IS CHRONIC PAIN NECESSARY?

Millions of Americans cope with persistent pain that goes untreated or is
inadequately treated, even though the means exist to bring them relief.
Arthur Rosenfeld - author of the new book "The Truth About Chronic Pain" -
explores the world of the pain patient and suggests how to make it better.

"OFTEN, IT FEELS AS IF MY ARM, my leg and the left side of my face are on
fire" says Esther Reiter of Chicago.

"When that pain starts, it doesn't stop, though I can block it when I sleep."

Reiter, 60 - who has a brain condition called thalamic pain syndrome - is
one of an estimated 50 million Americans who cope daily with pain, often
disabling. Many suffer needlessly and lead unnecessarily restrict-ed lives
because they do not get the relief they need.

Chronic pain takes over lives. Reiter calls pain "an adversary I must
continually fight in order to function." While she has access to the strong
medications she needs to cope, her pain never goes away completely. For 19
years, it has ruled her daily activities. "I'm in extreme pain when I wake
up," she says. "if I have to be somewhere at 9 am., I have to getup at 5:30
or 6, take medication, rest while it takes effect, then get up again and
shower."

Pain also is a key factor in her relations with others. "1have to be
careful," she says. "Talking about it with friends carries the danger of
burdening the friendship. People feel badly when you're in pain. It can
become a barrier.

"It's an enormous part of who I am. That bothers me. I don't want to be
'the person in pain.' I don't want to be pitied."

Hal E. Garner, 4l, of N. Logan, Utah was a promising player with the
Buffalo Bills when a spinal injury ended his football career and propelled
him into the world of a chronic-pain patient.

Gamer lived with pain for 12 years before he found effective therapy. He
felt pressure to adopt a stoic posture. 'Everyone gets sick of hearing how
you hurt," be says. 'I had to paint a smile on my face every day.

"People think you're making it up. They want you to see a psychiatrist. But
this pain is real. It comes from rods in my back and scar tissue pressing
on nerves. It was hard to sleep, to get out of bed in the morning, go to
work day to day and make a living-and keep everybody happy."

Today, Garner has a pump that delivers strong medication directly into his
spine. A specialist helps him to manage his pain. "Now" he says, 'I don't
have to put on a smile or make excuses for myself."

Why Pain Patients Don't Get Better Treatment.

Ideally, alleviating chronic pain is a straightforward exercise of human
kindness. Instead, "pain management" has become a battle ground of
conflicting agendas and priorities among doctors, patient advocates,
government regulators and the insurance companies.

A key issue is the widespread fear of addiction.

"Hooked" on Painkillers?

The medications that help Reiter and Garner are called opioid analgesics.
Related to morphine, one of the strongest painkillers known, they are
generally safe and effective. They're not for everyone, but for many, these
drugs are a god-send. (Treatments such as hypnosis, biofeedback, surgery,
physical therapy and acupuncture also can help.)

Yet not everyone who needs these drugs gets them. Many doctors are
reluctant to prescribe opioids for fear that their patients will become
addicts. Addiction is a serious disease with psychological, social and
probably genetic roots. Dependence is an unavoidable side-effect. While
pain patients may become physically dependent on medications, research
shows that addiction is uncommon unless there is a previous history of
substance abuse. The pain patient depends on the drug the way a diabetic
depends on insulin. Misunderstanding this difference creates problems.

"When you tell somebody you take an opioid" says Reiter, "they look at you
like, 'Oh, my goodness, she's going to become addicted!' But I don't use
drugs, I take medication. I'm not addicted; I'm dependent. And I monitor
myself carefully."

"I ran into prejudices at every job I went to," says Gamer. "I was seen as
addicted to medications."

Some doctors withhold or under-prescribe opioid painkillers because they
are wary of scrutiny by state medical boards (some states set dosage limits
for these drugs) and the Drug Enforcement Agency. In the climate created by
the "war on drugs," a person reporting pain whose cause can not be
determined may be suspected of seeking a prescription for a controlled
substance.

"They thought I was faking pain." Mathew Rudes, 17, of Northridge, Calif.
was born with severe infantile Marfan syndrome - an often lethal
connective-tissue disease that also affects the heart, blood vessels, eyes
and skin. Multiple surgeries and other procedures saved his life but Rudes
had recurrent episodes of severe spinal pain that doctors could not
diagnose. Many didn't believe it was real. "They'd do scans, X-rays and
other tests, and they'd come up negative" Rudes says. "The doctors thought
I was faking it. That made me really angry."

He is now under the care of a pain specialist, who prescribes effective
medications and monitors his dosage weekly. Mathew is an 11th-grade honor
student. "I have a 4.O grade average" he says.

The Cost of Relief.

Finding the best treatment often requires a trial-and-error process. Few
treatments are cheap, and health plans may put caps on how much they will
pay and for how long. A patient who needs a costly medication for a
lifetime may be covered for only six months.

What Needs to Change.

If chronic pain is to be defeated, say pain care professionals, people need
to understand that pain can have wide-ranging effects and hidden causes. We
need to be clear on the difference between addiction and dependence. The
romance with stoicism must go. Above all, more compassion is needed - from
doctors, legislators, insur-ers and everyone else - so that chronic pain
receives as much attention as drug abuse. We must stop judging sufferers
and see pain for what it is: a part of life. It could happen to any of us.