MISUNDERSTOOD CLASS OF DRUGS CAN SOOTHE CHRONIC PAIN SAFELY

Chronic pain suffered by 30 million Americans robs people of their dignity,
personality, productivity and ability to enjoy life. It is the single most
common reason people go to doctors.

Yet chronic pain, whether caused by cancer or a host of non-malignant
conditions, is seriously undertreated, largely because doctors are
reluctant to prescribe -- and patients are reluctant to take -- the drugs
that are best able to relieve persistent, debilitating, disabling pain that
fails to respond to the usual treatments.

These drugs are called opioids -- narcotics -- and many studies have
indicated that ignorance and misunderstanding impede their appropriate use.

"Some patients who experience sustained unrelieved pain suffer because pain
changes who they are," wrote Dr. C. Richard Chapman of the University of
Utah School of Medicine and Dr. Jonathan Gavrin of the University of
Washington School of Medicine.

Chronic pain, they wrote in the Lancet medical journal, results in "an
extended and destructive stress response" characterized by brain hormone
abnormalities, fatigue, mood disorders, muscle pain and impaired mental and
physical performance.

Neurochemical changes caused by persistent pain perpetuate the pain cycle
by increasing a person's sensitivity to pain and by causing pain in areas
of the body that would not ordinarily hurt.

Dr. Jennifer P. Schneider, a specialist in addiction medicine and pain
management in Tucson, Ariz., agrees. "When patients feel hopeless and think
they will never get relief, it makes chronic pain and its effects that much
worse," she said.

Far too little has been done to correct the misunderstandings that stand in
the way of using opioids to control chronic pain. Nowadays, doctors are
more inclined to use narcotics for pain relief in patients with advanced
cancer, assuming erroneously that "since they're dying anyway, it won't
matter if they become addicts." But the reluctance to use opioids for
non-cancer-pain patients persists, and patients are equally likely to
resist taking them.

"Like most doctors, most patients are relatively uninformed about the
safety of using narcotics for pain, thinking they're dangerous drugs that
will do bad things to them," Schneider explained. "They don't understand
the difference between physical dependence and addiction, and as a result
they're afraid they'll become addicts."

In three studies involving nearly 25,000 patients treated with opioids who
had no history of drug abuse, only seven cases of addiction resulted from
the treatment.

Physical dependence, whether to an opioid or to an immune-suppressing drug
like prednisone, involves reversible changes in body tissues. To avert
withdrawal symptoms, the medication must be stopped gradually. Addiction is
mainly a psychological and behavioral disorder. Schneider described the
hallmarks of addiction, whether to alcohol or narcotics, as loss of control
over use, continuing use despite adverse consequences and obsession or
preoccupation with the substance.

Unlike an addict, whose life becomes increasingly constricted by an
obsession with drug use, a patient using the drug for pain experiences an
expansion of life when relief comes from this life-inhibiting disorder,
Schneider said. An addict gets high by taking the drug in a way that
rapidly increases the dose reaching the brain. But opioids properly used
for pain do not result in a "rush" or euphoria. When given for chronic
pain, opioids should provide a steady amount throughout the day.

Nor do pain patients require ever-increasing amounts of opioids to achieve
pain control, because patients in pain do not become "tolerant" to properly
prescribed opioids. Higher doses are needed only if an inadequate amount of
the drug is given in the first place or if the pain worsens.