A Better Approach

“Build a Better Painkiller” (Winter 2017) nicely summarizes existing and emerging options for pharmacologically based chronic pain treatments. A pivotal argument within the article is that a superior drug is needed to relieve pain as well as or better than opioids do, without being addictive.

At first it seems hard to argue with this statement. But opioids, while excellent for acute pain relief, don’t have strong efficacy for relief in many chronic pain conditions, which the article acknowledges. Therefore, the implication that opioids are the best treatment in our current arsenal for chronic pain should be questioned.

In 2016, the Department of Health and Human Services released its National Pain Strategy to serve as a blueprint for how pain should be addressed, and a multimodal approach to chronic pain management was recommended. Alternatives to opioids can include a better drug, but should also include non-pharmacological biomedical approaches (e.g., ioral and psychosocial therapies (e.g., exercise, dietary methods and self-management).

David Williams // President, American Pain Society, Ann Arbor, Mich.

The Stigma of Suicide

“Lost in the Middle” (Winter 2017) covers the new epidemiology of suicide, and I agree with the focus placed on the social and economic, rather than psychological, causes of rising suicide rates among the middle-aged.

Part of what we may be witnessing is a generational shift in how Americans view suicide. Attaching less stigma to suicide today than we did in the mid-20th century might translate into higher suicide rates. Indeed, there is evidence that each age cohort since the baby boomers has been experiencing higher rates of suicide as they reach middle age.

General Social Survey data show that regions of the United States where survey respondents report greater tolerance (i.e., the least stigma) for suicide have higher suicide rates. The region with the greatest tolerance is America’s suicide belt, states in the intermountain West where suicide rates are roughly 60% higher. If this spatial association between less stigma and increased rates also holds true for the boomer generation, we may have found another piece of this very complex puzzle.

Matt Wray // Associate Professor, Department of Sociology, Temple University, Philadelphia