Pubdate: Thu, 28 Jul 2005
Source: Wall Street Journal (US)
Section: Pg A11
Copyright: 2005 Dow Jones & Company, Inc.
Author: Scott M. Fishman, M.D.
Bookmark: (Chronic Pain)


Drug abuse and undertreated pain are both serious public health crises, but 
the solution to one should not worsen the other.

Laura Landro's July 13 article, "The Informed Patient: Patients Press 
Doctors on Pain Issues," brought forward some of the more relevant issues 
faced by physicians who treat patients for pain.

It was refreshing to read an article that addressed these topics head on, 
especially in regard to the legal risks that many physicians perceive as 
they consider prescribing strong medicines for pain. The lack of pain-care 
education for general practitioners is partially responsible for hesitancy 
in prescribing opioid medications, leaving patients with cancer and other 
acute and chronic disorders undertreated due to overcautious physicians. 
Appropriate education for physicians as well as for patients can relieve 
many of these fears of addiction.

Although medicine has succeeded at curing diseases and extending life, your 
article highlights the fact that we have not done as well at improving 
quality of life. It was noted that chronic pain is estimated to affect more 
than 50 million Americans, and recent polls have shown that the majority of 
these individuals are older people -- suggesting that our "cure-focused" 
medical system is now at risk of creating victims of our own success.

Your readers should know that there is a specialty branch of medicine with 
physicians who are experts in the care of hard-to-treat pain. This 
specialty, called Pain Medicine, uses a comprehensive and integrated 
approach that applies a variety of techniques from different areas of 
medical expertise.

While your article focused on medications, medications are only part of the 
arsenal of pain-reliving treatments, which spans from psychological 
approaches (such as biofeedback, hypnosis and behavior modification) to 
injections and even surgically-implantable devices in the spinal cord. This 
is a new and growing specialty that needs increased public recognition and 
an official place within organized medicine.

If patients are to have the option of pain control when it is needed most, 
we must avoid unnecessarily putting physicians in the middle of two heated 
health-care crises.

Neither the serious epidemics of drug abuse nor undertreated pain are 
helped by trying to solve one problem at the expense of the other.

Shifting governmental roles in pain care from health agencies to law 
enforcement -- focusing on preventing drug abuse rather than easing 
suffering -- is unlikely to help either of these problems.

Targeting doctors as criminals has an unfortunate chilling effect on the 
average willingness to treat pain and suffering.

Appropriate medical decisions, including those involving legitimate use of 
strong pain relievers, should not be dictated by the actions of the DEA or 
other branches of law enforcement, but must remain in the hands of medical 
professionals. That way, patients can trust that their physicians are free 
to respond to their suffering and prescribe medicines that are in their 
best interests.

Scott M. Fishman, M.D.

Chief, Division of Pain Medicine Professor of Anesthesiology

University of California, Davis Davis, Calif.

(Dr. Fishman is president of the American Academy of Pain Medicine, author 
of "The War on Pain" and co-author of "The Massachusetts General Hospital 
Handbook of Pain Management and Essentials of Pain Medicine.")
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