On Chronic Pain and the “Opioid Crisis” – A Disability Issue

October 19, 2018 | Eiryn Griest Schwartzman, 2018 AAPD Summer Intern

Pain is a universal human experience, felt by some more than others. Similarly to disability, it can begin at any time in life, whether it exists acutely or grows into chronic pain. According to the Institute of Medicine, chronic pain is a reality for over 100 million Americans. For more than a quarter of my life, at 21 years old, I have lived with severe, unrelenting pain. I no longer remember how it feels to live without it. Nearly every conventional treatment failed me. I’ve received every kind of unsolicited medical advice. I’ve been there, tried that, and still score a seven on the pain scale at best. My pain has become both personal and political.

Pain is full of complexities. It can be felt in every system of the body. Different qualities of pain present different challenges to seeking relief. A single approach to pain management cannot reasonably treat and accommodate the diversity of pain people experience. Yet, the 2015 CDC guidelines have effectively codified a one-size-fits-all strategy for pain care in the U.S. While its intention was to recommend limitations on opioid prescribing, it has instead instilled fear in healthcare systems, preventing doctors from tailoring treatment to individual’s needs. Above all, the guidelines inspired a slew of policy proposals that are damaging to disability rights, violating our autonomy and threatening our independence.

Chronic pain patients and people with substance use disorders (SUD) are all members of the disability community and we must protect their rights jointly. We must acknowledge that one can live with both mental and physical pain and no one source of pain negates the validity of another. The crisis our country faces is in navigating SUD treatment, drug safety, pain care, and the obligation to “do no harm” are complex issues that cannot be met with a singular solution.

So policymakers:

When you endorse limiting the supply of a medication, I hope you realize pain will still persist, and people will turn to less safe means to manage it.

When you suggest massage and physical therapy as alternatives to prescription medications, I hope you advocate for coverage of Home and Community Based Services so we can access pain treatment on the days we cannot leave our beds.

When you suggest residential rehab as the main addictions treatment to invest in, I hope you try to understand the harm done in institutions to those of us who are multiply disabled and marginalized. I hope you consider that these programs are not accessible to all.

When you insist on limiting access to opioids for people who take certain psychiatric medications, I hope you appreciate how impossible a decision it is to choose between treating your mental and physical health.

When you imply that only terminal illnesses warrant pain care, I hope you realize untreated pain can cost us our lives even if the cause itself is not inherently fatal.

When you propose “pain acceptance” as an alternative to legitimate treatment, I hope you realize that permanent trauma results from such medical neglect.

I need you to recognize that adequate pain care is not optional: it is vital to live and to thrive.

For more information on chronic pain and opioid issues in the disability community, please visit http://ncil.org/cpo.


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Eiryn Griest Schwartzman is a 2018 AAPD Summer Intern. Eiryn interned at the Equal Rights Center.

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