LOCAL PAIN SUFFERERS TO GET DOSE OF RELIEF

Guidelines May Reduce Stigma Of Drugs For Chronic Conditions

For sufferers of chronic pain, moments seem to stretch into hours, and just
getting through the day comes as a small miracle.

Some people coping with debilitating headaches and back pain, cancer and
lingering aches that somehow defy diagnosis find little relief through
surgery, physical therapy or alternative therapies such as acupuncture.

Their only remaining option is a strict regimen of the same heavy narcotics
that street addicts crave and pharmacies keep under lock and key.

The medicines are highly effective, but the stigma associated with the
powerful drugs makes some doctors hesitant to prescribe them, and
pharmacies fear that stocking the drugs will make them targets for thieves.

New federal guidelines announced by the Wisconsin Medical Society and the
Drug Enforcement Agency last week aim to change that outlook and bring
relief to more of the estimated 60 million people nationwide who suffer
from chronic pain. The guidelines were developed by the DEA with assistance
of leading doctors in the pain management field.

They list steps for evaluating patients and setting up treatment plans, as
well as outlining the types of nondrug interventions and prescription
therapies available. Doctors are urged to take a complete patient history
and get a sense of the patient's goals for treatment.

Some Lowcountry doctors' approaches to pain management already mirror the
national guidelines, but the plans are expected to bring greater uniformity
to this hot-button medical issue.Physicians involved in keeping terminally
ill patients comfortable in their final weeks or months have been turning
to these powerful painkillers for decades. But doctors admit that care for
long-term sufferers is still lacking.

"We have to listen to the patients," said Dr. Wayne Weart, a professor of
pharmacy and clinical sciences and an associate professor of family
medicine at the Medical University of South Carolina. "If they say they're
in pain, they're in pain, and we have to treat that."

One Charleston-area woman who has struggled with crippling bouts of back,
neck and head pain for the past few years, said that for years, local
doctors failed to heed her pleas for help.

One neurologist labeled her a "drug-seeker" when she called him, writhing
in agony. At that point, all she'd been given for the pain, which came in
blinding spasms up the back of her head and into her eyes, and down her
spine into her legs, was Motrin.

Today, she has a prescription for a powerful combination of OxyContin,
Vicodin and muscle relaxers, which she takes each night before bed to numb
her pain during the day.

"I fought going on them. But I wasn't even functional. I had to do
something," said Diane, who asked that her last name not be used for fear
that friends and colleagues would judge her for depending on narcotics.

So urgent are problems like Diane's that the Joint Commission on
Accreditation of Healthcare Organization has named pain management a top
goal for hospitals across the country, along with emergency preparedness
and addressing the nursing shortage.

Lowcountry residents who seek their doctors' care for pain management
report problems ranging from phantom limb pain -- aches that seem to come
from the place where an amputated limb used to be -- to sports injuries.
Area doctors say lower back pain is especially common.

As new research and drugs become available, treatment methods are evolving.
Instead of treating pain on an as-needed basis, physicians have embraced
long-acting narcotics such as OxyContin and methadone, which are taken
regularly to keep pain at bay.

Most of the medications are taken orally, but newer and better delivery
mechanisms, such as pumps, are a growing trend.

Since these drugs can be dangerous if misused, Dr. Arthur Smith, director
of pain management at MUSC, asks patients to sign a "medication agreement,"
which spells out the exact dosage plan.

"The fewer choices the patient is given, the fewer bad choices they can
make," he said.

Keeping the pills out of the wrong hands remains a chief concern.

Tales of theft by drug-addicted family members and neighborhood junkies are
common across the nation, so doctors often encourage patients to lock up
their medicine and limit access to one or two relatives.

More painkillers are coming onto the market that don't induce the highs
sought by addicts, so the street value of pain medications may eventually
dwindle.

But with drugs such as OxyContin making headlines as the highly abused
"hillbilly heroin," some patients fear that they, too, could become
addicted. Local physicians say that's unlikely.

"The likelihood of addiction, by and large, is very low" for patients,
Smith said. But doctors must take care to adjust dosages to ensure that
patients do not become physically dependent and to account for their
increased tolerance to medications. Patients can be safely weaned off the
drugs, he said.

Positive reports from patients are another indicator that the treatments
are worthwhile.

Dr. Scott Lake, a medical adviser to Hospice of Charleston, recalls one
patient who was so debilitated by lung cancer pain that he was housebound.
After he began the appropriate drug regimen, he began riding his bike again.

Although Diane hasn't been able to return to work, her prescriptions have
transitioned her from being completely bedridden to "functioning as a mom
again."

She has had to reshuffle her priorities to meet the limitations of her
illness, but these days, the smallest things, like being able to attend a
child's school play, are great joys to her.

Doctors also hope t the new pain treatment guidelines will help patients
after surgery. People who take the drugs prescribed to them before leaving
the hospital are less apt to develop pneumonia or blood clots, because the
pain pills enable them to get back on their feet more quickly, Weart said.

For those who suffer chronic pain, doctors hope new therapies and surgeries
will eventually reduce reliance on drugs. In the meantime, educating
physicians and medical students is a top goal.

Even as awareness grows, patients are cautioned that no new drug or
treatment is likely to be a cure-all.

"They have to have realistic goals," Smith said. "It's unlikely that any
medication will entirely eliminate their pain, but they will moderate it to
the point that their life can get better."

What is chronic pain?

Persistent pain over time that hurts enough to interfere with a person's
well-being, ability to function at home or work and general quality of
life. Chronic pain sufferers also may have trouble sleeping or be anxious
or depressed.

What kinds of chronic pain are most common?

Back pain, arthritis, headaches, phantom limb pain, jaw pain and
fibromyalgia, a generalized musculoskeletal pain. Occupational and sports
injuries also may contribute.

How is it treated?

Physical therapy, nonprescription painkillers and surgery are doctors'
first plan of attack. Some sufferers get relief only from a regimen of
long-acting prescription narcotics.

What drugs do doctors prescribe?

Oxycodone (known by the brand names including OxyContin and Percocet),
methadone, morphine and codeine are most common. These drugs can be
administered orally or with injections or pumps like those used by
insulin-dependent diabetics.

Holly Auer covers health and medicine.