Faye Flam: Legitimate pain research is more crucial than ever

The damage from the opioid crisis extends beyond the harms of addiction and overdose. Some doctors say it also hurts people with chronic pain by derailing research intended to help them.

The need to help people suffering chronic pain seduced some researchers into believing misleading claims of pharmaceutical companies promoting opioids. Researchers today say opioids are not only dangerous; they are not a good long-term solution for chronic pain sufferers. The relief tends to wane with time.

And as public outrage grew over the addiction deaths, money that opioid producer Purdue Pharma LP pumped into pain research eventually tainted the reputation of scientists, and led to the collapse of the American Pain Society, which had served an important role for pain researchers with a journal and meetings they depended on to exchange ideas.

It’s worth thinking about the right lessons to take away from the opioid crisis now, as communities and local governments are advancing on a $26 billion settlement against pharmaceutical companies. Some of the settlement money will go to addiction treatment, as the opioid addiction deaths are far from over. (Though the main offender in promoting dangerous opioids, Purdue Pharma, has declared bankruptcy in an effort to shield the owners from lawsuits over OxyContin, implicated in killing tens of thousands.)

As journalist Barry Meier describes the situation in heavily affected areas in his 2018 book “Pain Killer,” bodies were piling up too fast for coroners to examine them, and morgues filling to capacity and, in desperation, corpses were being stored in rented refrigerated tractor-trailers.

The book lays out a complicated history, with drug marketing getting tangled up with a well-meaning “pain management movement” among doctors hoping to alleviate suffering. During the 1980s, doctors were learning how to help alleviate the crushing pain associated with cancer and other terminal diseases, and were using drugs to better manage post-surgical pain. Many were eager to help patients with chronic pain, which can stem from unknown sources or from known diseases, such as sickle cell disease.

Drug companies manufacturing pain drugs stepped in with funding for this quest, which hadn’t been well-funded by the National Institutes of Health, since pain was not considered a disease but a symptom. The drug companies’ involvement sabotaged the pain movement, said anesthesiologist and pain expert Jane Ballantyne of the University of Washington. Deceptive advertising didn’t just cover up the risk of addiction. It also exaggerated the benefits of these drugs for chronic pain sufferers.

Purdue specifically marketed the ultra-potent drug OxyContin as a treatment for chronic pain. As Meier described it: “In terms of pure narcotic firepower, OxyContin was a nuclear weapon.”

The company made claims that it wasn’t addictive, not based on any data but on an assumption that its slow-release formula would prevent people from getting high, and so discourage the kind of recreational use associated with addiction. It didn’t work, because patients got addicted taking the drugs as prescribed, and people wanting to get high found ways to crush up the pills and snort them.

OxyContin and the opioid crisis also hit when pain management was highly politicized, as medical historian Keith Wailoo explains in his book “Pain: A Political History.” The left was concerned with pain from illness and disability, and sought ways government programs could help. Conservatives, in Wailoo’s account, worried more about people taking advantage of the system, faking pain to get benefits or relief that wasn’t deserved.

But the opioid industry appealed to both sides, addressing the left’s concern over pain but with a free-market approach that pleased the right. The risk of addiction was known since wounded soldiers got hooked on the opioid morphine after World War I, but around the start of the 21st century there remained a strong current of belief that addiction was a weakness, or a sin, rather than a disease or drug side effect.

(Rush Limbaugh, the late conservative talk-show host, unwittingly shifted that attitude by becoming addicted to OxyContin after being prescribed the drug for chronic pain associated with spinal problems.)

I learned about Wailoo’s political history of pain during a 2019 lecture he gave at Harvard Medical School, after which several doctors and chronic pain patients shared concerns and experiences. Neil Schechter, an anesthesiologist and pain specialist at Boston Children’s Hospital, said he worried that pain research was being set back by the opioid backlash.

I called him a few days later, and he told me that until the 1980s, the medical community insisted that children’s nervous systems were immature, and that they didn’t feel pain the way adults did. There was surprisingly little concern about pain they might have felt from medical procedures. Babies were routinely operated on with paralyzing drugs and no anesthetic.

Before it was shut down in the wake of the opioid crisis, he said, the American Pain Society had been the only scientific society to address the science of pain and advocate for better pain treatments. It supported the one journal devoted to pain medicine as well as meetings where basic researchers, doctors and psychologists could share new advances.

The Pain Society was supported by pharmaceutical money — and so is seen as corrupted — but Schechter said it also served a critical function for him and other scientists trying to better understand pain and improve the way its treated.

Ballantyne, the University of Washington pain expert, said that the situation is complicated. Doctors who got research money from Purdue or other drug makers may have had the best of intentions, but it would be too easy for them to develop conscious or unconscious biases toward the use of opioids.

The opioid crisis should wake the medical community up to the dangers of aggressive drug marketing to doctors and patients, and to the biasing influence of drug company support for scientific research. But legitimate pain research is more crucial than ever and shouldn’t be added to the casualties in this national tragedy.

Faye Flam is a Bloomberg Opinion columnist and host of the podcast “Follow the Science.” She has written for the Economist, the New York Times, the Washington Post, Psychology Today, Science and other publications.