Treating pain

I have blogged about this problem previously, but this essay does a nice job of putting this problem into perspective. Doctors Behind Bars: Treating Pain Is Now Risky Business

This story is generalizable to the problems of medical care. Becoming the “right decision” is rarely clear.

Over the last decade or so, pain specialists and patient advocates have diligently educated doctors about the undertreatment of persistent and debilitating pain. But as physicians have expanded their use of opiate painkillers like oxycodone and hydrocone, the abuse and diversion of the drugs has also increased. This, in turn, has led the Drug Enforcement Administration to intensify its scrutiny of physicians.

The result is a clash of imperatives: The doctor’s job is to treat pain; the drug agency’s is to stop the diversion of prescription drugs for illicit use. And resolving this conflict has become a pressing matter for doctors, pharmacists, law enforcement officials and patient advocates alike.

“Pain management has become a crime story when it really should be a health care story,” said David Joranson, director of the Pain and Policy Studies Group at the University of Wisconsin.

No one questions that abuse of opiate painkillers is a problem. But federal and state law enforcement agents, who wield considerable power in deciding whether to initiate investigations, as well as the prosecutors and jurors who determine a doctor’s fate if the case goes to trial, are often misled by obsolete ideas about the practice of pain medicine and the effects of opiate drugs.

Pain treatment itself is an area ripe for misinterpretation. Many patients who seek doctors’ help have already tried nonsteroid anti-inflammatory drugs, conventional opiates like codeine and even surgery, yet they are still in severe pain from cancer, degenerative arthritis, nerve damage or other conditions. Large doses of medicines like hydrocodone (Vicodin), oxycodone (OxyContin), morphine or methadone may be required.

So we are damned if we do and damned if we do not. And that is medical practice in 2004.