PAIN TREATMENT DOES NOT EQUAL DRUG ABUSE

Drug abuse and undertreated pain are both serious public health crises, but
the solution to one should not worsen the other.

Laura Landro's July 13 article, "The Informed Patient: Patients Press
Doctors on Pain Issues," brought forward some of the more relevant issues
faced by physicians who treat patients for pain.

It was refreshing to read an article that addressed these topics head on,
especially in regard to the legal risks that many physicians perceive as
they consider prescribing strong medicines for pain. The lack of pain-care
education for general practitioners is partially responsible for hesitancy
in prescribing opioid medications, leaving patients with cancer and other
acute and chronic disorders undertreated due to overcautious physicians.
Appropriate education for physicians as well as for patients can relieve
many of these fears of addiction.

Although medicine has succeeded at curing diseases and extending life, your
article highlights the fact that we have not done as well at improving
quality of life. It was noted that chronic pain is estimated to affect more
than 50 million Americans, and recent polls have shown that the majority of
these individuals are older people -- suggesting that our "cure-focused"
medical system is now at risk of creating victims of our own success.

Your readers should know that there is a specialty branch of medicine with
physicians who are experts in the care of hard-to-treat pain. This
specialty, called Pain Medicine, uses a comprehensive and integrated
approach that applies a variety of techniques from different areas of
medical expertise.

While your article focused on medications, medications are only part of the
arsenal of pain-reliving treatments, which spans from psychological
approaches (such as biofeedback, hypnosis and behavior modification) to
injections and even surgically-implantable devices in the spinal cord. This
is a new and growing specialty that needs increased public recognition and
an official place within organized medicine.

If patients are to have the option of pain control when it is needed most,
we must avoid unnecessarily putting physicians in the middle of two heated
health-care crises.

Neither the serious epidemics of drug abuse nor undertreated pain are
helped by trying to solve one problem at the expense of the other.

Shifting governmental roles in pain care from health agencies to law
enforcement -- focusing on preventing drug abuse rather than easing
suffering -- is unlikely to help either of these problems.

Targeting doctors as criminals has an unfortunate chilling effect on the
average willingness to treat pain and suffering.

Appropriate medical decisions, including those involving legitimate use of
strong pain relievers, should not be dictated by the actions of the DEA or
other branches of law enforcement, but must remain in the hands of medical
professionals. That way, patients can trust that their physicians are free
to respond to their suffering and prescribe medicines that are in their
best interests.

Scott M. Fishman, M.D.

Chief, Division of Pain Medicine Professor of Anesthesiology

University of California, Davis Davis, Calif.

(Dr. Fishman is president of the American Academy of Pain Medicine, author
of "The War on Pain" and co-author of "The Massachusetts General Hospital
Handbook of Pain Management and Essentials of Pain Medicine.")