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Physicians' attitude toward suffering is a pain

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    Physicians' attitude toward suffering is a pain

    Physicians' attitude toward suffering is a pain

      Tuesday, October 1, 2002 - Page A15

    Guidelines set out recently by the University of Toronto Joint Centre for Bioethics encourage physicians to prescribe adequate doses of analgesic narcotics for the terminally ill.

    "Job No. 1 in caring for patients is to make sure they die with dignity, not in pain," said Dr. Peter Singer, director of the centre. Amen. But, similar compassion should inform the medical profession's attitude to the many thousands of people who endure chronic pain without having terminal disease. Their right to live with dignity, not in pain, also deserves to be recognized.

    Chronic pain disables more people than cancer or heart disease. Untreated, the suffering undermines not only a person's ability to work and function in daily life, but also his or her emotional balance, relationships with loved ones and self-image. It can be soul-destroying and greatly increases the risk for suicide. Even from a narrowly physiological point of view, the stress of chronic pain is harmful, as it can weaken the immune system's defensive powers against infection and tumour growth.

    Chronic non-malignant pain is due to conditions other than cancer, such as arthritis, back injuries, severe headaches and some vaguely defined syndromes affecting muscles and connective tissues. Frequently, it has no clearly evident cause. It often persists following an injury long past the time when the injury itself would have healed.

    In fact, it can go on for years as our natural, innate pain killers, the endorphins, become depleted, and the threshold for severe pain is lowered.

    Very little in the training of physicians prepares them to understand the complexities of chronic pain. Medical education tends to focus on diseases of individual organs or organ systems -- say, the heart or the respiratory system.
    Chronic pain, not classifiable in any particular category of diagnosis, is often ignored.

    Even where medical knowledge understands pain, it may not appreciate the nature of suffering. The two are not synonymous, although each may lead to the other. Pain is a highly unpleasant feeling located at a particular site in the body, as with a headache or a backache, or perhaps at several sites at once. Suffering is an emotional state involving the whole body and mind and makes one's relationship to the world intolerable. It darkens one's view of the past, the present and the future.

    Chronic pain is really a state of suffering that depends not only on the specific source of the pain but also on who is experiencing the pain, at what time in their lives, in what state of mind -- in short, on the history of the life in which the pain has made its appearance. Chronic pain, and the very conditions that cause chronic pain, occur for the most part in persons who were vulnerable well before the onset of their symptoms. All that will not be sorted out in the course of a typical 15-minute visit to the doctor.

    Current attitudes inhibit caregivers from empathizing with the chronic-pain sufferer -- attitudes the journal of the Canadian Pain Society calls the social disparagement of pain -- that is the tendency to see whining and weakness when a person reports unbearable pain. Unfortunately, many physicians also share the public's misperception that the administration of potent medications of the morphine type, known as opiods, would lead patients to addiction.

    The fear of narcotic addiction is grounded in old, discredited information. Medical evidence has shown that opiods prescribed for pain, even for long periods of time, do not lead to addiction except in a tiny minority who, in most cases, have had previous substance-abuse problems. In one study of more than 2,300 patients given opiod therapy for severe headaches, only three met the criteria for addiction. Other studies confirm the risk of addiction is infinitesimal.

    The suspicion with which doctors and others in authority respond to such pain sufferers is a major factor in entrenching chronic pain in people's lives. While narcotics are no panacea and should only be a small part of any treatment plan, their appropriate administration can do much to help pain sufferers regain function and hope and the possibility of healing.

    Gabor Maté, a Vancouver physician, is former medical co-ordinator of the palliative care unit at Vancouver Hospital. He currently works with drug addicts.

    I'll bet most SCI people can relate to some Doctors who act like anybody that asks for "good" pain meds is some kind of wimp or criminal. I just can't understand them saying "no to drugs" when you are in real pain as so many do. The drugs can't be as bad for you as the pain. Thanks for posting the article.WR