Fear of addiction causes unneeded pain as people avoid drugs


March 15, 1994|By Joe Graedon and Dr. Teresa Graedon | Joe Graedon and Dr. Teresa Graedon,King Features Syndicate

The war on drugs has caused untold pain and suffering for millions of people. We're not talking about drug pushers or junkies. Innocent people in pain are being punished for society's hysterical fear of addiction.

A new study has confirmed what pain experts have long been saying: Cancer patients are too often undertreated for severe pain caused by metastatic or recurrent disease.

A recent case confirms the tragedy that occurs daily in hospitals across the country.

A physician who takes occasional night duty in a veterans hospital was called in to look after a patient in extreme pain. He had metastatic prostate cancer that had spread to his bones. The doctor remarked that he must need more morphine, to which the nurse responded, "Oh, no, he's not on morphine. He's on Tylenol."

The doctor reported that she stayed with the patient for some time after the morphine she ordered was administered, and the patient expressed his relief: "Thanks, doc, that's much better. It really was unbearable."

Two nights later, this physician was again on call in the same hospital.

When she was once more called to this patient's bedside, she suggested to the nurse that they increase his morphine dose.

Imagine her dismay when the nurse replied, "He's on Tylenol, not morphine." The doctor checked the medical record, where she found the attending physician had canceled her order for morphine with the note: "I will not have any of my patients addicted!"

Unfortunately, this attitude is still far too prevalent. It is flat-out wrong! People in pain should not be suffering.

The Agency for Health Care Policy and Research recently released new clinical practice guidelines "in an effort to correct the problem of inadequate treatment of pain in patients with cancer."

What these researchers underscore is the importance of asking the patient about his or her pain and listening to the answer. No one can assess someone else's pain on the basis of how they look or act. Some people are embarrassed to let on how much they are really suffering, as if pain were a weakness in character.

Too many patients have been frightened by the prospect of drug addiction to request the pain relief they need.

Yet morphine and other narcotics are often essential in managing severe pain.

Even noncancer patients with chronic pain may require prescription analgesics to control their pain. We just received a letter from a man who suffered an industrial accident in 1985. He says: "Neither operations, pain clinics, biofeedback nor physical therapy have relieved my chronic back pain. As I still must work, my doctor has me take the painkiller Lorcet Plus three times a day. It is very effective, but I know that it is a narcotic and therefore addictive.

"I do not abuse this drug. I suppose in a way I am dependent, as I cannot function without it. My doctor says I'll need this medication the rest of my life."

Fortunately, this person has an enlightened physician. Many people in a similar situation must humiliate themselves and beg for relief. They are labeled "drug abusers" by health professionals who should know better.

Instead of waging war on drugs, perhaps it's time society declared war on pain.

Q: My husband started on Proscar about a year ago because of an enlarged prostate gland. It has helped, and we have noticed a strange side effect. He seems to be growing hair in places that were balding. Have you ever heard of anything like this?

A: Even before Proscar (finasteride) was approved, there were theories that this drug might be helpful against male pattern baldness and even acne.

The medicine blocks the conversion of the male hormone testosterone to its evil twin, dihydrotestosterone (DHT).

It is this secondary hormone that is thought to be responsible for enlargement of the prostate and hair loss.

We have heard through the dermatological grapevine of a few other cases like your husband's. The company that makes Proscar is now conducting studies to see if the drug can actually reverse baldness. As soon as there is news, we will let you know.

In the meantime, Proscar should be prescribed ONLY for prostate problems.

Joe Graedon is a pharmacologist. Dr. Teresa Graedon is a medical anthropologist and nutrition expert.

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