The marginalization of chronic pain patients on chronic opioid therapy.

The realities of treating chronic pain do not reflect the attention that marginalization of patients taking opioids has received. Physicians continue the same prejudices and biases that were present decades ago. One theory proposed to explain this poor treatment has been titled, the "barriers to pain management." The barriers are not treated as moral issues, but rather as clinical aberrations and do not explain continued poor treatment. However, the barriers do not explain certain types of cases where there appears to be specific unfounded concerns related to a specific class of medications, e.g, opioids. Four cases are presented, from the authors experience, illustrating the marginalization of chronic pain patients on chronic opioid therapy admitted to a tertiary care hospital. These types of cases have not been presented in the literature previously and illustrate the failure of the barriers to explain marginalization. In each of these cases mental status changes was the presenting problem. However, in each of these cases, these changes were not related to their opioids, but were explained by clear reasons, other than opioids. Regardless, in each case, the attending physician blamed the opioids, without further workup and stopped them reflexively. It is proposed that there may be more complex psychosocial issues involved in the marginalization of chronic pain patients. This case series illustrates a ubiquitous problem demanding further examination and discussion. It is hoped that this case series will create interest in further research in this area.