Use of Narcotics in Pain Management [00475] Medicine On Line

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Use of Narcotics in Pain Management

To day the practice of medicine relative to pain control management has
regressed to the Dark Age of the Practice of Medicine. 

The Virginia Board of Medicine has this evening revoked the license of
Dr. Hurwitz. His crime, dispensing narcotics for the relief of pain for
chronic pain patients.

It appears that the practice of medicine, when it comes to administering 
care to pain patients, divides the patients into two categories.

1. Those who are dying of cancer probably within 6 months or so and have
chronic pain. The physician knows that there is no hope and will in most
cases prescribe the proper narcotic medications to relieve the pain. When
a cancer patient is on their death bed no one wants them to die with a
grimace on their face. They want them to be pain free and die with a 

2. The cancer pain and chronic pain patients who will live a longer time
perhaps 2 or 3 or 5 or more years. Both types of patients will probably
have had operations. Tumor and or tissue/muscle mass removal in the case
of cancer. Operations such as spinal, reconstruction due to an accident,
or other which causes permanent pain to the body. This type of patient may
be sent to a pain clinic for biofeedback therapy, psychological therapy,
etc. with a minimal amount of pain medication. They are in constant pain.

In #2 physicians do not want to prescribe large amounts of narcotics
because they say that the patient will become an addict. This may be true
in some cases, but in most this is not true. I quote the following taken
from the 1996 edition of PDR Generics:

"In chronic pain patients and in narcotic-tolerance cancer patients, the
administration of Morphine Sulfate should be guided by the degree of
tolerance manifested. Physical dependence, per se, is no ordinarily a
concern when one is dealing with opiod-tolerant patients whose pain and
suffering is associated with an irreversible illness."

If the medical profession would take the time to monitor the patient and
titrate the narcotic dose to the individual patient then the amount of
prescribed narcotics would be reduced. Again I quote from the same 

"The chance of drug dependence is substantially reduced when the patient is
placed on scheduled narcotic programs instead of a "pain to relief-of-pain"
cycle typical of a PRN regimen."

The decision of the Virginia Board of Medicine will have a ripple effect
through this country. Physicians will further reduce the number of 
narcotic prescriptions they write. Who will suffer? Those of you who are
in pain be it minor or major. I suggest that all who read this send Email
to the President, Vice President, Senate and House of Representatives.
Perhaps those of you who have experienced or who now have chronic pain
can effect a positive solution.


* Arnold Smokler, Pharmacist, Pharmacologist & Computer Consultant     *
* Chairman, Waldenstrom's Macroglobulinemia Support Group (WMSG)       * 
* Email Phone:703-321-8888 FAX:703-321-8920 * 
* Visit my home page at       *
* Visit the WMSG home page at   *