||Many people have become slaves to pain medicine
Posted Sunday, June 12, 2005 - 9:56 pm
By Edwin Leap
Edwin Leap is a physician and writer. He lives in Tamassee and can be reached at [email protected] or www.edwinleap.com. He is the author of "Working Knights," a book of insights into medicine, available at booklocker.com.
When we treat people, it is our duty to do it using as much science as possible.
I still remember the woman who came to the hospital in the middle of the night for chronic headaches. Her pain was terrible, she said. She had already taken the powerful narcotics she used daily, and yet her "chronic pain" was worse.
She said to me, with slurred speech, "You haave to helppp zzzzzz." And with that, she drifted off to sleep. In a person with a sudden, new onset headache, that would have been cause for alarm. It would have been reason for a CAT scan of her brain, maybe even for a lumbar puncture (spinal tap) to look for a bleeding aneurysm or meningitis. In her case, however, this was just another normal day. I looked at her husband, who said with a sigh, "Why don't I just take her on home."
She reminds me of many of the patients I see with chronic pain. The whole idea of chronic pain has become a high-profile issue in medicine. Like so many things, the surge in interest has important roots. For too long, physicians were afraid to use strong pain medicine. And so, cancer victims and children with fractured bones, and countless others with pain, were given acetaminophen at best. People lived in agony because physicians were just under-educated or fearful; fearful of causing harm or addiction, fearful of over-prescribing.
Now, the pendulum has swung too far in the opposite direction. And the result is not that everyone, suddenly, is being treated properly. The result is that too many people are now slaves to pain medicine and too many families are slaves to the incapacity of their loved ones.
I understand that some people need lots of narcotics. I'm not afraid to give them. But we are now told that there are some 25 million chronic pain sufferers in the United States today.
I'm not sure what that number means. I know that huge numbers have legitimate pain problems. But some of those millions are just people with pain of some sort every day. In that case, include me, my wife and my adult relatives everywhere. The numbers may also reflect the fact that, out of sympathy or empathy, physicians have begun to develop new diagnoses to help categorize patients who don't seem to respond to normal therapies. And some of those millions are simply lying for drugs.
Medical science should be identifying and studying new syndromes. We should alleviate suffering. But physicians should not compromise truth just to be nice. The problem is, many patients with "pain syndromes" have no concrete findings, either on X-ray, MRI or lab studies, to prove their disease. When we diagnose and treat people with potentially dangerous and addictive medicines, it is our duty to do it using as much science and good sense as possible.
Even more relevant is our duty to tell the truth. And the truth is, too many patients are taking hundreds of pain pills a month, and in the process too many are overdosing. Because what they want is not pain relief, but euphoria and unconsciousness. I have seen it. Seen them in the ER hours after they fell asleep and stopped breathing at home. I have seen them die.
It's a tragedy born of irresponsibility and addiction in patients and too much trust and kindness in physicians. And sometimes born of profit, when corrupt physicians open clinics that are little more than "pay as you go" drug dealerships.
In America today, countless men and women are spending their days and nights asleep, moving from chair to bed and back, all because they have "chronic pain," and believe that their families should simply let them live their lives in a semi-coma. In fact, what many of them have is depression or addiction, and what they need is not a narcotic but counseling, and antidepressants where indicated. And what they and their families need is for physicians to say "no."
Some doctors and patients will be offended by what I'm saying. But across the country, emergency rooms are confronted day and night by people wanting ever stronger drugs. We are constantly trying to figure out how to safely help the patient who already takes methadone, Lortab, Percocet, Demerol and narcotic patches, and says the pain is unbearable.
If that doesn't give me enough credibility to speak to the problem, I can tell you that I see an equally unbearable pain in the eyes of patients' families. And that is where the truth is clear to see.