The premise of the Herald-Leader's July 6 front-page articles is false.
One of two cardinal rules of medicine is to relieve pain and suffering. But apparently in this day and time, it is not politically correct to prescribe or take narcotics for pain.
Too many people regard patients who require chronic pain management as addicts. Ignorance about pain, its management and consequences abounds even among those who should know better, including, unfortunately, many of my colleagues.
Pain management is at the heart of this issue. All the experts agree that pain is undertreated.
”Chronic pain is one of the most pervasive and intractable medical conditions in the United States, with one in five Americans affected,“ according to the June 4, 2007, issue of Newsweek.
Dr. Russell Portenoy of Sloan Kettering says 50 percent of people with pain are inadequately treated.
Chronic pain costs the country $62 billion in lost productivity and much more in medical fees.
The headline of the March 1997 issue of U.S. News & World Report, focused on pain, declared ”No Excuse for Pain! Doctors Have the Means at Hand to Relieve the Suffering of Millions of Americans. Why Aren't they Doing It?“
In a recent survey by the American Pain Foundation, more than 150 practicing primary-care physicians, 7 of 10 physicians agreed that chronic, non-cancerous pain is undertreated.
When asked to rank the most significant impediments to safe and effective long-term opioid (narcotic) use, they ranked regulatory and law-enforcement scrutiny as the biggest barriers to appropriate opioid (narcotic) prescribing.
A survey of 204 people with chronic pain found that most had sought help from an average of 10 physicians, yet only half had received drugs that reduced their agony. Hospital emergency rooms scorn many, and some pain clinics turn away pain sufferers at the door, suggesting they are malingerers, abusers, drug seekers or addicts.
Responsible agencies side with the chronic pain sufferer. DEA Administrator Asa Hutchinson says, ”We don't want to cause patients who have legitimate needs for these medications to be discouraged or afraid to use them. We don't want to restrict doctors and pharmacies from providing those medications when appropriate. Effective pain management is an integral and important aspect of quality medical care, and pain should be treated aggressively.“
And from the Kentucky Board of Medical Licensure: ”The board encourages physicians to view effective pain management as a part of quality medical practice for all patients, acute and chronic.
”Physicians should not fear disciplinary action from the board for prescribing controlled substances for a legitimate medical purpose and in the usual course of medical practice.“
Some would view these remarks as manifest schizophrenic by the board in light of its actions to the contrary.
At the heart of the debate is confusion about what constitutes addiction and physical dependence. There is widespread ignorance about the distinction between chronic use, abuse, physical dependence and addiction.
In three studies involving nearly 25,000 cancer patients, Portenoy found that only seven became addicted to the narcotics they were taking. That's a 0.028 percent addiction rate, which is one in every 3,600 patients. Addiction is excessive narcotic use with associated social pathology. Chronic use does not equate to abuse. Dependence is not addiction.
Many chronic pain sufferers need not be patronized by doctors, nurses, pharmacists, and others who do not understand the terms and specifics of pain management. Without adequate treatment, some patients consider suicide the last chance for relief, and at a bad moment, it may seem preferable to a life of agony.
The Herald-Leader focused on me unfairly. The characterization of my practice was irresponsible.
”I will follow that method of treatment which according to my ability and judgment I consider for the benefit of my patients,“ says the Hippocratic oath, which all physicians take.
The management of pain supersedes the article's sensational aspects.
I have faithfully and honestly served the people of this state for 49 years. I have made 300,000 to 500,000 patient visits during that time. I served my country during wartime at Fort Knox and in Vietnam and have an honorable discharge.
I make no apologies for following the dictates of my profession in trying to help my patients deal with pain.
Finally, the issues raised in the news article are not about me or my embattled colleague, nor about irresponsible would-be journalists or a vocal, inexperienced practitioner who comments on things about which he knows very little.
It is about the patients — the poor souls who, upon rising this morning, were met with the gloomy prospect of another day of agony.