SUPPORT FOR HIGH DOSES TO KILL PAIN

WASHINGTON (Reuters) -- The majority of Americans support the use of high
doses of pain medication such as morphine for the treatment of severe pain,
according to a survey released Wednesday.

The survey of 1,000 Americans' attitudes toward pain was commissioned by
the Mayday Fund, a New York City-based foundation. The researchers found
that 70% of Americans questioned supported high doses of strong analgesic
drugs in the treatment of severe pain, even when presented with the risk of
addiction.

While anywhere from 30% to 70% of cancer patients have chronic pain, 40% of
those patients will be undertreated, said Dr. Russell Portenoy, chairman of
the Department of Pain Medicine and Palliative Care at Beth Israel Medical
Center in New York. Portenoy also estimated that as many as 85% of patients
with AIDS-related pain are undertreated.

Portenoy cited several reasons for the undertreatment trends: there is
limited training in the field of pain management, pain is a low priority
for many clinicians, there is a limited amount of time to deliver care, and
there is an overestimation of treatment risks such as addiction. Portenoy
also said that patients don't report pain often enough because they try to
be stoic or "the good patient."

The Mayday survey found that 44% of individuals believe that doctors are
prescribing the right amount of pain medication and 38% believe they are
prescribing too much. But in fact, Portenoy said that there remains "a
striking level of misunderstanding" among medical practitioners of the
risks and benefits of opioid pain killers, leading to undertreatment.

The predominant perception, Portenoy said, is that "patients who are given
opioid drugs often become addicted and have substantial risk of serious
adverse effects." Although he says that attitude is changing, doctors still
mislabel addiction and "frighten their patients needlessly."

Part of the reason for undertreatment stems from fears physicians have
about losing their medical license for prescribing controlled substances.
Sandra Johnson, law professor at the Center for Health Law Studies at the
St. Louis University School of Law, says physicians repeatedly report that
they are afraid to treat pain in patients because they fear they will be
investigated and will lose their practice license. "Our research has
revealed that the legislative system has produced an environment of fear"
around pain treatment, she said.

Johnson said that State Medical Boards are particularly aggressive in
pursuing physicians that they think are overprescribing these substances.
But often their investigations focus on volume or length of time for
prescription rather than on the kinds of conditions the doctor is treating.
States are beginning to change, she said. Fourteen have passed intractable
pain treatment acts that gives physicians more leeway in treating patients
who need pain medication. Also the Federation of State Medical Boards is
developing guidelines to improvement the enforcement of pain relief. But
she says "the fear of losing their license is so deeply ingrained in the
medical profession that it is going to take extraordinary efforts to
unbalance this."

The surveyors also found that although 91% of people believed that
prescription drugs are the best way to relieve pain, 80% of people
preferred to try nondrug alternatives to relieve pain before resorting to
medication. These alternative therapies include exercise, massage, and
relaxation therapies.

Half of those questioned reported experiencing pain in the two weeks prior
to the survey, with head and back pain most commonly reported. And one out
of six US households includes an individual with severe chronic pain,
according to the report.

The survey also found that 33% of people thought they could withstand a lot
more pain than most. And over half (62%) said they would rather bear pain
than take action to relieve it.

Copyright © 1997 Reuters Limited.