The case for opi­ate use

Cape Breton Post - - IN MEMORIAM/ADVICE - Keith Roach Dr. Roach re­grets that he is un­able to an­swer in­di­vid­ual letters, but will in­cor­po­rate them in the col­umn when­ever pos­si­ble. Read­ers may email ques­tions to ToYourGoodHealth@med.cor­nell.edu or re­quest an or­der form of avail­able health newslett

DEAR DR. ROACH: I hope you will of­fer your opinion on my ex­pe­ri­ence with opi­ate med­i­ca­tion. My wife is now on a com­bi­na­tion of mor­phine pills to ad­dress chronic shoul­der pain re­sult­ing from a fall. The rea­son it be­came chronic is be­cause of a mis­di­ag­no­sis, fol­lowed by er­rant X-rays and three un­nec­es­sary surg­eries. She has been in grip­ping pain all that time, and the pain re­mains acute and can in­crease with too much use of her arm. That’s why I re­fer to it as “chronic.”

While there is a grow­ing fear of opi­ate treat­ment for pain, it prob­a­bly has saved her life. This all be­gan about 20 years ago, and she is now 60. Most mixes and matches of painkillers left her ei­ther with lit­tle pain and lit­tle func­tion, or too much pain. The sav­ing grace was the re­sult of an of­fchance con­ver­sa­tion with doc­tor prac­tic­ing at a learn­ing hospital. He men­tioned a new time-re­lease mor­phine that is now avail­able. That, along with an op­tional booster pill if needed, filled the need. Con­sti­pa­tion has be­come some­thing ad­di­tional to deal with, al­though man­age­able. I write to you to of­fer hope to some­one who is ex­pe­ri­enc­ing chronic pain, and to ask law­mak­ers to leave room in their dis­cus­sions on opi­ates. Peo­ple’s lives can re­main pro­duc­tive, or at least liv­able, with mea­sured opi­ate med­i­ca­tion.

AN­SWER: While it is true that there is an epi­demic of abuse of pre­scribed pain med­i­ca­tion, it is im­por­tant to re­mem­ber that there are some peo­ple for whom opi­ate pain med­i­ca­tions are safe and ef­fec­tive. The cur­rent back­lash against pre­scrip­tion pain med­i­ca­tions does raise the risk that some peo­ple’s lives will be made more dif­fi­cult by the ad­min­is­tra­tive ob­sta­cles put in place to com­bat pre­scrip­tion drug abuse.

I don’t think opi­ates are first­line treat­ment for non-can­cer­re­lated chronic pain. Very of­ten, non-opi­ate op­tions, pre­scribed by a skilled and ex­pe­ri­enced provider, can treat chronic pain more ef­fec­tively, with fewer side ef­fects. How­ever, I am pub­lish­ing your let­ter since I do agree with you that opi­ates need to re­main an op­tion if used wisely in ap­pro­pri­ate pa­tients.

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