From Ivanhoe Broadcast News 30 Jan 97
by Jim Brown, Ph.D. Executive Editor, Penn State Sports Medicine Newsletter ŠIvanhoe Broadcast News, Inc. 1997
"Every year, thousands of people suffer needlessly and many commit suicide because they cannot get treatment for pain," says Dr. Dennis C. Doherty, a board certified pain specialist and anesthesiologist who directs Interventional Pain Management at Workplace Medical Solutions in Atlanta. "Between 33% and 70% of those who die do so in pain, and that is unnecessary."
Doherty is on a panel of the American Society of Addiction Medicine that is redefining addiction in relation to the need for medication. "We are trying to establish reasonable policies for offering a compassionate avenue to those who suffer from chronic, hard-to-manage pain. The premise that patients should 'just have to suffer' is absurd. In some cases, the use of opiates for intractable pain is suitable and humane."
"Methadone, developed in the 1960s for chronic pain, is a good example of an opiate that is under-prescribed," states Doherty. "It is an inexpensive narcotic medication that is very effective, allows the patient to maintain psychomotor skills, and doesn't cause a high. Yet, physicians are reluctant to prescribe it and patients (and their families) are afraid to request it."
There are both medical and political obstacles to the use of opium-based drugs for the treatment of pain. "First, there is a lack of education among physicians, patients, legislators, and regulators," explains Doherty. "There are at least three myths regarding the use of opiates to treat pain. First, it is not true that using opiates for medical purposes makes the patient less important to society. Second, using opiates does not automatically cause addiction. Many patients are mislabeled as addicts because they take or even become dependent on pain medication. Finally, the practitioner should not be labeled as 'inappropriately prescribing' medications simply because that person prescribes an opiate."
A lack of communication exists between patients and caregivers. Many patients under-report pain and many physicians and other health care providers underestimate pain. Because of the lack of education and understanding in the medical community, there is a shortage of medications that could reduce patients' suffering. The result of all these problems is millions of people with chronic pain who suffer a loss of function and self-esteem.
Government agencies are beginning to recognizing the devastating consequences of chronic pain and are starting to do something about it. The Drug Enforcement Agency, as well as states such as North Carolina, California, and Texas, have rewritten their policies and laws regarding prescription opiates to reinforce their positions of not interfering with the management of pain. More than 600 health professionals (including physicians, pharmacists, social workers, and psychologists) convened recently in New York in what has been described as "a turning point in the fight against untreated pain."
Doherty recently met with Gen. Barry McCaffrey, White House Director of National Drug Control Policy, to discuss pain management vs. addiction. He came away from the meeting impressed with McCaffrey's awareness that addiction treatment programs and management of chronic pain are completely separate issues.
"Patients must seek care from those best trained in pain management or who are at least current on the complexities of the problem," concludes Doherty. "They also have to understand that caregivers must abide by local and federal regulations. The solution depends on pain specialists and addiction specialists coming together to address the appropriate use of opiates. As the public is made more aware of its alternatives, the barriers to treatment for pain will fall."
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