Pubdate: Thu, 06 Feb 2003 Source: Charlotte Observer (NC) Copyright: 2003 The Charlotte Observer Contact: http://www.charlotte.com/mld/observer/ Details: http://www.mapinc.org/media/78 Author: Danny Brooks Note: Observer community columnist Danny Brooks of Davidson is a computer programmer/analyst and member of the Cabarrus Libertarian Party. Chronic Pain Often Undertreated OUR GOVERNMENT'S WAR ON DRUGS CAUSES PATIENTS TO SUFFER NEEDLESSLY Millions of Americans suffer daily from chronic, nonmalignant, intractable pain. Intractable pain has been defined as pain that is excruciating, constant, incurable and of such severity that it dominates virtually every conscious moment, produces mental and physical debilitation, and may produce a desire to commit suicide for the sole purpose of stopping the pain. Yet this horrendous pain largely goes untreated. Doctors find numerous excuses. Some blame our government's insane War on Drugs and fear of the Drug Enforcement Administration. Others claim their hands are tied by the state medical and pharmacy boards. Others worry about addiction. They pass this fear to their patients, in spite of numerous studies showing that far less than 1 percent of chronic pain patients who take opioids, including the now infamous OxyContin, have addiction issues. As a pain clinic nurse told me recently, all doctors could treat pain, but unfortunately very few choose to treat pain. A patient who requests pain medication is immediately suspected of being a junkie, labeled a "drug-seeker" and treated accordingly. Some are told that the pain is all in their head or are told to "tough it out." Often, patients are told that they are depressed. Gee, I can't imagine why anyone living in constant agony, treated like a drug addict and ignored or yelled at by doctors would be depressed. I would be more concerned if they were not! Four years ago my wife, Linda, was diagnosed with CFIDS (Chronic Fatigue Immune Dysfunction Syndrome) and severe FMS (Fibromyalgia Syndrome). Her chief symptoms were chronic fatigue, cognitive impairment and chronic pain that approaches suicide levels. In less than a month, she was unable to work. Six months later, she went on long-term disability. Once a well-respected computer operator, she may never be able to work again. After seeing first-hand the lack of understanding and willingness to treat pain, I'm surprised the suicide rate of these sufferers is only 900 percent of the national average. Only Opioid Medication Helped For over a year, Linda's pain was grossly undertreated. She tried numerous "alternative modalities" -- acupuncture, physical and massage therapy, chiropractic, antidepressants, NSAIDs, psychiatric and psychological counseling, etc. The only thing that helps is opioid pain medication.Many pain clinics use physical therapy, counseling and small amounts of opioids. However, trying to exercise the pain away does far more harm than good for patients with CFIDS/FMS. Another approach involves prescribing antidepressants to trick the brain into thinking that the pain isn't as severe as it really is. I'm convinced the purpose is simply to turn patients into zombies who don't complain as much. My wife was shuffled from one pain doctor to another. We were eventually referred to a specialist in Chapel Hill, who unlike past doctors, actually listened to us. He understood the inhumanity of telling patients that "pain management" means that they have to "manage to live in pain for the rest of their lives." He knew the difference between addiction -- a psychological craving, even though no benefit is gained and harm is done -- and physical dependence, which occurs when the body becomes accustomed to opioids and has withdrawal symptoms if the medication is suddenly stopped. As a result of being on an adequate amount of opioids, Linda was able to get out of bed every morning, live a semi-normal life and not obsess on the pain. But like most things that seem too good to be true, it didn't last long. The pain doctor decided he no longer wanted to treat patients outside of the Triangle area. This contributed to her local doctor becoming more uncomfortable writing such high levels of opioids. We spent all of 2002 trying to find another pain doctor. We were not able to find anyone to continue the opioid therapy or perform an opioid rotation. Despite repeatedly reassuring my wife that he would not abandon her, the Chapel Hill doctor sent a certified letter giving her 30 days to find another doctor. He refused to listen to reason and knew full well that if we couldn't find another doctor in a year, we probably couldn't find another doctor in a month. Like the majority of chronic pain patients who do nothing wrong and don't abuse their medications, we now have to find a way to continue treatment before she goes through withdrawal. Bring back over-the-counter heroin The Libertarian philosophy on the drug war is that it should be put out of our misery immediately. If this were to happen, those few doctors who aggressively treat chronic pain could do so without fearing the DEA. Also, people in chronic pain could buy whatever they needed for their level of pain from any pharmacy without a prescription or insurance. Prior to World War I, people could buy a measured packet of heroin for pain, sold by Bayer, right beside their aspirin. This would go a long way in helping many Americans, my wife included, who have an unbelievably poor quality of life. Some may see this as one more reason to end the drug war. Personally, I can't think of a better reason. - --- MAP posted-by: Beth