Life Arts

The Agony of Pain The Hope of Science

By (about the author)     Permalink       (Page 1 of 2 pages)
Related Topic(s): ; ; , Add Tags Add to My Group(s)

Well Said 1   Interesting 1   Valuable 1  
View Ratings | Rate It Headlined to H4 9/24/13

Become a Fan
  (2 fans)
- Advertisement -

From Rheumatoid Arthritis Fingers
Rheumatoid Arthritis Fingers by david__jones

The Agony of Pain the Hope of Science

Alen J Salerian MD

This article is about the agony of chronic pain and addiction and the hardships faced by physicians treating people with chronic pain and addiction.

We speak the names of "pain doctors" in trouble, in a hushed and nervous way. Our intuition is to avoid the doctors who have stumbled down. Even when a highly respectable doctor suddenly retires after allegations of over prescribing narcotics we look away, we refuse to find out more, we change the topic when the conversation is about pain, pain doctors and personal agonies of doctors and patients in pain.

There are good reasons why we should not continue to ignore the problems associated with pain treatment. First they are very common. Chronic pain is a problem for some 1 20 million people in the United States.  Second the current solutions don't seem to be working. In June 2012 the Institute of medicine released a summary report which said the under treatment of pain is a major national challenge (1).  Third and the single most important reason is the advances in neuroscience.

In this article there will be brief discussions of recent discoveries in neuroscience. It is these brief discussions that represent the basic premise of my belief that science has effective solutions.  It is a widely held belief that the narcotic pain medications are harmful and their benefits are dwarfed by the potential risks including addiction abuse and death.

Nowadays, it is known that harm from the judicious use of narcotic pain medications is impossible as long as the liver functions normally. It is also recognized that the most common alternatives to narcotic pain medications such as surgery or various medications are not risk free. We also know that there is a serious risk of brain injury shown by neuroimaging studies from chronic pain (2).

- Advertisement -

In general the addictive potency of a substance is sensitively dependent upon its property to elicit initial greater and faster euphoria and calm and upon it's withdrawal to induce greater and quicker dysphoria and discomfort (3).

A major discovery has been the significance of withdrawal symptoms in promoting addictive behavior. Any withdrawal associated discomfort is a biological cue for relief and thus a trigger for a fresh intake. Basil and colleagues did some fascinating work on mice. By using bioengineered mice absent of M5 receptors they were able to show that morphine dependent mice may experience analgesia without withdrawal symptoms (4). This finding is consistent with the relatively low addictive potential of long-acting morphine like substances such as methadone and heroin (intramuscular) for pain or addiction.

There are many examples to illustrate the shortcomings of our regulatory guidelines and I shall pick two of them: the death reporting system and the controlled substance s classification system. The death reporting system is inaccurate and exaggerates the deaths from morphine like substances. Wrongly any trace of any morphine like substance in the system is registered as a death because of a narcotic. Thus contributing to a false alarm of narcotic painkiller overdose epidemic.

Thanks to an extraordinary study by Dr. Webster and Dr. Dasgupta the flaws of the reporting system are well documented with practical solutions (5). Of equal significance, our control substance classification system is neither medical nor neuroscientific. The fact is that what we know about pharmacological agents today is very different than what we knew in the 70s. The omission of any pharmacokinetic or pharmacodynamic data compromises the systems validity.

The flaws of the major systems bring us to the core issue: People with pain and addiction and the doctors treating them live in a world of false alarms often vilified for social and medical problems.

- Advertisement -

This also means every physician prescribing controlled substances must watch out.... must remain vigilant to remain off the law enforcement radar.  Reality says it makes sense to avoid red flags (high or frequent prescription of narcotics.) The important thing to note here is that the fear factor may dampen the Hippocratic spirit: The duty to place the need of a patient ahead of all other influences.  The fear factor is toxic. Rooted in survival instincts it compromises sound judgment and individual needs.

In summary, the way we treat people with chronic pain and addiction is wrong. Science, not law must lead neuroscience In Washington DC, Rome Istanbul now or 1000 years from now. Science has the solutions but only if we let science lead the practice of medicine.


Next Page  1  |  2

Alen J. Salerian, MD is a Washington, DC based physician, author, and historian who has been practicing psychiatry and psychopharmacology for 35 years. He is the former chief psychiatrist of the FBI's mobile psychiatric unit. He has authored (more...)

Share on Google Plus Submit to Twitter Add this Page to Facebook! Share on LinkedIn Pin It! Add this Page to Fark! Submit to Reddit Submit to Stumble Upon

Go To Commenting

The views expressed in this article are the sole responsibility of the author and do not necessarily reflect those of this website or its editors.

Follow Me on Twitter

Contact Author Contact Editor View Authors' Articles
- Advertisement -
Google Content Matches:

Most Popular Articles by this Author:     (View All Most Popular Articles by this Author)

An Archaic Foe of Modern Psychiatry: DSM-IV

November 1, 1963

A Death on the Subway and Many Deaths in Washington, D.C.

Newtown and Neuroscience

A Black Hole Between Neuroscience and Mental Illness

Why Do We Have Methadone Clinics?


The time limit for entering new comments on this article has expired.

This limit can be removed. Our paid membership program is designed to give you many benefits, such as removing this time limit. To learn more, please click here.

Comments: Expand   Shrink   Hide  
2 people are discussing this page, with 2 comments
To view all comments:
Expand Comments
(Or you can set your preferences to show all comments, always)

A relevant case readers may be interested in. Robe... by Daniel Geery on Wednesday, Sep 25, 2013 at 1:59:53 PM
Diet, diet, diet is so important.  So many pe... by laurie steele on Friday, Sep 27, 2013 at 8:57:34 PM