PAIN, PART 2

Facts about narcotics that doctors assume patients know (and therefore don't address):

• Narcotic medications are addictive. Period. Even if you really need them, you can still be addicted. There was a big scandal recently which revealed that some drug companies had mislead doctors and patients about the dangers and addictive qualities of narcotics, so everyone needs to be aware.
• "Narcotics" aren't just illegal drugs like heroin. Narcotics are also those "pain pills" you get as a prescription. Sometimes the doctor asks if you've ever been dependent or addicted to drugs- THESE COUNT, and doctors assume you've never had a problem if you say no.
• TOLERANCE: The more narcotics you take, the more your tolerance builds up. Then when you experience even more pain, you need more medication. It's excruciating to watch people who are dependent on narcotics after surgery or an injury experience excruciating pain that we can't control because your body has such a high tolerance....

PAIN, PART 1

Being in a surgeon's office this week has really made me reflect about the wide variation of pain perception. Clearly, assessing and treating pain presents major quandary for physicians- who is really in pain? Whose pain are we missing? Are we killing people by over-managing pain?

I've heard the surgeon discuss narcotic pain medications multiple times with patients this week, and the bottom line is evident: doctors often do a horrible job of screening for pain (I'll place most of the blame on a lack of tools, because there's no magic lab test or xray) but also explaining the proper use of narcotics and the risks of inappropriate or long-term use.

Narcotics are a big pet peeve of mine (not when used "correctly" of course, but even that's not well-defined). Volumes of books could be written on this subject (and have been) so ill try to be brief (and also divide this up into multiple posts).

This is a bit like discussing politics around election time, so I'll try to be as objective as possible (which is impossible)....