"When Pain Drugs Hurt" - According to Whom?

August 2, 2010

To The Editor
The New York Times
Re: “When Drugs Hurt”

It is roundly accepted that approximately 26% of the population suffers from chronic pain. Inadequately treated pain commonly results in the destruction of lives – bed-ridden, unable to function, cut off from family, friends and society. It is a living nightmare for the victims. Virtually every chronic illness will result in chronic pain. And virtually every person will confront this during his or her lifetime.

Chronic pain, when adequately treated, can virtually always be controlled. Tragically, however, few physicians have the experience, training or confidence to prescribe adequately. Paradoxically, when confronted with the failure of their inadequate treatment, pain “specialists” (most often anesthesia-trained “interventionalists” who prefer remunerative procedures over cost-efficient prescribing) rationalize their inadequate dosing with various chimera. They hypothesize patient non-responsiveness, or hyperalgesia (a mythical syndrome in which the patients develop increased pain in response to the pain medications), or demonize the patients as non-compliant, drug-seeking or addicted, when the simple truth is that they have failed to prescribe adequately.

Adequately treated pain patients blossom – they regain the quality of their lives and consider their treatment to be “miraculous”. They suffer no complications, adverse effects, impairment of cognition, or the induction of any form of addictive disorder. They do become physiologically dependent, just as a diabetic would upon insulin or a cardiac patient upon digitalis – sudden discontinuation of their medication will result in definite withdrawal symptoms. Compliant and legitimate pain patients virtually never suffer overdoses. But pain patients must often travel hundreds, if not thousands, of miles to find a physician with the expertise and training to treat them adequately, and most state medical boards, although paying lip service to supporting pain care, intimidate physicians so consistently that few doctors are willing to undertake pain treatment (just ask your private medical doctor if he is willing to write a schedule II prescription.)

The current campaign to reverse the progress of pain management in the last decade (a 30% increase in prescribing) is driven by a resurgence of “opiophobia” (see the original article in 1984 by John P. Morgan MD); by the attempt of interventionalists to corner and control the pain treatment market; by the attempt of insurers to escape or extremely limit the costs of treatment; by addiction treatment mavens who want to label all opioid using patients as candidates for their services; and by “drug warriors”, who having totally failed to solve any illicit-drug related problems after a trillion dollars of income, now seek to continue their gravy-train by redirecting the tabloid-driven hysteria about drugs to the prescriptive side. The drug war is a total scam and the perpetrators can be simply identified by noting where the trillion dollars went.

The current media-supported propaganda is based upon the “epidemic of overdoses” over the last five years. Two facts are neglected in these breathless articles. First, federal surveys over the last four years show that drug us in America has actually decreased . Second, although Emergency Room visits doubled and there were 8,000 deaths in the last three years from drug overdoses, none of the deceased were pain patients. or "little old ladies" from the general public There were over 50 million doses of OxyContin consumed last year. How do 8,000 crazy abusers killing themselves compare to the good done for the majority millions? It is not ‘little old ladies with arthritis” as claimed by Dr. Cahana, but reckless drug-abusers, most often combining illicitly obtained opioids with alcohol, benzodiazepines and many other drugs. The millions of little old ladies with arthritis cannot even FIND a doctor willing to prescribe, so they remain crippled and denied.

Analysis of the actual data cited by the hystericals and the political fellow-travelers reveals that the use of opioids has increased significantly without statistically significant harm. The harm cited in your article is not to legitimate patients, but to abusers who, apparently driven by “natural selection”, relentlessly find ways to take themselves out of the genetic pool.

What is needed is to require every physician to become expert in the ADEQUATE treatment of pain, compel them to treat ALL legitimate pain sufferers, and to provide adequately funded treatment for every person (a tiny percentage of the whole) who suffers an addictive disorder, or who reveals their compulsion to abuse prescriptive or illicitly obtained drugs by overdosing.

The current tabloid campaign is simply an attempt to resuscitate Opiophobia – throwing the baby out with the bathwater – by a conspiracy of the misguided, the self-interested, insurers, the ideologues and the trillion-dollar enriched scam artists behind the war on drugs - now trying to morph into the war on doctors and legitimate pain patients.

J.S. Hochman MD
Executive Director
The National Foundation for the Treatment of Pain
www.paincare.org
1714 Whoite Oak Drive
Houston, Texas 77009
713 982-9332