Chronic pain should be treated with effective drugs


May 24, 1994|By Joe Graedon and Dr. Teresa Graedon | Joe Graedon and Dr. Teresa Graedon,King Features Syndicate

What would we do without pain? You'd pick up a hot frying pan and burn yourself badly if it weren't for an almost instantaneous reflex that makes you drop it. You might walk miles on a sprained ankle doing further damage except for the body's protective signal that says stop.

Pain is the body's early warning system that alerts you to anything from appendicitis to a heart attack.

Despite its importance, pain can ruin people's lives. You could live with a stuffy nose or stiff joints, but pain gets your attention and can dominate every waking moment. We got an inkling of what this can be like from this reader's letter:

"At the age of 20 I was an avid athlete and played competitive college basketball. In one brief moment that ended with torn knee ligaments.

"I am now 33, have had seven operations on that knee and have been in two serious automobile accidents. I suffer daily. I can't tell you how many nights I have slept in a bathtub full of ice water in attempts to numb the pain for just a brief nap. Or how many times I have had to cancel plans at the last minute because it is rainy and the pain kept me in bed.

"I am a licensed mental health counselor working with emotionally disturbed children. I am also a full-time doctoral student working on a degree in substance abuse prevention. Ironically, I have been treated by doctors as if I were an addict looking for a fix.

"Many of us with chronic pain have legitimate problems. We are people who are trying to stay productive so as not to lose our mental health along with our physical health. I have contemplated suicide and if not for the love of a very good friend would probably not be here today. I hate begging for pain relief."

As this person points out, coping with pain is difficult enough without having to battle the health care system. But that is too often the position pain patients are in.

We know physicians who would like to sneak out the back when they see their chronic pain patients walk in the front door. People in pain are not fun to deal with. Once measures such as surgery, physical therapy, biofeedback and psychological support have been exhausted, patients often beg for painkillers. This makes physicians uncomfortable.

Until recently, cancer patients frequently suffered unnecessarily because their doctors feared they would become addicted to narcotics. Experts now realize that concern is unwarranted. Cancer patients should receive effective relief.

Unfortunately, the medical community has even more difficulty dealing with noncancer pain. But people who contemplate suicide to escape their daily agony deserve appropriate pain relief as well. Sometimes that means a carefully monitored treatment program with effective pain medications.

Q: Have you ever heard of amitriptyline for treating pain? My doctor prescribed this for my fibromyalgia, but when I looked it up in my drug reference I found it is an anti-depressant.

A: Although amitriptyline is mostly prescribed for psychological depression, it is also being used to relieve certain kinds of chronic pain. Not everyone benefits, but some patients do find low doses of this drug is helpful. Side effects may include drowsiness, constipation, blurred vision, dry mouth and sexual problems.

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

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