Lynn R. Webster, MD

Tinseltown does not generally have much in common with medicine, but the big screens will occasionally reflect what is happening in society.

It’s been more than two decades since Tom Hanks won his first Best Actor Oscar award for his role in “Philadelphia,” a movie that contributed to a national social movement to better the lives of people who are HIV-positive. As a medical director of an ambulatory surgery center at that time, I recall the executive director of the facility telling me that we were not equipped to accept people with AIDS and to steer them to a nearby hospital. This type of fear fueled prejudices and discrimination for years until “Philadelphia” and icons like Magic Johnson helped change the discussion. The commitment to research and treatment that followed has culminated in an HIV-positive diagnosis no longer equating to a death sentence. It was a timely movie for the country.

Today, we have another epidemic that has degraded the lives of a huge swath of our society and another movie portraying how people suffer because of it. Jennifer Aniston did not receive an Oscar—lacking even a nomination—for her performance in “Cake,” a movie about living with chronic pain. As a physician who has treated people suffering with chronic pain and addiction for 30 years, I can attest that Aniston did a stellar job as Claire; her behavior and appearance ringing true of a person in severe chronic pain. In my opinion, she deserved recognition.

However, “Cake” is no “Philadelphia,” and is unlikely to spur the same sort of social movement for change.

I saw “Cake” on opening night at 7 p.m. It was prime time and there were only 24 people in the 300-seat auditorium in my hometown of Salt Lake City. Granted, the Sundance Film Festival was in town, perhaps pulling potential attendees away, but I feared that the low interest mirrored the public’s lack of interest in the topic of chronic pain.

This is unfortunate, because few people realize that the Institute of Medicine has documented 100 million Americans with chronic pain—more than heart disease, cancer and diabetes combined. And the subset of people in pain who benefit from pharmacologic treatment are often stigmatized like people with AIDS were in an earlier era. They are dismissed as malingerers or mistakenly judged to be addicted—even labeled as lowlifes. The difficulty is that there is currently no cure for most severe chronic pain. Furthermore, opioid analgesics are too often the primary treatment, a reality that has contributed to an epidemic of prescription drug abuse. The time is right for a movie that could highlight some of these issues.

The movie’s primary lack is the context of the bigger story. As it stands, there is little portrayal of the heroism of people who struggle daily with pain, their dignity routinely assaulted by family members and doctors who don’t believe them, friends who abandon them, and public and private insurance policies that will not pay for the interdisciplinary care encompassing medical, physical and behavioral therapies that could help them.

Nevertheless, “Cake” did have its strengths. Claire’s alcohol use, pill overuse and eventual overdose were, unfortunately, accurately portrayed and far too typical of many people in severe pain. My interpretation is that Claire was trying to get relief from pain, not get high. Her depression and frustration led her to take more medications than prescribed because she thought it was necessary to stop the pain. This “mental defeat”¹ is what some researchers describe as the predictor of suicides or unintentional overdose deaths in people with chronic pain. There are more than 16,000 deaths per year involving prescription opioids, according to the Centers for Disease Control and Prevention (CDC), many of which occurred in people in pain.

“Cake” also gets right the link between chronic pain and suicide: half of people with chronic pain consider suicide.² Claire’s preoccupation with it was frighteningly accurate. The CDC reports that about 40,000 deaths per year are suicides.

Despite its shortcomings, “Cake” is the first movie to attempt to truly tell the story of people with chronic pain and should be applauded for the effort. “Cake” may not go down in movie history as a cultural touchstone or elevate society’s awareness of the plight of people with chronic pain. However, Aniston’s Oscar-worthy performance should at least generate discussion about the country’s most prevalent public health problem and the thousands of tragedies that occur due to pain.

A version of this editorial previously appeared in the Sun Sentinel on Feb. 10, 2015.

References

1. Teng NK, Goodchild CE, Hester J, et al. Mental defeat is linked to interference distress and disability in chronic pain. Pain. 2010;149(3):547-554.
2. Hitchcock LS, Ferrell BR, McCaffery M. The experience of chronic nonmalignant pain. J Pain Symptom Manage. 1994;9(5):312-318.

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Lynn Webster, MD, is the immediate past president of the American Academy of Pain Medicine and Vice President of Scientific Affairs at PRA Health Sciences. He is a Pain Medicine News editorial board member. He is the author of a forthcoming book, “The Painful Truth.” Visit his blog at www.lynnwebstermd.com/ blog and follow him on Twitter @LynnRWebsterMD. He lives in Salt Lake City.

Original article: http://bit.ly/1H8hGzy