CHRONIC PAIN UNDERTREATED, EXPERT SAYS

Many Americans with chronic pain don't receive the treatment they need
because of "misapplied" fears about addiction, an expert in the field
told an ethics conference Saturday at Creighton University in Omaha.

Those fears include doctors' and patients' concerns that the use of
narcotic painkillers would lead to substance abuse, and doctors'
worries about legal problems, said Dr. Steven D. Passik, a
psychologist who is director of oncology symptom control research at
the Indiana Community Cancer Care Center in Indianapolis.

He said these are major factors in what he described as a "dramatic
undertreatment" of chronic pain.

Passik, whose research has included the palliative care of AIDS and
cancer patients, was one of several speakers to address aspects of
suffering at the Saturday conference, sponsored by Creighton's Center
for Health Policy and Ethics.

Many of the 110 people in attendance from Nebraska and surrounding
states serve on ethics committees at hospitals and other health-care
institutions. Such committees often are involved in drafting or
reviewing their institutions' policies for patient treatment, said
Ruth Purtilo, director of the Center for Health Policy and Ethics.

The fact that ethics committees are discussing such issues is good
news for the general public, said Dr. Robert McQuillan, vice chairman
of the Department of Anesthesiology at the Creighton University School
of Medicine. He also is the medical director of the Pain Control
Center of St. Joseph Regional Health System, and a member of St.
Joseph Hospital's ethics committee.

Most experts agree that patients' pain is undertreated, he said. Yet
the situation continues, in part because of doctors' fears that they
will be disciplined for prescribing such painkilling drugs as morphine
in large-enough dosages and also due to societal fears about narcotics.

McQuillan said medical licensing boards in some states have
aggressively gone after doctors for prescribing such "opioids" for
pain. That has not been the case in Nebraska, he said. Even so,
McQuillan said doctors have told him that they have shied away from
aggressively treating pain because of fear of disciplinary action.

Passik said research, including his own, has shown that the risk of
addiction to painkillers is not nearly as great as it is assumed to
be.