A few nights ago, I was talking with my wife about something fairly benign – probably weekend plans or paying the light bill – when she suddenly got a look on her face that I know very well. It was that solemn, glaze-eyed look that says, “I’m so over this.” Like any good spouse would do, I asked, “What’s wrong? Are you ok?” Her eyes snapped to and she gave a slight smile accompanied by the quietly murmured, “I’m fine.” This was obviously not the case so I interpreted her response to mean that something was wrong…

As we enter this last year of the second decade of the 21st century, clinicians working with patients who experience pain confront the challenge of providing safe and effective pain management while facing numerous barriers to doing so. During the past few years pain management in the US has been dramatically affected by the opioid crisis. This is true for patients and clinicians alike. It is tempting to lament the resultant changes, barriers  and difficulties; however, without appropriate action such lamenting will only deter from working to improve pain management options and care. 

Historically, the interactions between health care providers and patients involved a therapeutic component that enhanced the beneficial effect of the medications and treatments which were provided. Today, when they sense empathy and compassion from clinicians, patients continue to report greater satisfaction, less anxiety, and feeling safer, with improved outcomes demonstrated. Although compassion clearly is important in health care, it is often misunderstood.

Barely a week goes by without at least one, often multiple, mainstream news articles about the practice of pain management. Just the other day, there were a number of stories about a huge federal multi-state crackdown on “rogue prescribing” of opiate pain medications by 76 doctors which led to them being arrested for fraud and a long list of other charges. We also read of a dramatic increase in raids on nationally prominent specialists in opiate dependence who prescribe buprenorphine.

The monoclonal antibodies (mAbs) targeting calcitonin gene-related peptide (CGRP) are a valuable addition to our preventives. However, there are significant conceivable long-term adverse effects associated with them. We will have a better feel for the true risks in 10 years. For each patient, we have to decide whether the benefits outweigh the possible risks. With luck, it may come to pass that the biologics targeting CGRP carry very few long-term risks.