From: Arthur.Saus@p160.f72.n376.z1.fidonet.org (Arthur Saus)
Newsgroups: misc.handicap
Subject: Birmingham Pain Clinic Visit #4
Date: 13 Apr 92 20:52:53 GMT
Reply-To: Arthur.Saus@p160.f72.n376.z1.fidonet.org
Organization: FidoNet node 1:376/72.160 - Windows of the Worl, Columbia SC

Index Number: 21038

[This is from the Chronic Pain Conference]

Hello Alan!

01 Apr 92, Alan Hess writes to Arthur Saus:

 AH> I am not disputing that narcotics are addictive.  However, several
 AH> physicians with which I have dealt have told me that it is better to be
 AH> addicted to a narcotic and be able to function than to not take narcotics
 AH> and suffer.

I am not exactly disagreeing with this concept.  Certainly it is
better to be able to function without suffering while using the
appropriate medications, administered in an appropriate manner,
than to use no medications and be unable to function.  Properly
used, narcotics can provide this for people who have certain pain
problems.

 AH> The studies they mentioned show that chronic pain patients
 AH> will only take enough medication to allow them to function, since that is
 AH> all they want.

Yes, some studies will show this, and other studies as well as
practical experience will often show exactly the opposite.  This is
why a broad sweeping statement like this is not correct.  There are
some patients who have recurring pain problems that will use only
the appropriate dose of a narcotic to manage their pain, and do not
become addicted to the drug; patients with severe pain from cancer
are a good example of this type of patient.  The biggest part of my
disagreement with this lies in semantics.  There is a significant
difference in the patient who has "chronic pain" and the patient
who had "acute recurring pain" although this is not generally
recognized by patients and medical personnel who have not
specifically trained in pain management.  The true "chronic pain"
patient is very likely to abuse a narcotic and become addicted to
it, while the narcotic does not actually provide the pain relief
the patient is seeking; ie the narcotic is the wrong drug to treat
the problem.

 AH> It is absolute foolishness to deny effective pain-control
 AH> treatment to people just because their condition isn't terminal, due to
 AH> fear of addiction.

True, but the real issue should be prescribing the proper therapy
for that particular problem.  The proper medication selection would
avoid the addiction issue altogether.

 AH> Any drug that the body develops a tolerance to can be
 AH> called addicitve, since the person must be weaned off and can't stop cold
 AH> turkey without withdrawal problems.

Sorry, but this generalization doesn't hold true for "any drug".
Certainly discontinuation of some drugs requires a gradual tapering
of the dose, rather than a sudden stop, but this is not the same as
addiction.  Furthermore, development of tolerance to a medication
is not addiction.  Again I believe we are disagreeing on semantice
here rather than the actual issue.

 AH> Addictions can be handled just as any other tolerance can be.

Oh, if only it could <sigh>.  Sorry, but it doesn't work that way.

Arthur

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