Is There Anyone Out There?

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That question has been with me for more than a year. I didn’t know whether anyone was reading the editorials. The last editorial, “Out of the Opioid Fog: A Personal Perspective” (Willens, 2006), was written to share my personal perspective of taking opioids and experiencing severe pain. It is embarrassing to be certified in pain management and be unable to manage my own pain. I never had such a foggy feeling after taking opioids, and it surprised me.

After the editorial was published, I quickly learned that people do pay attention to the editorials. Margo McCaffery and Chris Pasero read it and quickly voiced concern. This is my mea culpa. I assumed, apparently incorrectly, that editorials are not considered published research. I do understand that research is based on averages. Although Margo and Chris’ comments and reference to the research literature are appreciated, I must be an outlier because I definitely felt unsafe to drive. In a review article (Fishbain, Cutler, Rosomoff, & Rosomoff, 2003) it was noted that there was some impairment in some people who were taking opioids long term.

Margo and Chris present a very interesting question in their letter to the editor: What are the effects of pain on driving? Ethically, the study could only be conducted in a laboratory setting or a large area with no traffic and a car that could be “overtaken” by a person who was not under the influence of opioids. There is no way to know whether the bench research findings could be translated into clinical practice.

Personally, I felt unsafe to drive: unsafe for myself and other drivers. The five questions that ended the editorial were included in the hope of making the reader think about these issues, and perhaps those who treat patients with chronic pain would inquire about their patients’ level of functioning and thoughts on safety.

I thank Margo and Chris for writing a letter to the editor. Many of us are very grateful to them. They are excellent mentors, authors, practitioners, and entrepreneurs. Without their work, interests, and passion for pain management, we would not be practicing at the level we are now. Thank you for being out there.

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References 

1. Fishbain DA, Cutler B, Rosomoff HL, Rosomoff RS. Are opioid-dependent/tolerant patients impaired in driving related skills? (A structured evidence-based review). Journal of Pain and Symptom Management. 2003;25(6):559–577
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2. Willens JS. Out of the opioid fog: a personal perspective. Pain Management Nursing. 2006;7(3):79
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