Painful choices: Physicians challenged by quest to end suffering

Like many patients with the kind of pain that can make a person want to kill herself, Marcia Solum has suffered at the hands of a medical system that is struggling to do the right thing.

As her back pain worsened to the point that it hurt just to open her mouth, Solum went from doctor to surgeon to doctor to surgeon looking for help. When two surgeries only intensified the pain, the former buyer for O.C. Tanner asked for enough medication to make life bearable — and was accused of being an addict. It took four years to find a doctor who provided any relief.

Now on a morphine pump that has reduced her pain to a tolerable "5," Solum falls into the category of patients at the heart of a national debate: Are people in chronic pain being adequately treated?

At the debate's core is the love/hate affair with the powerful class of pain medications known as opioids. The painkillers may deliver an incomparable level of relief to some patients with severe pain, but they also have a downside. The most notorious example, OxyContin, has been blamed for addiction, crime and overdose deaths.

Faced with these unintended consequences and trying to sort out who's genuinely miserable from those just seeking a fix, doctors have become acutely aware that they must get it right. They want to provide relief, but they also want to keep people safe and stay out of trouble themselves — since doctors have been sued for undertreating pain and jailed for overtreating it.

The perception among doctors is that the regulatory environment has become more hostile, says Micke Brown, director of advocacy for the American Pain Foundation, headquartered in Baltimore. "Many health care providers are running scared," especially primary care physicians, she says. "Some are even backing away from managing people's pain."

"Stand up and look around the room," says pain management doctor Lynn Webster, who heads the Utah Academy of Pain. "At some point in their life, every other person will have intractable, protracted pain . . . not just for days or weeks but for months or longer." Pain management, he concludes, "should be a very personal issue to everyone."

Personal because the numbers are clear: One in two adults will experience severe, chronic pain.

For some the pain will come at the end of life. For others it will be pain that lingers for decades, set off by injury or illness or even by something that defies diagnosis. What doctors understand about pain now that they didn't just 10 years ago is that chronic pain is often a malfunction of the nervous system, itself a neurobiological disease.