Cultural Differences in the Treatment of Pain
Due to the rapid increase in prescription drug abuse, the Centers for Disease Control and Prevention has declared prescription drug abuse an epidemic. The latest National Survey on Drug Use and Health indicates that over 70 percent of people who abused prescription pain medications obtained them from friends or relatives, while approximately 5 percent got them from a drug dealer or over the Internet.
Fighting prescription pain medication abuse is an uphill battle with no easy solution. It requires a comprehensive approach to address the problem at clinician, patient, and manufacturer levels. The Food and Drug Administration requires the manufacturers of long-acting and extended-release opioid medications to submit a risk evaluation and mitigation strategy (REMS) that focuses on educating the prescribers of safe use of these medications. The effectiveness of the opioid REMS is yet to be seen. Some pharmaceutical companies have developed new opioid drug formulations to deter drug abuse. What else can be done to mitigate prescription pain medication misuse?
Logically, if we decrease the prescription of opioids, we can decrease the abuse of opioids. Opioids, some of them the most powerful painkillers available, can be life-saving medications for cancer patients and some patients with chronic, severe, noncancer pain. However, are these medications overprescribed? In other words, can some pain be treated with an alternative with less or no abuse potential? In China, opioid use is less common due to cultural differences in pain perception and management. In Chinese culture, pain itself is not generally considered a disease that needs treatment. One is expected to try to “tough it out.” Even patients with severe acute pain might not take painkillers, some for fear of the addiction potential, some holding it off for worse pain to come. Chinese clinicians generally reserve opioids for cancer patients. For acute short-term pain such as postoperative pain, opioids might be used in a hospital setting, but patients are not discharged home with prescriptions for opioid medications. Opioid is also generally not the choice for chronic, noncancer pain, which is treated in China with physical therapy, massage therapy (in a clinic or self-administered), herbal medicine (oral or topical), and acupuncture. Non-opioid pain medications are used in some patients on an as-needed, short-term basis.
Is it feasible to replace opioid medications with these alternative measures in America? For some patients, the answer may be “yes,” but for others, no. Let’s look at postoperative pain for instance. In China, postoperative patients are usually bedbound for some time and taken care of by family members. According to tradition, a woman is to stay home for a month after giving birth, and grandparents usually pitch in to care for the newborn. Therefore, there is less need for powerful painkillers. American patients on the other hand, pride themselves as independent and request a quick return to normal life. After caesarean sections, women need to be ambulatory to care for their babies. This cannot be achieved without medications that provide quick pain relief. Patients who do not respond to nonsteroidal anti-inflammatory drugs require opioids. As for chronic, noncancer pain, the alternative measures, such as herbal medicine and acupuncture, may be too novel to be accepted by the majority of the general population. In addition, herbal medicine may not provide quick onset action, which hinders its use in patients needing immediate pain relief.
Despite the obstacles, these alternative pain management remedies can at least complement the mainstream biomedicine and thereby decrease the reliance on opioid medications. The increased recognition of osteopathic medicine and integrative medicine in this country will help to introduce more patients to alternative pain treatment.
By the American standard, pain is undertreated in China. With economic growth, medical care in China will eventually focus more on improving patients’ quality of life, and not just treating and controlling the diseases. Easier access to pain medications may bring with it the problem of prescription drug misuse. Nonetheless, the fear of drug misuse should not be a reason to deny patients effective treatment options. In any country, the medical community and the regulators should seek to keep the fine balance between access to opioid medications by patients who really need them, and steps taken to control the risk of potential misuse of these medications.
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