patients really see as their tangible treatment objective.

Now, since chronic non-cancer pain patients are not dying and do very much want to go back to work, socialize, do housework again and improve their chances of an increased salary and all that future-oriented stuff, the “quality of life” is not what they want as a key outcome of their pain treatment. In fact, in repeated studies with non-cancer pain patients, the tangible, future oriented things are precisely what they want more of, and those really constitute “quantity of life,” which is quite a different bird from “quality of life,” which is just a matter of feeling a bit better about your suffering and, therefore, about your prospects of dying or not, or again, your overall “quality of life.”

What is the implication for chronic non-cancer pain patients? Obviously, keep your eye on the ball. If your treatment objective really is to go back to work and all those good activities that constitute your “functionality” and “ability to function as normally as possible,” then do  NOT allow a physician to mix metaphors on you. If a physician tells you, in offering you a pain medication, that “it should increase your quality of life,” do two things. First, remind her/him that you’re not dying and that you want an observable, measurable, objective measure of improvement relevant to your life, like going back to work and all those other activities you want restored. In other words, you want “increased quantity of life,” in a reliable, predictable manner over the long term, not some vague, subjective “quality of life” that is no different than telling your boss that you want an “improved quality of salary” rather than that you want a “12 percent increase in salary.” And, second, you had better start looking for another physician to prescribe your pain medications, because the one that couldn’t tell the difference between “quantity” and “quality of life,” you really don’t want treating your pain any more.

See the difference? And that’s the difference between effective and ineffective treatment for chronic non-cancer pain, that you can, and must make for yourself… if you want restored ability to function!

Dr. Henry E. Adams

1-IX-2009