How Should People in Pain Be Treated?

People in pain are often treated like criminals. Narcotics may be the best treatment for severe pain, but they can also be drugs of abuse.
Readers have shared horror stories in which loved ones have suffered because doctors were unwilling to prescribe adequate pain relief. Sometimes pharmacists refused to dispense a legitimate prescription for a narcotic.
That’s because both physicians and pharmacists often worry about getting into trouble with the DEA (Drug Enforcement Administration). The war on drugs has led this federal agency to restrict access to medications like Vicodin and OxyContin that could be abused.
One controversial policy prohibited physicians prescribing more than 30 days’ worth of narcotic at a time. This meant that many people suffering from debilitating pain had to trek back to their doctors each month. Not only was this expensive; traveling can be challenging for patients with severe back problems or cancer. Any doctor who gave a patient more than a single month’s prescription could have been prosecuted.
After receiving over 600 comments from physicians, nurses, pharmacists and people in pain, the DEA has just revised its two-year-old rule. Doctors will now be permitted to give a patient three 30-day prescriptions in one visit, to cover 90 days of pain relief.
This step is certainly welcome, but it does not address all the problems arising from fear of addiction. More than a decade ago, the American Pain Society admonished doctors: “Undertreatment of acute pain and chronic cancer pain persists despite decades of efforts to provide clinicians with information about analgesics” (Journal of the American Medical Association, Dec 20, 1995). Pain specialists insist that adequate pain relief–including narcotics, if necessary–should be provided for all patients who need it, not only those who have cancer.
Unfortunately, that guideline is not always followed. We recently received the following account:
“I endure constant suffering from chronic pancreatitis. I do everything in my power: eschew alcohol, avoid fatty foods and take supplements that may help.
“But getting relief for my pain is beyond my power. I take OTC pain relievers, but they don’t touch it. Yet I have been to five different physicians and all refuse to provide pain medication. Two stated that they do not write prescriptions for narcotics, since these drugs lead to substance abuse.
“Before I moved to this new city, I was treated with methadone or Percocet and never abused them. In fact, they helped improve my quality of life immensely.
“I am at my wit’s end and beginning to wonder if my sole recourse will be to lurk on dark street corners at night in search of a ‘street pharmacist.’ Imagine that, the medical community forcing me to become a criminal.��?
We discussed the treatment of severe chronic pain, including pharmaceutical and non-drug approaches, with two physicians who specialize in pain management. Anyone who would like a CD of this one-hour radio interview can order it for $16 from the People’s Pharmacy (CD-576), P. O. Box 52027, Durham, NC 27717-2027 or from www.peoplespharmacy.com.
Many studies show that, despite popular belief, people in pain rarely become addicted. They deserve to be treated with compassion.