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Friday, January 23, 2015

Will accurately portraying life with chronic pain be a piece of Cake?

Lemon Cake Inspired By Thiebaut by DarisArt

My friends living with chronic pain and fibromyalgia are all a buzz about a new film called Cake.

According to Variety.com, the movie tells the story of Claire Simmons (played by Jennifer Aniston) who struggles with both chronic pain and a painkiller addiction.  It addresses the issues of suicide, grief and separation with a "darkly amusing" combination of humor and drama.

The story begins with the suicide of Nina, a member of the chronic pain support group that Claire attends.  After her death, Claire gets obsessed with Nina and starts an affair with Nina's husband (Sam Worthington.)  The story features Claire's support group leader (Felicity Huffman), housekeeper and physical therapist, as well as her husband.

Another article at Variety.com focuses on the fact that Jennifer Aniston doesn't wear make-up for this role.   According to the film's director Daniel Barnz, this is to show that Claire doesn't take care of herself.

A lot of my friends are sure are excited about someone with chronic pain being the main character of a movie.  The hope is that this character will somehow validate all our pain experiences to the doubters and disbelievers in our lives. I haven't seen this movie yet.  Neither have any of my chronic friends.  But we'll get our chance when the movie opens wide today in the USA (after a limited release in December 2014.) 

I do have some thoughts about all the press this movie is getting and all of the comments it has generated over on the Variety.com website.

First, I am concerned that Variety review says this movie is "...falling back on one of the hoariest and most overused of movie cliches..." and "...this manipulatively layered “Cake” probably won’t rise to the occasion..."  Ouch!

Second, while I guess being an actress and forgoing make-up for a role is some kind of Hollywood accomplishment, I think the explanation for why Claire doesn't wear make-up -- because she doesn't take care of herself -- is a little one-dimensional.  After all, I live with chronic pain and don't wear make-up, not because I don't take care of myself, but because I choose to forgo makeup and use my energy for other things I think are more important, like cooking or going to a doctor's appointment.  Which begs the question: does this movie really explain what it is like to live with chronic pain or does it just stereotype this condition?

Third, I am really concerned about how the story paints the picture of  Claire, the painkiller addicted chronic pain patient, because the fact is addiction is not common among chronic pain patients.  According to an evidence-based review of all available prior studies published in the medical journal Pain Medicine in 2008:
"...chronic opioid analgesic therapy exposure will lead to abuse/addiction in a small percentage of chronic pain patients..."  

Specifically, the risk for abuse and/or addiction was found to be on average about 3.27%.  They found that the greatest predictor of pain medication abuse or addiction was a current or past history of alcohol and/or illicit drug use, abuse or addiction.  Their recommendation? Pre-screening patients for these problems before prescribing opioid analgesic therapy.

Given all the changes that happened in 2014 with tightening access to narcotic pain medications, I'm afraid Cake is just going to be a visual aid for the public, feeding misconceptions about painkiller abuse.

Even healthcare professional have misconceptions about the proper use of narcotic pain medications to treat chronic pain.  Just this week, a prominent doctor in the field of fibromyalgia and chronic fatigue proclaimed, "You'll be pain free, because you'll be dead. Taking opioids for chronic, non-cancer pain increases your risk of death by 72%, according to a recent study in the journal Pain..."

I read a summary of that journal article and found it full of contradictory information.  For example, some researchers think that it's only the patients who obtain their narcotic pain medications from "nonmedical sources," like Claire in Cake, that overdose and wind up in the ER.  Then there is this quote (which I edited just a tiny bit for clarity):
"Safe and effective treatment of opioid-sensitive pain is possible... It requires deep pharmacological knowledge, experience, resources, considerable patience, and mental energy from a group of helpers who are able to take care of the whole bio-psycho-social conundrum of the chronic pain patient."  

That sounds exactly like what happens in my pain management doctor's office.  Hmm, too bad Claire didn't come and see my doctor.

But then again, someone treating their chronic pain appropriately with narcotic pain medications probably isn't the most interesting or provocative subject for a major motion picture, is it?  Hollywood loves misfits, even chronically ill ones.

Watch the trailer for Cake.


My most heartfelt advice for those who live with chronic pain and decide to go see Cake?  Don't get your hopes up thinking it will appropriately portray or advocate for the needs of people living with chronic pain.  Oh, and take it with a whole shaker of salt!

Until next time...


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1 comment

Kelli Williams Karnish said...

Great read, Selena! I indeed have been hearing SO much chatter and excitement around this movie within my chronic pain circles. Thank you for putting together some facts to possibly help temper the excitement of those that may very likely be hurt/disappointed by the true focus of the movie.