Pubdate: Tue, 08 Mar 2005
Source: New York Times (NY)
Copyright: 2005 The New York Times Company
Author: Jane E. Brody
Bookmark: (Chronic Pain)
Bookmark: (Oxycontin/Oxycodone)


The dozens of letters, phone calls and e-mail messages I've received
since writing my recent columns on total knee replacement and pain
management reveal that I struck a chord.

Some readers chastised me for scaring potential patients away from
this surgery, which, when healing is completed, can greatly enhance
quality of life. But many others praised me for "telling it like it
is" about an often painful and difficult recovery that surgeons don't
warn patients about.

Clearly I've not been alone in having prolonged, debilitating
postoperative pain that was not adequately treated.

Obviously, many people have had total knee replacements without
experiencing the kind of pain I suffered.

I knew going into surgery that a friend 10 years my senior had both
knees replaced at once, as I did, and was dancing after four weeks. I
could not walk down stairs using both legs at nine weeks after surgery
despite prompt and intensive physical therapy.

Another friend, a woman in her 80's, said she had almost no
postoperative pain.

An Ohio man who had both knees replaced at age 77 wrote: "After
surgery, my pain was very tolerable, and I took minimal pain
medication. I now walk everywhere, miles, over hill and dale, all
without pain, and I'm hoping to return to the tennis court. I would
encourage those who need knee replacement to 'go for it,' even both
knees at the same time."

Since I entered surgery slender and in top physical condition, I
expected a similar recovery experience, and my surgeon reinforced that

Who can explain it? Not me or my surgeon.

A Patient's Right to Know

To those readers who fear that I unduly frightened some prospective
knee replacement candidates away from this life-enhancing surgery, I
must say that was neither my intent nor my message.

My message was that whatever procedure a patient faces, full
disclosure is imperative. People have a right to know what they may
encounter, not just what the surgeon hopes will happen.

An orthopedic surgeon called after reading my article to say that he
tried to fully inform patients who asked about knee

As a result, he said, he scares some people off, and the chief of
surgery at his hospital has complained that he does not do this
operation often enough.

This is outrageous, and just reveals the monetary motives behind much
of modern medicine. The patient be damned; just bring in the bucks.

So here's the good news: at 10 weeks post-op, I insisted that the
surgeon take another look at me because I was convinced - as I had
been for weeks - that there was something wrong with my right knee.

The left, the most severely afflicted with arthritis going in, was at
last healing nicely, but the right continued to keep me tied to potent

As it turned out, I had tendinitis, a seriously inflamed tendon across
the outside of the knee cap that was aggravated with every bend of
that knee. All it took was a shot of cortisone to bring relief and get
the healing process back on track.

I just wish that my weekly complaints of disabling pain in that knee
had been acted upon much sooner.

The day after the shot, I was able to walk half a mile each way to my
local Y and resume my daily swim.

In just four days I was swimming three-fourths of a mile and feeling
almost fully human again.

Yes, I still take medication, but much less than before, and I still
have to rest from time to time. But I now anticipate the day when I
can resume riding my bicycle and walking around the park, hiking and
ice skating with my friends.

I am certainly not alone in wishing I'd been prepared for a difficult

A Need for Planning

Here's what one reader who had total knee replacement wrote: "I wish I
had known how incapacitating the recovery period would be so that I
could have planned accordingly. It would not have changed my resolve
to have the procedure - only my planning for its aftermath."

Is this too much to ask of the medical profession?

I had set aside six weeks to recover and done all my work in advance
for that period, only to find that I needed twice the time to return
to normal daily activities, including getting to the subway, on it and
off it.

Another surgeon wrote to me about doctors' fear of legal action over
prescribing narcotics. Yes, the government has unfairly attacked some
pain management specialists who treat dozens of patients with chronic

Dr. Jennifer P. Schneider, the author of "Living With Chronic Pain,"
has testified on behalf of such doctors who were unjustly accused of
feeding the habits of drug addicts.

An Uprising Overdue

This is hardly the case, and a mass uprising by doctors and patients
in support of legitimate pain treatment is overdue.

It is also not true that pain patients get hooked on narcotics,
craving ever greater doses of them. Addicts get hooked; pain patients
need increasing doses only when their pain worsens, as often happens
to those with advanced cancer.

And as Dr. Laura Lewis Mantell of New York wrote to me, "The use of
opioid analgesics (narcotics) need not be avoided out of concerns that
addiction will ensue, because the incidence of addiction arising out
of postoperative exposure to opioids is negligible."When faced with
the kind of pain I experienced, doctors must treat it properly and not
act like frightened children when it comes to prescribing narcotics,
by far the best drugs for dealing with severe pain.

A narcotic like OxyContin is not abused by pain patients but by drug
addicts. I feel no euphoria, just pain relief, and I'm having no
problem weaning myself off it now that I am in much less pain.

The American Academy of Pain Medicine, the primary organization for
physicians who treat pain, is alarmed by the interim policy statement
issued by the United States Drug Enforcement Agency, which threatens
to make it even more difficult than it now is for legitimate
physicians to prescribe adequate pain relief for their patients.

Undertreatment of pain is already a public health crisis and the
government should act to improve the situation, not make it worse.

Undertreated pain destroys lives. As one young woman put it in an
e-mail message: "The effect of pain had an insidious effect on my
life, my outlook, my well-being and my relationships in every sphere
of my life. Pain is a funny thing. Unless you're the one feeling it,
it's basically meaningless."

The time is long overdue to instill empathy, not fear of persecution,
into the nation's physicians.
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MAP posted-by: Larry Seguin