Wednesday, June 29, 2011

Chronic Pain Treatment

"There are people who really need access to pharmaceuticals to manage their pain and there are some who abuse the pharmaceuticals, but the abusers are a very-very small proportion of those who need but don't have access to the treatment."

This is from the recent Institute of Medicine (IOM) report on chronic pain in America.  See this article for details. 

This philosophy reflects the idea that the doctors of the world have the duty to provide all people of the country with complete pain control.  While in part a laudable goal, this idea is contributing to a massive over-use of narcotic prescriptions in the U.S. right now.  When faced with a problem like this, we must ask ourselves many questions that as yet have not been adequately addressed:
1.  Are narcotics the best plan for chronic pain that does not respond to other medications?
2.  Can we fully rely on the patient who is taking narcotics, who 100% of the time develops tolerance and other features of dependency when taking narcotics for chronic pain, to tell us whether or not this is the best management?  Even if he is behaving himself by not selling or otherwise "misusing" the medication?
3.  We cannot only look at the pain control aspect:  what are the philosophical, ethical, sociological, and other ramifications of using narcotics for chronic pain?  
4.  Even those patients who never "abuse" the medications, what are the ramifications of this legalized drug?

Note heroin was initially a prescription drug.  And it worked well for pain.  But the societal effects were to damaging and it lost favor.  Let us be careful!

No comments: