Pubdate: Fri, 20 Aug 2004 Source: Post and Courier, The (Charleston, SC) Copyright: 2004 Evening Post Publishing Co. Contact: http://www.charleston.net/ Details: http://www.mapinc.org/media/567 Author: Holly Auer, Of The Post And Courier Staff Bookmark: http://www.mapinc.org/find?232 (Chronic Pain) Bookmark: http://www.mapinc.org/heroin.htm (Heroin) Bookmark: http://www.mapinc.org/find?136 (Methadone) Bookmark: http://www.mapinc.org/oxycontin.htm (Oxycontin/Oxycodone) Bookmark: http://www.mapinc.org/rehab.htm (Treatment) LOCAL PAIN SUFFERERS TO GET DOSE OF RELIEF Guidelines May Reduce Stigma Of Drugs For Chronic Conditions For sufferers of chronic pain, moments seem to stretch into hours, and just getting through the day comes as a small miracle. Some people coping with debilitating headaches and back pain, cancer and lingering aches that somehow defy diagnosis find little relief through surgery, physical therapy or alternative therapies such as acupuncture. Their only remaining option is a strict regimen of the same heavy narcotics that street addicts crave and pharmacies keep under lock and key. The medicines are highly effective, but the stigma associated with the powerful drugs makes some doctors hesitant to prescribe them, and pharmacies fear that stocking the drugs will make them targets for thieves. New federal guidelines announced by the Wisconsin Medical Society and the Drug Enforcement Agency last week aim to change that outlook and bring relief to more of the estimated 60 million people nationwide who suffer from chronic pain. The guidelines were developed by the DEA with assistance of leading doctors in the pain management field. They list steps for evaluating patients and setting up treatment plans, as well as outlining the types of nondrug interventions and prescription therapies available. Doctors are urged to take a complete patient history and get a sense of the patient's goals for treatment. Some Lowcountry doctors' approaches to pain management already mirror the national guidelines, but the plans are expected to bring greater uniformity to this hot-button medical issue.Physicians involved in keeping terminally ill patients comfortable in their final weeks or months have been turning to these powerful painkillers for decades. But doctors admit that care for long-term sufferers is still lacking. "We have to listen to the patients," said Dr. Wayne Weart, a professor of pharmacy and clinical sciences and an associate professor of family medicine at the Medical University of South Carolina. "If they say they're in pain, they're in pain, and we have to treat that." One Charleston-area woman who has struggled with crippling bouts of back, neck and head pain for the past few years, said that for years, local doctors failed to heed her pleas for help. One neurologist labeled her a "drug-seeker" when she called him, writhing in agony. At that point, all she'd been given for the pain, which came in blinding spasms up the back of her head and into her eyes, and down her spine into her legs, was Motrin. Today, she has a prescription for a powerful combination of OxyContin, Vicodin and muscle relaxers, which she takes each night before bed to numb her pain during the day. "I fought going on them. But I wasn't even functional. I had to do something," said Diane, who asked that her last name not be used for fear that friends and colleagues would judge her for depending on narcotics. So urgent are problems like Diane's that the Joint Commission on Accreditation of Healthcare Organization has named pain management a top goal for hospitals across the country, along with emergency preparedness and addressing the nursing shortage. Lowcountry residents who seek their doctors' care for pain management report problems ranging from phantom limb pain -- aches that seem to come from the place where an amputated limb used to be -- to sports injuries. Area doctors say lower back pain is especially common. As new research and drugs become available, treatment methods are evolving. Instead of treating pain on an as-needed basis, physicians have embraced long-acting narcotics such as OxyContin and methadone, which are taken regularly to keep pain at bay. Most of the medications are taken orally, but newer and better delivery mechanisms, such as pumps, are a growing trend. Since these drugs can be dangerous if misused, Dr. Arthur Smith, director of pain management at MUSC, asks patients to sign a "medication agreement," which spells out the exact dosage plan. "The fewer choices the patient is given, the fewer bad choices they can make," he said. Keeping the pills out of the wrong hands remains a chief concern. Tales of theft by drug-addicted family members and neighborhood junkies are common across the nation, so doctors often encourage patients to lock up their medicine and limit access to one or two relatives. More painkillers are coming onto the market that don't induce the highs sought by addicts, so the street value of pain medications may eventually dwindle. But with drugs such as OxyContin making headlines as the highly abused "hillbilly heroin," some patients fear that they, too, could become addicted. Local physicians say that's unlikely. "The likelihood of addiction, by and large, is very low" for patients, Smith said. But doctors must take care to adjust dosages to ensure that patients do not become physically dependent and to account for their increased tolerance to medications. Patients can be safely weaned off the drugs, he said. Positive reports from patients are another indicator that the treatments are worthwhile. Dr. Scott Lake, a medical adviser to Hospice of Charleston, recalls one patient who was so debilitated by lung cancer pain that he was housebound. After he began the appropriate drug regimen, he began riding his bike again. Although Diane hasn't been able to return to work, her prescriptions have transitioned her from being completely bedridden to "functioning as a mom again." She has had to reshuffle her priorities to meet the limitations of her illness, but these days, the smallest things, like being able to attend a child's school play, are great joys to her. Doctors also hope t the new pain treatment guidelines will help patients after surgery. People who take the drugs prescribed to them before leaving the hospital are less apt to develop pneumonia or blood clots, because the pain pills enable them to get back on their feet more quickly, Weart said. For those who suffer chronic pain, doctors hope new therapies and surgeries will eventually reduce reliance on drugs. In the meantime, educating physicians and medical students is a top goal. Even as awareness grows, patients are cautioned that no new drug or treatment is likely to be a cure-all. "They have to have realistic goals," Smith said. "It's unlikely that any medication will entirely eliminate their pain, but they will moderate it to the point that their life can get better." What is chronic pain? Persistent pain over time that hurts enough to interfere with a person's well-being, ability to function at home or work and general quality of life. Chronic pain sufferers also may have trouble sleeping or be anxious or depressed. What kinds of chronic pain are most common? Back pain, arthritis, headaches, phantom limb pain, jaw pain and fibromyalgia, a generalized musculoskeletal pain. Occupational and sports injuries also may contribute. How is it treated? Physical therapy, nonprescription painkillers and surgery are doctors' first plan of attack. Some sufferers get relief only from a regimen of long-acting prescription narcotics. What drugs do doctors prescribe? Oxycodone (known by the brand names including OxyContin and Percocet), methadone, morphine and codeine are most common. These drugs can be administered orally or with injections or pumps like those used by insulin-dependent diabetics. Holly Auer covers health and medicine. - --- MAP posted-by: Jo-D