As a chronic pain patient, I believe that people with severe pain should receive appropriate, effective and adequate pain relief, including opiates (narcotics) if that is what is required; and that this assistance, which is generally given to terminal patients, should not be denied to those who may live many years with their pain and the illness that causes it.
See also Managing our chronic pain - information on
medications and living with pain;
More about pain - how pain works;
Chronic pain websites to visit for information
and support.
Dr.
Hurwitz, age 60, is serving a 25-year sentence in prison.
(March 2006) "Several of his patients testified at trial that he had
relieved them of crippling pain that other doctors refused to treat." "A
mere suspicion that a patient might be diverting is now apparently enough to
make a doctor a conspirator in a drug-dealing scheme,” commented AAPS
Public Affairs Counsel Kathryn Serkes"
'Good
Faith' at Issue in Pain Doctor's Appeal
"... a federal judge sentenced Virginia pain management doctor, William Hurwitz, M.D. to four 25-year sentences, forty-six 15-year sentences, and more than $1 million in fines for prescribing legal painkillers in a northern Virginia courtroom on Thursday, April 14. The sentences are to run concurrently, so Dr. Hurwitz will be eligible for release at age 84. Several of Dr. Hurwitz’s patients had pleaded for leniency, tearfully explaining how they were alive today because of his compassionate, thorough care." http://www.aapsonline.org/nod/newsofday161.htm April 2005.
Healers and Dealers - by Jacob Sullum from ReasonOnline, November 19, 2004 "Prosecuting doctors for their patients' misuse of narcotics hurts people in pain" - why Dr William Hurwitz faces a life sentence.
Pain Control in The Police State of Medicine, Part II - Dr William Hurwitz, the persecuted pain doctor, explains why he has decided to stop practicing medicine in the USA. Journal of American Physicians and Surgeons, Spring 2003. See also: The Police State of Medicine Part I, (1997-8) ... and this page of links to news and information about Dr Hurwitz's trial on drug-dealing charges.
A World of Pain - transcript of ABC (Australia) Radio National documentary about chronic pain treatment (5 December 2004). Helen Thomas interviews pain patients, doctors and researchers about attitudes to opiate drugs: " ... doctors worry about prescribing them, patients fret about taking them, and we all buy into the stigma that surrounds them. The end result is a widespread lack of pain relief, an under-management of pain that some describe as a national crisis." Features quotes from one of the webmasters of this site, and also Ricky.
Prisoners
of Pain - by Barry Yeoman. AARP magazine, Sept/Oct 2005. Why are millions
of suffering Americans being denied the prescription drug relief they need?
Hamalainen waited quietly as nurses wandered in and out of the
examination room, taking her vital signs. Finally, she lost it. "My pain
is real," she said frantically to one of the nurses. "I need relief.
Why does he keep refusing to talk to me about it? What do I have to do?"
The nurse turned to her conspiratorially and lowered her voice.
"I should not tell you this," she said. "But he doesn't want
to treat your pain because the treatment that works is opioids, and he's afraid
to prescribe them."
Chronic Pain and Fibromyalgia: Trapped In A World Of Hurt: 50 Million Americans Have Chronic Pain, And So Far Doctors Can't Offer Much Relief - by William Hathaway, on the ImmuneSupport.com website. "Medical schools do little to teach doctors how to deal with patients in chronic pain ..."
The use of oral opioids in patients with chronic non-malignant pain - by Paul Graziotti and Roger Goucke, Australian Pain Society. "... many doctors may decide not to prescribe opioids for patients with chronic non-malignant pain ... Worldwide though there is a growing body of opinion that a small sub-group of patients with with chronic non-malignant pain may improve their level of function whilst achieiving improved analgesia in the absence of rapidly escalating doses and/or behaviour."
Making gains on chronic pain - Medical Journal of Australia press release dated 5 January 2003 about the poor treatment of pain among nursing home residents in rural NSW. A survey has shown that older people are suffering pain unnecessarily and too many of them are being offered no pain relief medications at all.
The Politics of Pain - The controversy surrounding Chronic Pain and Opioids (2002) "Anyone who lives with chronic pain is acutely aware of many physicians’ difficulty in coming to terms with prescribing adequate pain medication. For us, this is more than a research or academic issue. We know first hand that pain is debilitating and can erode our standard of living and ability to earn an income. ... We live in an era where our right to adequate pain relief is recognized but continuously challenged." Anne-Marie Vidal reviews recent events.
Judy Hall's letter to Congress - "Judy wrote this letter about the ‘Pain Patient Crisis’ and sent it to the women of the Congress and Senate in August 2001, hoping to enlist their help for the cause. Unfortunately - probably because of the tragic events of September 11th - it seems those in Washington put it aside or didn't read it. Not long after mailing her letter, in November 2001, Judy found that she couldn’t live with her pain any longer…and took her own life."
Oxycontin Problem - not that complicated - Terri Robert of Headaches About.com discusses recent developments and introduces an article from MAGNUM, the National Migraine Association's magazine (March 2002). "The OxyContin issue has produced an aggressive public health policy that would limit access to those in pain from receiving appropriate pain management. Furthermore, discussions at recent hearings could lead to very tight control over what pain medications doctors may prescribe in general. Doctors may chose not to treat those in debilitating pain for fear of being profiled and/or targeted by law enforcement or other monitoring state or federal agencies."
No Relief by Damien Cave, from Salon Magazine. "Increasing numbers of the estimated 30 to 50 million people in the country who suffer from some form of chronic pain say the OxyContin crackdown means they can no longer get adequate or sustained relief."
Politics of Heroin - transcript of the ABC's Four Corners TV broadcast, 1 April 2002. Read how Howard put the Salvation Army in charge of the war against drugs, and opposed an Australian prescription heroin trial.
Medical uses of cannabis - links from Australian ABC website which on 25 March 2002 broadcast a Four Corners report on the topic, including the use of cannabis for chronic pain.
Is this the AIYH backlash? The pitfalls of opiates for chronic non-malignant pain - "Self-efficacy and dependence on drugs for pain are opposite therapeutic objectives" says Dr Stephen Gelfand, arguing that too many people are getting opiate pain relief, and doctors are paying insufficient attention to "psychosocial factors": "As a result of an organized educational and marketing campaign by the manufacturer of OxyContin and a number of pain societies, the message has spread that pain is often undertreated in general and that opioids are safe in most instances and should be prescribed more often for chronic pain of all types ... Because chronic widespread pain and psychological distress in the general population are closely associated, the indications for treatment with opioids have been expanded to patients with chronic pain of central affective origin, including ... fibromyalgia" - from Medscape Rheumatology.
Misunderstood Prescription Drugs and Needless Pain by Jane E Brody, New York Times Jan 22 2002. "Far too little has been done to correct the misunderstandings of both patients and doctors that stand in the way of using opioids to control chronic pain." You need to register with NYT to read the article, but it's free.
Bankruptcies Of The Heart: Secondary Losses From Disabling Chronic Pain - Marcia Bedard dispels the myth of "secondary gain". See also: Dr Bedard's Chronic Pain Fact Sheet - both on the website of the Chronic Syndrome Support Association.
Europe against Pain - news of an initiative to educate European Union decision makers and health professionals about chronic pain issues.
AAPM Releases Statement on the Diversion and Abuse of Controlled Substances "Millions of people have suffered unnecessarily because of barriers to effective pain treatment. Exaggerated and unrealistic fears of addiction are paramount among these barriers, which should not be re-erected in response to publicity regarding drug abuse." Press release from the American Academy of Pain Medicine annual meeting, January 2001
Countering Chronic Pain Myths - "When representing chronic pain patients, attorneys must counter the chronic pain myths." A certified pain practitioner gives advice to lawyers on how to rebuff the arguments put by "the other side" in insurance and disability cases.
Chronic pain and opioids - debunking the myths [PDF]- by Frank Fisher. From Our Chronic Pain Mission.
Trends In Medical Use and Abuse of Opioid Analgesics - article from JAMA (April 5 2000) and related press releases, on the Pain & Policy Studies Group website. "This article challenges the conventional wisdom that drugs used for relief of severe pain - such as morphine - are widely abused."
Risk Of Addiction To Pain Relief Is Small, Expert Says "Most pain experts say the public's concern about inadvertently becoming addicted to narcotics while being treated for pain is unfounded. Unfortunately, some physicians share that concern, and some patients are not getting the pain relief they need." Address at the American Academy of Emergency Medicine annual meeting, Feb 2000, reported on the Doctor's Guide website.
Report of the Oregon Pain and Symptom Management Task Force - January 1999. Recommendations include the adoption of a Resolution of Rights for Persons with Pain, and better education for health care providers.
The Psychology of Medication - Australian psychologist Mark Grant explains the history of beliefs about pain, and comments on current attitudes. "When are opioids indicated in the treatment of chronic pain? The simple answer is probably a lot more often than is generally thought."
Fibroworld's page on The Opioid Controversy includes an article on Tolerance, Physical Dependence, and Psychological Dependence (Addiction), and good links.
Rights and Responsibilities of Physicians in the use of Opioids for the Treatment of Pain - Public Policy Statement from the American Society of Addiction Medicine (April '97). "Physicians' concerns regarding possible legal, regulatory, licensing or other third party sanctions related to the prescription of opioids contribute significantly to the undertreatment of pain.".
Facts About Commonly Held Fears Regarding Opioid Treatment - from the American Society for Action on Pain website. "Constipation is the side effect to fear." Also Addiction vs Dependence - what are your chances of getting addicted? 3 hundredths of 1 percent! says Skip Baker.
Unprecedented Changes in State Pain Policy (1997) - from the Pain and Policy Studies Group. "There is increasing recognition on the part of health professionals, the public and policy makers that the management of pain, including chronic non cancer pain, is inadequate; and the past avoidance of opioid analgesics for chronic pain is changing." This article analyses the trend. More articles like this from the PPSG.
Articles from Pain Research & Management - Official Journal of the Canadian Pain Society:
Opioid analgesics
in the management of neuropathic pain - D Moulin (from Neurology
and Chronic Pain - Special Spring 2000 edition of the journal): "Psychological
dependence or addiction ... is not usually an issue in pain management with
opioid analgesics. The extant literature strongly suggests the trial of an
opioid analgesic in the management of neuropathic pain if adjuvant analgesics
fail to provide adequate pain control. Failure of one opioid warrants a trial
of another opioid because their effectiveness can vary among patients; the
results are based on physiochemical properties of the drug and idiosyncratic
reactions of the patient. Neuropathic pain can be a difficult problem to manage,
and sometimes the use of an opioid analgesic can make the difference between
bearable and unbearable pain so that patients can get on with their lives."
Use of opioid analgesics
for the treatment of chronic noncancer pain – A consensus
statement and guidelines from the Canadian Pain Society "Pain
of all types is undertreated in our society ... Physicians’ fears of
using opioid therapy, and the fears of other health professionals, contribute
to this problem."
Back pain: Bankrupt
expertise and new directions: "Bankrupt experts
operate with the faulty assumption that pain not seen on x-rays or scans,
nor cured by surgery, was ‘nonorganic’, equalling ‘psychosomatic’
or ‘psychogenic’ (which in many jurisdictions is noncompensable)."
writes Dr Ellen Thompson from Ottawa.
The denial of chronic
pain by Robert W Teasell MD FRCPC. This article argues against the "rehabilitation
model" described in my piece Know your enemy
and beloved of insurers: "There is a current disconcerting
trend towards dealing with chronic pain and its subsequent disability by denying
its reality. The reason for this has primarily been cost containment and cost
reduction."
The End of Pain: "Now There's a Pill That Can Safely Ease Every Agony From Cancer to a Bad Back - So why are doctors and patients afraid of it?" This article discusses the use of morphine and methadone for chronic pain, and especially the work of neurosurgeon James Campbell, who runs the pain clinic at Johns Hopkins Hospital.
The Case for Morphine -"IF NOTHING IS BETTER FOR PAIN THAN NARCOTICS, WHY DON'T MORE DOCTORS PRESCRIBE THEM?" by Christine Gorman, from TIME Magazine Online, April 28 1997.
Morphine as Medicine - transcript of CNN/Time Impact story
From US News Online:
The Police State of Medicine - Dr. William Hurwitz's address to the Drug Policy Foundation in New Orleans, October 18, 1997. Suspended from practicing medicine, caught in a legal nightmare (which continues to this day, as of December 2004. "I was charged with having prescribed excessive doses of opioid analgesics in the treatment of 30 patients who, it was acknowledged by the Board of Medicine, had conditions causing intractable pain." Also here at the Schaffer library of drug policy.
NO RELIEF IN SIGHT - by Jacob Sullum from Reason Magazine Online, January 1997. "Torture, despair, agony, and death are the symptoms of "opophobia," a well-documented medical syndrome fed by fear, superstition, and the war on drugs. Doctors suffer the syndrome. Patients suffer the consequences."
Pain Management With Opiates - by Jim Brown, Ph.D. "Every year, thousands of people suffer needlessly and many commit suicide because they cannot get treatment for pain". From Ivanhoe Broadcast News 30 Jan 1997.
The use of opioids for the treatment of chronic pain A consensus statement from the American Academy of Pain Medicine and the American Pain Society (1996) - "The under-treatment of pain in today's society is not justified."
When will adequate pain treatment be the norm? - only when patients themselves are empowered to demand adequate pain relief, says this JAMA editorial (Dec. 20, 1995) .
The Tragedy of Needless Pain - by Dr Ronald Melzack. "Contrary to popular belief, the author says, morphine taken solely to control pain is not addictive. Yet patients worldwide continue to be undertreated and to suffer unnecessary agony" - from Scientific American, February 1990.
The Painful Dilemma: The Use of Narcotics for the Treatment of Chronic Pain - prepared by the Sacramento-El Dorado Medical Society ad hoc committee on the treatment of pain, 1990. "Evidence is steadily accumulating that persons with intractable pain do not respond to narcotics in the same way as do street addicts. Their motivations are different, and so are their psychological reactions and tolerances to the drugs. The pain patient can be treated with narcotics with little risk of developing the self-destructive behavior characteristic of addiction."
Further reading: For more links, see Pain Policy & Law, The Use of Opioids in the Treatment of Chronic Non-Malignant Pain and other pain pages on Lois Randall's excellent Medical Information Network site.
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