EXPERT: DON'T USE NARCOTICS AS SOLE PAIN CURE

The Observer interviewed Dr. Mark Romanoff, a respected Charlotte pain
specialist, about pain, the use of narcotics, and addiction.

Q. What causes chronic pain, and at what point should a patient seek a pain
specialist?

Chronic pain is pain that lasts two to three months longer than usually
expected from the event that caused it. Any pain that lasts over six months
is considered chronic. There are many causes of chronic pain. It may be
related to soft tissue injury, nerve damage, arthritis, muscle spasm,
degeneration of discs or a combination of all of these.

Most aches and pains will improve by themselves, with ice or heat, rest and
anti-inflammatory agents. If the pain persists, then it would be reasonable
to see a pain specialist.

Q. How is pain generally treated?

Pain treatment should combine many different approaches including
medications, injections or nerve blocks, as well as physical therapy and
counseling. There are many types of medications used to treat pain.

Nerve blocks or injections can help diagnose exactly which nerve is
involved in the pain process. These injections contain local anesthetic and
usually a steroid medication. The combination helps to break the "pain
cycle" and decreases inflammation and swelling of nerves. The injections
often provide long-term pain relief and can help the medications work more
effectively.

Physical therapy is important to help with muscle spasm, stabilize the
spine and improve the use of the extremities.

Q. At what point should narcotic painkillers be used?

Narcotics are potent pain relievers derived from opium and should only be
used for severe pain. Often they can provide pain relief when no other
medications can, but they have limitations and serious side effects. It
should be stressed that narcotics alone should never be used to treat
chronic pain.

Q. Should patients be wary of a powerful pill like OxyContin?

Patients and physicians should always be aware of any medication used to
treat pain. Narcotics are no exception. All narcotics have significant side
effects including, swelling, nausea, vomiting, constipation and itching.
The most serious side effect is slowing or stopping breathing.

Another risk is that of addiction. Addiction is defined as taking a
medication that you know is harming you, taking an illegal substance, or
becoming so preoccupied by the medication that your work or life suffers.
In most patients the risk of becoming addicted is less than 1 in 10,000.
The risk of addiction is higher when short-acting narcotics are used, such
as Vicodin, Lorcet and Percocet. These are the brand names of hydrocodone
or oxycodone. Long lasting narcotics give a more stable blood level, this
provides more consistent pain relief, less side effects and limits the risk
of addiction. Long acting narcotics include: OxyContin, MS Contin,
Duragesic patches, Kadian and methadone.

Q. Does everyone taking narcotics run the risk of becoming addicted?

The risk of addiction is low, if you take the medication exactly as
prescribed. It is important to understand the difference between addiction
and a withdrawal syndrome. Some people think that if you abruptly stop
narcotics and you experience withdrawal (chills, nausea, muscle aches) that
you are addicted to the narcotic. This is not true.

Addiction is using a medicine in a way that harms you. A withdrawal
syndrome can occur with many different medications. In some patients,
medicines become less effective over time. This is called tolerance. It can
happen with narcotics as well. But what we have found is that once we find
the right dose of narcotic, that dose works well for many years.

Q. What safeguards do you put in place to make sure patients aren't abusing
their pills?

To prevent problems, our pain clinic has patients sign a narcotic
agreement. This agreement allows only one physician to prescribe narcotics.
Taking more medication than prescribed, selling medication, receiving other
narcotics by "doctor shopping," or refusing a random drug screen are all
signs of addiction and grounds to have the narcotics stopped.

Q. Does chronic pain ever go away?

Unfortunately the nerves, spinal cord and brain respond poorly to chronic
pain. If you have pain for a long time, you are more likely to continue
having pain. This happens because there are chemical changes that occur in
nerve cells that make them more sensitive to pain input over time. In fact,
recent studies have shown DNA changes in the spinal cord in chronic pain
patients. New DNA is activated in these patients and this amplifies the
normal pain response. That is why it is so important to seek treatment early.

Mark Romanoff, M.D., is an anesthesiologist and pain specialist at
Southeast Pain Care of Charlotte, a division of Southeast Anesthesiology
Consultants. He's been in practice almost 15 years and is board-certified
in anesthesiology and pain management.