Hurts so bad: Pain drugs create quandary

Cybill Shepherd and Bruce Willis were steamy until they actually "got steamy" on Moonlighting. Why is it when the boy catches the girl, the magic of the show is gone? Look at The Bachelor– proposal, diamond ring, and poof– end of show and the couple– or even worse, gulp, The Bachelorette II. In Moonlighting, Cybill's character says to Bruce, "Do you know what real pain is?" He replies, "Sure I do. When you get a pimple inside your nose."

It's a good question. What is a doctor to do when his or her patient has chronic pain?

Doctors are going to jail for over-prescribing narcotics for pain control. Over 400 physicians have recently been taken to court for writing prescriptions for narcotics. The Drug Enforcement Agency monitors prescribing habits of physicians, and there are a few Virginia doctors in the news who are in trouble with the DEA. At the same time, doctors are being sued for under-prescribing narcotics by patients. Damned if you do, damned if you don't. It's like being a politician.

About one-third of people in our country have used illegal drugs. (Does it count if you don't inhale?) About 10 percent have a substance abuse disorder. The dictionary says drug abuse is "compulsive use of a substance resulting in physical, psychological, or social harm to the user and continued use despite that harm."

What happens when a patient is in pain and needs pain medication? In cancer patients, the answer is easy: if they need narcotics, they get them. For those with chronic pain without cancer, it is still controversial whether narcotics should be used when other medications and modalities are not successful.

The main problem physicians like me have with narcotics is, "When is the patient faking pain to get narcotics?" If a patient tells me he's in pain, he's in pain. I cannot disprove it, nor should I try.

"I'm in pain, Doc." "No, you're not." "Yes, I am." "No, you're not." "Am too!"

Before you know it, a big pillow fight breaks out.

There are addicted patients who might not even know they're addicted. These patients complain of pain that really isn't pain from the original problem but is the mind and body's craving for narcotics. Once I had a patient in the hospital pass out on me saying, "I need just a little more dem... Demerol..." Snore. I had another patient on so many narcotics you could get high just inhaling her breath, but she kept saying, "I'm in a lot of pain, sugarplum," with a big smile on her stoned face– like Courtney Love at the Oscars.

Also, physical tolerance can develop so that higher doses of narcotics are required to get the same effect. Hmmm, kind of like inflation and gas prices. This is one reason I don't like narcotics.

For the majority of people in severe pain, taking a Percocet is as addictive as taking a Flintstones Vitamin. However, others become as addicted to narcotics as Oprah is to sugar.

We've all heard the classic stories about a person with pain problems who initially started a narcotic that led to addiction: Elizabeth Taylor, Elvis Presley, and a hypocritical hateful radio personality...

I fear for the future of American medicine for many reasons. Smart people don't want the hassles of malpractice, lower pay, longer hours, and the threat of going to jail. I know I would not survive as well as Martha Stewart did.

Many doctors do not feel comfortable prescribing narcotics, and, in fact, many practices do not prescribe narcotics on a long-term basis.

Sounds painful, doesn't it?

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