Until 1990, there existed in the US a world-class, absolutely brilliant system of treating chronic pain. The doctors who worked in these clinics knew that medication should only constitute a tiny part of comprehensive pain treatment that includes psychological, occupational, behavioral, etc components.
These clinics were finding it hard to survive, however. Insurance companies refused to cover anything but meds. And even when doctors managed to convince the insurers to pay for other things, patients clamored for an instant fix and resisted the clinics’ philosophy of individual responsibility for pain.
In the 1990s, an alternative kind of clinic started to spring up. Unscrupulous or downright criminal doctors would sell prescriptions for opioids to anybody who asked for them. It took less than 3 minutes for a patient to see a doctor and leave with a bottle of pills. That these patients started to become horribly addicted, switching to heroin and dying of overdoses interested nobody.
And the comprehensive clinics that offered non-opioid treatment all closed down for lack of demand.
Today, even mentioning that chronic pain doesn’t need to be treated with meds makes people angry. (See my previous posts on the subject.) And even just 25 years ago it was an entirely mainstream medical approach.
Clarissa's Blog 
How do you know about those former clinics’ rates of success, if you arrived to USA long afterwards?
Would love to hear more what exactly is meant by “psychological, occupational, behavioral, etc components”. Learning to ignore pain somehow?
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I’m reading a book about it. It’s fascinating. I will post a review when I’m done. This was just a small snippet.
Talk therapy, yoga, meditation, swimming, relaxation techniques, massage, breathing exercises, group therapy, couples therapy- there are so many things that can be done. But none of them brings instant results and all require patients to make an effort.
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I suspect a lot of pain results from people who are in poor physical shape injuring themselves, with their lack of exercise poor physical shape inhibiting their recovery from such injury. Any kind of fitness makes sense for pain reduction – body building weight training, swimming, yoga perhaps. Fitness is good even if you don’t experience pain.
However, the other stuff – talk therapy, group therapy, etc. sounds like ooga booga to me. I don’t see how this stuff can reduce physical pain.
I just finished the book “Dreamland”. The gist I get from this book is that a lot of people on pain meds are actually looking to get high or feel good. Apparently opiates produce a euphoric state in some people. In other words, the pain med crisis may be nothing more than an old-fashioned recreational drug use. “Dreamland” seems to imply this.
If someone does experience real pain, this is obviously caused by an underlying medical condition. Medical professionals need to determine and treat the underlying condition, not just pass out pain meds which does nothing to solve the underlying condition. “Dreamland” depicts many of these pain clinics as nothing more than legal drug dealing.
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Great catching! Dreamland is precisely the book I’m reading.
I love how my readers always can reference books on the spot.
We rule.
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What’s the book called?
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Dreamland.
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Yes, please post the title of the book. My husband is recovering from a major surgery and dealing with intense pain that he will possibly last for about a year or more. I am not sure if this falls under the category of chronic pain but it would really help to know that the only way to deal with pain is not just to take more meds. And yes, I do find doctors prescribing pain meds as a way to keep their approval ratings high. It’s very disconcerting.
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I’m skeptical that there ever was a time when integrated pain management was the way Americans treated pain. There may have been clinics here and there that did it and that shut down when opiates became easier to obtain, but the U.S. does not embrace “ooga booga” treatments.
It’s too bad that non-pill treatments are ignored because people in pain could use some psychological help. If nothing else, counselors can help people figure out how to reduce how much pain interferes with doing what they want to do.
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It wasn’t prevalent, of course, but it was wide-spread. There was over a thousand such clinics as late as 1998. In just 6 years, only 85 remained. This is evidence of a massive cultural shift.
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Given all the concern about addiction to pain killers, they seem to be very easy to get. I had a minor accident a few weeks back and broke a toe. I went to the ER, had an X-ray, and left with some tape around my toe and a huge bottle of hydrocodone. I didn’t ask for pain meds and I certainly didn’t need anything as strong as what they gave me. They knocked me out for hours at a time and I wound up taking just two of them before I had had enough. After that I just decided to keep my foot propped up as much as possible. I didn’t even take aspirin or Tylenol for the pain and I did just fine.
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