Wall Street Gazette Misnomer: Part 4, Chronic Pain Is Not a Crime

By | July 9, 2011

Physicians who withhold therapy from a patient in pain are as guilty as the ones who create prescription drug addicts for their own convenience or personal gain. The use of narcotics, like any medicine must be rational, well founded and compassionate.

Another problem caused by overprescribing of oral opiates is the stigma that it creates for all chronic pain patients. Karen Lee Richards, a co-founder of the National Fibromyalgia Association eloquently describes the situation “I hear from people all the time who say they are at a loss to communicate how bad they feel to their doctors – without being eyed as potential criminals.”  I have said many times in this website that I am physician and not a judge. My daily interactions with my patients are guided by the famous quote from the Oath of Maimonides “May I never see in the patient anything but a fellow creature in pain.” This being said It is critical to separate the question of pain from the question of narcotics.


As we have said many times in this series of blogs and on this website in general chronic oral opiate therapy is almost never the best treatment for your chronic pain. I will go one step further by saying that anyone who reflexively prescribes narcotics for chronic pain regardless of cause is practicing bad medicine. Don’t get me wrong I still use narcotics where they are indicated, for acute nociceptive pain. The patients understand why the medicine is being prescribed and for how long. The chances of abuse and addiction are virtually nil.


Ms. Richards brings up another excellent point about doctors who trivialize pain complaints as a normal concomitant of old age. Old age is a life cycle designation, not a diagnosis.  Chronic pain is always a result of a pathologic condition and the search for that condition should be no less strenuous in the old than in the young.


In tomorrow’s blog we will delve further into the problems of opioid use and misuse. We will examine the comments of Scott Fishman an acknowledged expert in this field and search for a rational way to use these powerful drugs.

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