As a Society We Are Becoming Dangerously Intolerant of Pain

In 2016 opioids such as fentanyl, oxycodone (sold as OxyContin and Percocet), hydrocodone (sold as Vicodin) and the usual suspects (methadone and heroin) killed more than 50,000 Americans. Total overdose deaths (including deaths from methamphetamine and other drugs) stood at 70,000 by the end of the year. Consequently, addiction became the leading cause of death for people under the age of 50 and the leading cause of preventable death. According to a New York Times report this figure exceeded the highest ever annual toll for gun deaths (39,000 in 1993), the highest ever annual count for road deaths (54,000 in 1972), and the highest ever number of HIV related deaths in one year (47,000 in 1995).

The roots of this opioid epidemic go back to the 1990s when there was a massive upsurge in the production and marketing of opioid analgesics for medical purposes. Big pharmaceutical companies began aggressive marketing strategies to promote the expanded use of drugs like oxycodone. From the very start, it was argued (incorrectly) that these opioids were less addictive than morphine and diamorphine (heroin). Purdue, and other big pharma companies funded research into pain management protocols that effectively changed the existing landscape for the medical use of opioids. These findings, whose agenda becomes clear when one considers their hyperbolic titles (The Tragedy of Needless Pain is one particularly good example) heralded the start of a sustained campaign to change the public’s perception of pain — of how much pain we should be expected to tolerate. It worked.

During this time, significant amounts of pressure were also brought bear on the medical profession who hitherto had prescribed opioids almost exclusively for the treatment of cancer patients and almost never on an outpatient basis. Between 2000–2010, in the UK, Australia and US, the use of opioids by physicians for the treatment of non-cancer pain rose dramatically. Doctors felt increasingly compelled to dispense opioids for the treatment of less severe pain (known as ‘chronic non-malignant pain’). There were even discussions as to whether pain was ‘the 5th vital sign’. (There are only 4 vital signs). Serious talk of ‘punishing’ doctors for leaving people in pain abounded. Physicians, who after all exist to make our lives more comfortable, were placed in an impossible situation. They became afraid of not prescribing opioids for pain, and in an increasingly hostile environment, with litigious big pharma on one end of the stick, and med-seeking patients on the other, many capitulated.

Of course, during these decades, the more liberal use of opioids produced no demonstrative reduction in chronic pain. It did however, produce an addiction epidemic. By 2010, the sale of opioid painkillers such as OxyContin and Percocet had quadrupled. Today more than 2 million Americans are dependent on painkillers, and more people are using painkillers than tobacco. All of this has occurred in spite of firm evidence that the long-term use of opioids actually increases pain — a condition known as hyperalgesia.

By 2007, the backlash had started in earnest. Purdue were forced to settle with the federal government to the tune of $600 million when three of their executives were found guilty of misleading regulators, doctors and the general public about Oxycontin’s potential for abuse. This reckoning process is still ongoing, and is holding other large pharmaceutical companies like Rochester to account as well.

But this is not the whole story. As a society I would like to suggest that we are becoming hopelessly intolerant of pain or discomfort of any kind. Hyperalgesia is about as good an analogy for our societies woes as anyone could possibly invent. The more we refuse to tolerate pain, the more pain we are in. The more we become expectant, the less we feel that we are receiving. And this is where we are at: intolerant of pain, nay, angry with pain for presenting its impertinent face in the first place. We seem convinced that happiness and pleasure are our birth-right, and we affirm it with a sense of indignant evangelism.

Well it’s not. natural selection did not equip us in any way to be seekers of happiness. Quite the contrary. It equipped us to be chronically dissatisfied. A permanently satisfied animal would soon be a dead animal in the ancestral environment. We are not adapted to the pursuit of happiness. We are adapted to the pursuit of reward and meaning. Our default position, as carved out by evolutionary processes, is discontentment. I don’t know if you’ve noticed.

Of course, discontentment is not something we should strive for. Freeing ourselves from this state is both worthy and possible. But neither should we be naïve. Our periods of happiness are like hot summer days in a life lived mostly in temperate climes. So, let us look to a higher purpose than mere happiness, contentment and personal satisfaction. Let us look even beyond freedom from pain. Freedom from pain is an unrealistic expectation. Most especially, freedom from mental and emotional pain. We should not nurture our expectations of happiness, but rather, engage ourselves in projects and goals which are not centred entirely on self.

So, who is to blame for this society wide unwillingness to suffer pain? Those unscrupulous suits and academics? The doctors who should have shown more resilience, who after all took an oath to ‘do no harm.’ Or is it we, the perpetually ill and needy citizens. We, the sweepstake winners. The least oppressed generation that has ever lived. The recipients of every conceivable form of physical comfort that could possibly be imagined. Because while big pharma is surely culpable, and while many well-meaning physicians have taken the line of least resistance, we must say that we too have played our part.

I am not being so trite as to suggest that human beings can ‘believe what they want to believe’ and thus rationally and logically think their way out of pain. Whilst positive psychology gurus might wish to assure us that reality is ‘whatever we think it is’ — we know that this is a lie in the final analysis. Pain has a reality all of its own that confounds the theories of such romantics. No. The intrusive power of real pain cannot be denied. It cuts through such delusional belief systems.

So let’s save our recourse to full powered pain relief for such dire circumstances. Let’s consider how being bereft of the values that once served us so well has left us prey to our own demanding emotions and cognitions. Because it is only these values (such as the ability to delay gratification, or the strength to tolerate discomfort without the immediate need for relief) that have held us together throughout our torrid evolution as a species. Mental toughness and durability need practice like any other muscle or habit. If we are not exposed to them with relative frequency, then we have no hope whatsoever of overcoming them in the moment — whenever that moment comes.