A New Look at Drugs for Treatment of Chronic Pain

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A patient approaches a doctor, saying he is in severe pain. The doctor gives a tentative diagnosis, prescribing an OTC pain reliever, prescription NSAID, or mild opiate. But, to the chagrin of all, the pain doesn't go away, or gets worse. Tests are taken; maybe operations are performed; yet, the pain remains, often going worse with time. It used to be traditional for the doctor to give up; the patient must "grin and bear it." If the patient still cannot find relief,he may try this for awhile; the pain may indeed go away. Or it may not. Precisely when should the stronger opiates, for long to indefinite periods of time, be considered? When the patient requests it? This is a controversial position. Won't the patient get addicted? Not necessarily. Several studies have shown that, especially when kept on a regular dose of narcotics, the patient will develop no signs of addiction. Any alteration in the patient's mood that occurs, (and many patients say none does) will not be associated with the pain relief; it's always there. Once an a satisfactory dose, the patient may stay at the same pain level for months, even years. What about the danger of overdose? This is next to impossible, since the dose is raised gradually. A patient with a history of drug abuse may find this difficult, but this may be taken care of with different kinds of drugs, more frequent appointments (so the person in question is unlikely to be able to hoard a dangerous amount), and family or friend accountability Won't the patient become lethargic, unable to work? Most likely, the opposite. These are people who have pain all the time. Instead of feeling sick, and wanting to rest, they may feel active for the first time in years. However, progress should be measured in relation to their past amount of activity. One who hasn't worked in years should not be expected to change, immediately. But there is usually some increase in activity, rather than the lethargy and indifference often shown in anti-marijuana mis-infomercials. I'm not saying this is any magic cure. When it is decided that the patient should stop, the drug should be decreased gradually. And patients and doctors should always think of the possibility of the patient's ending up in a place where their drug is not available, or affordable;in

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