TREATING PAIN DIFFICULT

Several physicians have been accused of drug trafficking and other
crimes for prescribing pain medications.

This is neither to accuse nor defend them; it is simply to inform how
difficult it is for a doctor to diagnose chronic pain, and how
frequently he/she may be placed in no-win situations.

Pain is a subjective feeling; people perceive it in different ways.
The same injury that for one person may be trivial and requires
nothing or just an aspirin, for others may cause excruciating pain.

There are no chemical or radiological tests that can confirm pain.

Moreover, pain-free patients can have MRIs, CT-scans and X-rays that
are abnormal, while people with severe pain can have normal studies.

The only two tools available to a physician to determine if a patient
is in pain are the history that the patients provide and the physical
examination -- the same tools that have been available for millennia.

Physicians are trained to accept this information as truthful.

It accounts for 90 percent clue to the diagnosis; the examination adds
10 percent.

Do patients lie to us? Yes.

Can they fake pain during examination? Yes.

Is every pain patient a drug addict? No, but many are and those are
remarkably good at fooling us.

Do some docs prescribe it for profit? Probably.

However, a doctor's mission is help and relief, therefore we trust
patients and write a prescription with instructions as to how to use
it.

It is beyond the doctor's control if the patient takes more or less
pills, mixes them with alcohol and/or other drugs.

Apparently the law does not see it that way, while we are constantly
reminded at seminars and medical literature of how lousy a job we are
doing in treating pain.

It is great to be retired.

Percy D. Kepfer, M.D.,

Fort Pierce