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Michael Jackson, King of Pain?

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Details about Michael Jackson's passing are still fuzzy, but already people are drawing conclusions about the superstar's premature demise. One media thread has him using prescription medications in what may have been a troubling way http://www.huffingtonpost.com/2009/06/25/michael-jackson-prescript_n_221178.html, railing http://www.huffingtonpost.com/deepak-chopra/a-tribute-to-my-friend-mi_b_221268.html against the so-called "enablers" who made sure he had access to them.

Whether he had an addiction to prescription medications will, I suppose, come out in time. As storm clouds gather around the early, tragic end to what was surely one of his generation's most eccentric and gifted performers, I worry that the halo of celebrity will blind us to a problem bigger than whatever issues Michael Jackson may or may not have had with drugs. That problem is the plight of people in pain who use prescription pain medications for legitimate medical reasons.

I should disclose, before I go any further, that I am a consultant in the pharmaceutical industry, specifically to Purdue Pharma, the manufacturers of OxyContin. In an early, executive capacity for that company I became aware of the sad and inappropriate prejudices against people who use pain medications--opioid analgesics in particular--and the doctors who prescribe them. 20 years ago, I watched my dear late uncle, Arthur Master suffer unimaginable pain before finally succumbing to metastatic prostate cancer. I watched him bravely battle his pain, but when I asked his caregivers to prescribe more medicine, they declined. When I pressed, they said more might addict him. At that time I was unaware of the differences between addiction and physiological dependence, but even without special medical knowledge it was obvious my uncle would never leave the hospital and so the point was moot.

In the years leading up to 2004, still plagued by the injustice of lumping people whose intractable medical suffering together with drug abusers and addicts, I wrote my book The Truth About Chronic Pain, http://www.arthurrosenfeld.com/ArthurRosenfeld-TheTruthAboutChronicPain.html. It became a bestselling resource to patients and caregivers alike. Researching that book gave me a visceral understanding of the issues of pain and pain relief, and led me to understand the magnitude of the problem. Millions of Americans live in pain today. They are grandmothers with arthritis, 20-somethings who survive car accidents, your cousin whose toolbox fell on his hand, you waking up from surgery. They are our neighbors and family and friends. Succinctly put; pain patients are us.

Was Michael Jackson in pain? It is a matter of record that he had a high-pressure, perhaps abusive childhood. It is a matter of record that he suffered fears, obsessions and paranoia. Was his pain the sort of angst that leads some people to escape to from the world by abusing prescription medicines or street drugs? I cannot pretend to know. Did he suffer from a genetic predisposition to substance abuse? I haven't a clue. Did his doctor or doctors prescribe the proper doses of the proper medications in the proper combinations to treat whatever injuries or afflictions he may have had? I am not privy to that information either. Frankly I would never presume to judge another person's experience of life, their pain or their suffering or their choices. Judgments like that lead to the prejudices that plague our world.

What I can say with some regrettable confidence, however, is that if it turns out that prescription medications are in some way linked to his death, Michael Jackson's larger-than-life footprint will posthumously obscure the silent, tragic lives of millions of pain patients who make smaller, but no less important marks in the sand. I worry that instead of leaving a joyous, luminous legacy, the "Thriller's" end will bring more difficulties, more misunderstanding and more difficulties to the pain patients when they go to their doctor with a complaint or their pharmacy for a much-needed refill.

If such a maelstrom emerges over the next few weeks, please don't forget the intimacy of pain and the way it cuts through all stages and stations of life. Be compassionate. Don't join the nodding throngs who pass judgment on the suffering of others. Join me in mourning the loss of a musical genius instead. Crank up an MJ tune, and be happy that your body doesn't hurt too much to let you dance.

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