Chronic Pain: In Defence Of Morphine
News Desk
I've talked about my own chronic pain a couple of times in this space
in the past, so I'm not going to go into details of my own condition
again. ...
Chronic Pain: In Defence Of Morphine
June 19, 2006
Richard Marcus
>From Chocolate to Morphine : Everything You Need to Know About
Mind-Altering Drugs
Andrew T. Weil
I've talked about my own chronic pain a couple of times in this space
in the past, so I'm not going to go into details of my own condition
again. Having had one case of acute pain cured, and now living with
what looks like a far more intractable situation, I'm well aware of the
difficulties presented by the circumstances of the condition for both
the sufferer and their caregivers.
Sufferers of acute non-malignant chronic pain, in other words you're
not going to die from it, very often have nothing discernibly wrong
with them. Nothing shows up on any type of scan, be it x-ray, nuclear
medicine, or any other test they can think of to inflict on the
patient. As a result the sufferer is sometimes faced with the
additional burden of having to prove the veracity of their claim to
illness.
Most Family Doctors are not in a position to treat chronic pain. Even
though they can play a key role in the treatment of a patient's
symptoms, they simply do not have the wherewithal to do more than
monitor pain levels and prescribe analgesics. But if a client's doctor
is unsympathetic towards the patient, or of the belief that
non-malignant pain is not worthy of proper medication, a person could
find them self suffering far more than necessary.
It is quite amazing how when a patient is admitted into hospital, or
even held in emergency for any length of time, and experiencing pain,
they have no hesitation in giving them morphine to relieve their pain.
They never seem to worry about you becoming addicted, even if you spend
an extended period of time in their care. They're just trying to make
you as comfortable as possible.
The first time I was hospitalized for my pain condition, I expressed
concern to a nurse about being given morphine. I have a history of
substance abuse and figured the last thing I needed was to risk
becoming hooked on anything. She told me that there was nothing to
worry about because as long as I was in pain I wouldn't develop a
psychological dependence on the drug.
>From my own perspective I've never enjoyed taking the drug, and can't
see how anybody would want to utilize it for getting high. When taken
for immediate relief it most likely will cause you to fall asleep, thus
allowing you to escape from the pain you are in. In some instances it
can actually cause you to feel like you are disassociating, separating
from your body, so you still know you're in pain, but don't really
care.
The best way to prevent any sort of addiction from happening is to
ensure the body is never placed in the situation of having to crave the
medication. In the case of painkillers like morphine it is essential
for the client who will be utilizing it on a long-term basis to have a
pain threshold established. What amount of the drug will maintain a
comfort level for them on a daily basis?
This can easily be established by discovering how many doses a day a
client needs to take of the five to ten milligram pills in order to be
comfortable. Once established the patient is switched over to a slow
release product that maintains their comfort level at all times. They
are given a supply of short term medication for periods when the pain
peaks - "breakthrough" - but it shouldn't be necessary for those to
be taken more than once or twice a day. If they do start having to use
the breakthrough medication more often than that, their long-term
medication is adjusted accordingly to reflect the usage.
In this manner the person doesn't develop a "need" to take morphine on
a frequent basis and the possibility of addiction is removed. Of course
that doesn't mean it won't occur. There are always people who will
abuse a situation, and there are doctors who won't make the effort to
work out a proper drug maintenance program with their clients, both of
which could result in a client becoming addicted.
But since the same scenario is possible with drugs other than morphine,
muscle relaxants and tranquilizers for instance, I really can't figure
out why people get so freaked out about it. It's not so surprising from
lay people, I was nervous about it because I had believed everything I
had been told about how dangerous it was, so why shouldn't others be.
What shocks me are the medical professionals who are still perpetuating
the myth and refuse to prescribe it for their patients unless they are
dying, and even then they worry about addiction.
I kid you not. I have friends who are palliative care nurses who have
had to argue with doctors to increase the dosage of people dying from
horribly painful cancers. Here's an instance where the best thing a
doctor can do for their patient is to make the passage out of this
world as easy as possible, maybe even prescribing them heroin, but they
won't because they are worried about them becoming addicted. (In
Canada, as far as I know - this may be hearsay - it is legal for a
doctor to prescribe heroin in certain circumstances for pain, but
because doctors haven't in the past, the pharmaceutical companies won't
carry it. So even if a doctor wanted to utilize it for a patient now he
couldn't because it wouldn't be available.) How ridiculous is that?
Thankfully there are fewer and fewer people in the medical profession
who have such antiquated beliefs, but unfortunately you still run up
against them now and again. Nothing quite does your self-esteem as much
damage as to be in agony and be treated like a junkie at the same time.
It's probably no coincidence these are invariably the same doctors who
tend to say things like "It's only a little pain, what's your problem?"
A few years ago my wife was having one of her wisdom teeth extracted.
To say she was a little nervous about the procedure was an
understatement; she hadn't had very pleasant experiences with dentists
prior to this time. Five minutes after he started the dentist was
finished and she hadn't felt a thing. He also made sure to give her a
prescription for pain medication in the event she needed it.
When she made some comment about the difference in treatment she had
received this time as opposed to previous occasions, the dentist
responded by saying, "In this day and age there is no excuse for
anybody to suffer from pain." Now he was only referring to dental
procedures, which is a refreshing enough attitude on its own, but that
should be the refrain of the whole medical profession.
With the medications at our disposal, and the increased sophistication
of their delivery, (you can now get a morphine patch which works like a
nicotine patch and the drug is slowly absorbed into your system that
way) there should be no reason why anybody need suffer from untreated
pain. Whether you have a chronic condition, or it's only temporary, you
deserve to have your suffering alleviated as much as possible.
It doesn't matter if you are suffering from a chronic pain condition,
or you are watching a loved one being crippled by pain, there is
nothing worse than knowing that the means of reducing the suffering is
being denied. Whether pain is a symptom that will clear up when a
solution is found, or it is caused by some permanent damage to the
system that may never be resolved should be immaterial to its
treatment.
Only recently has non-malignant chronic pain been considered serious
enough to warrant specialist attention. But even now the only medical
professionals who work in the field are usually anesthetists. Since
they already have one specialty, the amount of time they can put into
this work is limited, (the doctor I see has only one clinic every two
weeks), and waiting lists to see them can be substantial.
The fact that they have chronic pain clinics is a step in the right
direction, but it's not enough. The study and treatment of pain needs
to be recognized as a distinct branch of medicine, not merely the
secondary practice of already busy people. Until chronic pain is seen
as a legitimate illness at all levels of society, and outmoded fears
and prejudices are abandoned, people will continue to suffer
needlessly.
[photo]
Richard Marcus is a long - haired Canadian iconoclast who writes
reviews and opines on the world as he sees it at Leap In The Dark and
Desicritics
http://blogcritics.org/archives/2006/06/19/165435.php
***