Commentary

PATIENTS HAVE A RIGHT TO KNOW PAIN LEVEL THEY MAY ENCOUNTER

The dozens of letters, phone calls and e-mail messages I've received since
writing my about total knee replacement and pain management reveal that I
struck a chord.

Some readers chastised me for scaring potential patients away from this
surgery, which, when healing is completed, can greatly enhance quality of
life. Many others praised me for "telling it like it is" about an often
painful and difficult recovery that surgeons do not warn patients about.

Clearly I have not been alone in having prolonged, debilitating
postoperative pain that was not adequately treated. But obviously, many
people have had total knee replacements without experiencing the kind of
pain I suffered.

To those readers who fear that I unduly frightened prospective knee
replacement candidates away from this life-enhancing surgery, I must say
that was neither my intent nor my message. My message was that whatever
procedure a patient faces, full disclosure is imperative. People have a
right to know what they may encounter, not just what the surgeon hopes will
happen.

An orthopedic surgeon called after reading my article to say that he tried
to inform patients fully who asked about knee replacement. As a result, he
said, he scares some people off, and the chief of surgery at his hospital
has complained that he does not do this operation often enough.

This is outrageous and just reveals the monetary motives behind much of
modern medicine. The patient be damned; just bring in the bucks.

So here is the good news: At 10 weeks post-op, I insisted that the surgeon
take another look at me because I was convinced that there was something
wrong with my right knee. The left, the most severely afflicted with
arthritis going in, was at last healing nicely, but the right continued to
keep me tied to potent painkillers.

Tendinitis Is Tamed

As it turned out, I had tendinitis, a seriously inflamed tendon across the
outside of the kneecap that was aggravated with every bend of that knee.
All it took was a shot of cortisone to bring relief and get the healing
process back on track.I just wish that my weekly complaints of disabling
pain in that knee had been acted upon much sooner. The day after the shot,
I was able to walk half a mile each way to my local Y and resume my daily swim.

Yes, I still take medication, but much less than before, and I still have
to rest from time to time. But I now anticipate the day when I can resume
riding my bicycle and walking around the park, hiking and ice skating with
my friends.

Prescribing Narcotics

I am certainly not alone in wishing I'd been prepared for a difficult recovery.

Here is what one reader who had total knee replacement wrote: "I wish I had
known how incapacitating the recovery period would be so that I could have
planned accordingly. It would not have changed my resolve to have the
procedure -- only my planning for its aftermath."

Another surgeon wrote to me about doctors' fear of legal action over
prescribing narcotics. Yes, the government has unfairly attacked some pain
management specialists who treat dozens of patients with chronic pain.

It is not true that pain patients get hooked on narcotics, craving ever
greater doses. Addicts get hooked; pain patients need increasing doses only
when their pain worsens, as often happens to those with advanced cancer.

As Dr. Laura Lewis Mantell of New York wrote to me, "The use of opioid
analgesics (narcotics) need not be avoided out of concerns that addiction
will ensue, because the incidence of addiction arising out of postoperative
exposure to opioids is negligible."

More Empathy Needed

Undertreatment of pain is already a public health crisis, and the
government should act to improve the situation, not make it worse.
Undertreated pain destroys lives. As one young woman put it in an e-mail
message: "The effect of pain had an insidious effect on my life, my
outlook, my well-being and my relationships in every sphere of my life.
Pain is a funny thing. Unless you're the one feeling it, it's basically
meaningless."

The time is long overdue to instill empathy, not fear of persecution, into
the nation's physicians.