Every minority claims to be misunderstood, but people with chronic pain have a particularly legitimate beef. If you need proof, tell a joke about fibromyalgia at your next dinner party. When my husband did that, regaling dinner guests with a (true) story about a coworker who had the condition and asked the company for an $800 ergonomic chair, people couldn’t get their witty quips (“Oh, and I require a foot massage while I work!”) in fast enough.
Claire (Jennifer Aniston), the protagonist of the new movie Cake, doesn’t have fibromyalgia, but she does suffer from chronic pain. From the beginning of the film, it’s clear that there’s nothing to giggle about here. Claire’s face (and, we later find out, her body) is littered with scars, and every movement she makes—even changing positions in bed—causes her excruciating pain. Not only can’t she drive, but she needs to be in a completely prostrate position in the passenger seat when her housekeeper, Silvana (Adriana Barraza), drives her to her various appointments. Aniston portrays the pain with such conviction that by the time she’s asked to put a vodka bottle down on the floor, the act feels as impossible for Claire as moving a car would be for the rest of us.
Equally clear is Claire’s psychic pain. Aniston portrays this so well that we feel her heartbreak even though we don’t discover the cause of it until halfway through the movie. Though we don’t know the reason for her emotional state, we understand the extent of it not only because of red flag behaviors—like becoming obsessed with the suicide of a fellow member of her chronic pain support group and her subsequent obsession with the woman’s husband left behind—but because of what can only be described as her overall sadness. That her feelings of hopelessness may be connected to her unabating physical pain becomes apparent when Claire’s physical therapist notes with exasperation that Claire has made no progress in six months of therapy.
Like many pain patients, Claire also suffers from painkiller addiction. We see her charm a nurse-practitioner into writing her a prescription for Percocet and oxycodone despite the lack of authorization. She keeps a secret stash of pills, pops them constantly, and even has her housekeeper drive her to Tijuana to a pharmacy that routinely dispenses these powerful meds without a prescription.
The movie does a tremendous job of portraying all of this, which is especially important as we battle a national opioid addiction and overdose epidemic in which “people like Claire are the most underrepresented group in treatment—but are overrepresented in overdose deaths,” says Andrew Kolodny, M.D., Chief Medical Officer of Phoenix House and Director of Physicians for Responsible Opioid Prescribing. According to Dr. Kolodny, there are two groups of people with painkiller addictions. The first is made up mostly of young people who get a prescription for painkillers following a medical experience like wisdom tooth removal or a sports injury, find that they like the effect, keep taking the pills, and develop an addiction. This story commonly ends a little differently from Claire’s. The addictions of people in this category lead them not to Tijuana to purchase pills without a prescription, but to the streets of their hometown, where they purchase heroin (which produces an effect on the brain that’s indistinguishable from that of prescription opioid painkillers) on the black market.
The other group is made up mostly of people 45 and older. The people in this group, like Claire, typically become addicted through chronic pain treatment. Unlike Claire, however, they usually have what is referred to as “central pain” for which doctors can’t find anything objectively wrong with them, and so they have the added stress of having others think the pain they are experiencing isn’t real. But regardless of the root of the pain, the largest increase in opioid overdose deaths has occurred to those ages 45-54. Clearly, this is a group that we shouldn’t ignore, and Cake is shining a much-needed spotlight on the demographic.
That’s great, of course. But what would be even better is if the movie also shined a spotlight—or even a small pocket flashlight—on the need for this demographic to seek treatment. We see Claire “detox,” but she is then sent home, left in the same position she was in before she overdosed, with the same problems that led to her painkiller addiction in the first place. She’s clearly in need of substance abuse treatment, but she also needs to address the psychological trauma she’s endured and the physical pain she constantly battles. In short, she needs treatment that treats the whole person; and as a nation, we need to start making such treatment widely and readily available.
The point of this blog isn’t to give a movie review, but if you want one, here it is: Cake gives us a convincing portrayal of chronic pain and painkiller addiction. Jennifer Aniston’s portrayal of Claire is heartbreaking, and there won’t be a dry eye in the theater by the end of the movie. Really, go see it. At the very least, you’ll never tell another fibromyalgia joke again.