Interview with lynn r. Webster, md
The Painful Truth
Lynn R. Webster, M.D.
Webster Media LLC (2015)
Reviewed by Susan Violante for Reader Views (08/15)
Article first published as Interview: Lynn R. Webster, MD – Author of ‘The Painful Truth’ on Blogcritics.
Lynn R. Webster, M.D., F.A.C.P.M., F.A.S.A.M., is an expert in the field of pain management. He is the vice president of Scientific Affairs of PRA Health Sciences and past president of the American Academy of Pain Medicine. Dr. Webster is a leading voice in trying to help physicians safely treat pain patients, by working within the industry to develop safer, more effective alternatives for pain and addiction. He is board certified in anesthesiology and pain medicine and is also certified in addiction medicine. Dr. Webster lectures extensively on the subject of preventing opioid abuse and has authored more than 300 scientific abstracts, manuscripts, and journal articles. His first book is titled Avoiding Opioid Abuse While Managing Pain: A Guide for Practitioners.
Dr. Webster is the developer of the Opioid Risk Tool (ORT), which is currently used and is the standard in multiple countries and thousands of clinics worldwide. He spends most of his time now developing safer and more effective therapies for chronic pain and campaigning for the safer use of medications.
He received his doctorate of medicine from the University of Nebraska and later completed his residency at the University of Utah Medical Center’s Department of Anesthesiology.
Sheri: Welcome, Dr. Webster, and thank you for being with us today. Why don’t you start by telling our readers a little bit about yourself?
Dr. Webster: Thank you for the opportunity to speak with you.
I grew up on a farm in Nebraska and attended a one-room schoolhouse through the 8th grade. I had one classmate for most of the years in the rural schoolhouse. Our school did not have indoor plumbing until I'd reached 7th grade. Our school was exactly like the one depicted in the television show, Little House On The Prairie. The only thing missing was Miss Beadle!
Our family was very close. There were four siblings: two girls, a brother, and me. Our paternal grandparents always lived with us, or we lived with them. That was how it was in those days. Keeping extended families under one roof was more economical and part of the agrarian culture.
My older sister was the first person to go to college from our clan, so that was a big deal. Later, when I was accepted to medical school, my parents and all of the extended family were very proud and treated me like a king. Of course, first and foremost, they respected the hard work I'd put into achieving my goals. They were never really "impressed" by me, but their support of me was my greatest motivator.
My grandfather was a stoic gentleman who unconditionally loved all of his grandchildren. I felt he gave me special attention. But of course, he didn't. That was just who he was, and he made all his grandchildren feel as if they were cherished. I always wanted to be like him.
The man I am today is rooted in my rural Midwest upbringing and the fact that I was a farm boy with a loving family.
You can see from my bio that I began my medical residency in anesthesiology 40 years ago. In the late 80's, I was among the first physicians in the country to recognize the need to help people in pain.
I began the journey that led me to where I am today by wanting others to know that some people -- those who are in pain -- are not as fortunate as others, but they are still heroes in the true sense of the word.
Sheri: I understand your first book, Avoiding Opioid Abuse While Managing Pain, is actually a guide for practitioners; tell us about The Painful Truth, seemingly a book for the “rest of us,” so to speak.
Dr. Webster: Yes, the first book was more of an academic book. I wanted to speak to my peers in the medical community with that book. Now, with the current book, I want to speak to everyone else.
The Painful Truth is about a problem that human beings have had since the dawn of time. Although they've had the most experience with it, they've understood it the least of all their problems. That problem is chronic pain.
As a physician who has treated thousands of patients and devoted my life to clinical research, I can tell you that this scarcity of understanding is at the root of our over-reliance on opioids, the spike in suicides, billions of dollars of economic loss and, to a good extent, the prescription drug epidemic.
I wrote the book so people without pain (temporarily, at least, since most of us eventually join the fraternity or love someone who does) could get to know people who live with pain. I want their stories to be known. Most importantly, I want people in pain to be seen and heard as family members, neighbors, colleagues, and friends. I want readers to empathize with them. When that happens, I believe we will begin to turn the corner in effectively addressing chronic pain. We will have enhanced our humanity to a stigmatized part of our society.
Sheri: Do you believe that there will indeed one day be a cure for chronic pain?
Dr. Webster: Pain is a symptom and a disease. Pain develops from other diseases, medical treatments, surgery, trauma, aging, and more. Drugs are in development that could be game changers for some of the causes of pain. I am working on the development of some of them.
Pain research is about 70 years behind cancer research. Many cancers, but not all of them, have been cured over the past 70 years. Life expectancy is almost 20 years longer today than it was a half century ago. Some of this is due to cures for cancer.
Just as with cancer, the longer we live, the more likely we'll be around to experience pain-related challenges. But just as we have enjoyed huge successes in other areas of medicine, I foresee major therapeutic breakthroughs in pain care within the next 10 years.
However, the success of new, effective therapies will be directly related to funding for research. If there is sufficient funding for research, millions of Americans who suffer from disabling pain, one day, will have therapies that could essentially cure their pain.
Sheri: How is research developing to that end?
Dr. Webster: Actually, I think our current opioid crisis is bringing attention to the lack of safe pain therapies. If the opioid crisis is to be reversed, we must solve the pain crisis.
This will require a massive approach that is commensurate with the Apollo project. We need a goal similar to landing on the moon.
There is no medical problem that affects more Americans than chronic pain. It should be a national priority. I do see considerable investment by Pharma in developing novel and exciting medications that should be available within the next 5-10 years.
Sheri: In the meantime, we have pain management, and while the benefits are certainly numerable, don’t some of the side effects often negate the healing process? I am referring to substance abuse specifically.
Dr. Webster: Pain management is not about opioids. This is a perceptional and clinical problem. Effective pain therapy minimizes the use of opioids.
Opioids should not be the mainstay of most pain control.
However, due to lack of insurance coverage for safer and more effective therapies, opioids have become the most common treatment for acute and chronic pain.
All treatments, whether they are pharmacologic or non-pharmacologic, have both benefits and side effects. All drugs have significant risks and should never be used if non-pharmacologic approaches would suffice.
Lack of treatment also has risks. Failure to treat pain increases the pain severity, comorbidities, and risk of suicide.
People in pain should always be offered the best treatment we have available, but they must also be told about the potential risks as well as the potential benefits. These benefits and risks are general and individualized. Each person has to understand the risks and then decide if he or she is willing to accept them. If not, the individual should decline that treatment option.
But declining a treatment may mean accepting life with pain. Of course, denying a treatment today doesn't preclude accepting the treatment tomorrow. The treatment just may not be as effective at a later date.
There is a lot to consider. I strongly recommend that patients find doctors with whom they can develop a mutually trusting relationship. Open and honest communication will result in the best outcome for patients.
Sheri: There is a certain stigma in being prescribed pain medication, and it seems that quite often it begins at the doctor’s office. Is there paranoia in the field that all patients requesting pain medication are addicted?
Dr. Webster: Yes, unfortunately, there is a stigma. But is not just about receiving an opioid prescription. It is also about having pain. It's about being different and not able to participate as a "normal" part of society. Stigmatizing patients with pain is disappointing behavior that I see in many members of our society, including some physicians.
About 100 years ago, we criminalized the use of opioids. This began the stereotyping of opioid addiction.
Unfortunately, people who became addicted were often poor and black. Opioid addiction was perceived as a behavioral flaw.
Our society was cruel to these people, and not many people seemed to care about the problem until opioid addictions infested the white suburban communities.
The stigma of poor people with addictions has become part of our psyche. We have created cultural memories and have taught the prejudices to our children for decades. Now it is hard to escape them.
Most people who are prescribed an opioid do fine even if they must take the drug for decades. However, some will begin a path of self-destruction with the first exposure. I share the stories of people who fall into that second category in my book. These are not bad people. These are simply people for whom opioids were the wrong choice for pain treatment.
We need to think about people with pain and addiction differently. They are not criminals nor should they be outcast. These are people with diseases who need our compassion.
Sheri: How do you help your patients deal with the stigma?
Dr. Webster: The key is to counter the negative with its opposite.
I think of children who bully classmates who seem different. It may be that their victims have a disability, a speech impediment, or obesity. You name it. Any difference can be an excuse for a fearful, unkind response. Like children, adults can be innocently cruel.
The cure for intolerance is acceptance.
As a parent, I gave my children love and reassurance. I still do. As a physician, I would offer my patients compassion and support. I listened and cared. That is my role as a physician.
Sheri: Our Managing Editor, Susan Violante said in her review of The Painful Truth that you did an amazing job taking the reader through the stages of pain, suffering, and treatment by presenting the firsthand accounts of your former patients. What inspired you to write the book in this format?
Dr. Webster: I wanted to give a voice to people in pain. Pain is an interloper. It's the uninvited guest that robs us of the life we desired.
Pain has such an enormous impact on families and relationships, and I wanted readers to understand that. I hope my book will make the general public aware of what is like to live in chronic pain and motivate them to support the needs of people with chronic pain. Most of all, I want people in pain to know they are not alone.
Sheri: What was your biggest challenge in writing The Painful Truth?
Dr. Webster: Telling the stories of my patients in such a way that my readers would be able to connect with them. I did not want to lecture or be pedantic. I wanted the book to be experiential -- to touch the heart, more than the mind, of the reader.
My biggest challenge in writing the book was to find ways to convey the meaning of these people's stories. I had to close the gap between the reader and the subjects of my book. I wanted to host an intimate family gathering without appearing to be remote or professorial.
Sheri: You are a very busy man, with your practice, the non-profit foundation, writing, lecturing, etc. Do you have any downtime, and what do you like to do with it?
Dr. Webster: Oh, yes, I'm busy. But I love what I do. I love working to make a difference in the world. I have been blessed to receive the training and opportunity to improve the lives of others.
But I also love spending time with my family. We host most holidays at our home. My wife and I love to entertain family and friends who seem like family to us.
I also love cinema. I try to see all the popular movies and many foreign films.
But reading and writing take up most of my time, and I love to do both.
Sheri: Is there anything else you would like to share with our readers today?
Dr. Webster: I have co-produced a documentary with the same title as my book: The Painful Truth. It will air on public television in early Fall 2016. The documentary addresses the political and medical barriers to accessing appropriate pain treatment. It is my hope that the book and the documentary will be seeds of a social movement that will lead to treating people in pain with dignity.
Sheri: Do you have a website or a blog (or both) where our readers can learn more about The Painful Truth and other works?
Dr. Webster: Yes, I have two websites. They both have blogs. The book website is ThePainfulTruthBook.com and my personal website is LynnWebsterMD.com. Follow me on twitter @LynnRWebsterMD and Facebook.com/DrLynnWebster
Sheri: Dr. Webster, thank you so much for being here today. It was a pleasure getting to know more about you and your work.