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Alexander DeLuca, M.D.
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Pain Treatment Does Not Equal Drug Abuse:
Letter to the Editor of the Wall Street Journal

Scott M. Fishman, M.D.; Wall Street Journal; page A11; 2005-07-28. Posted: 2005-07-29; Modified: 2006-06-26
Related resources:
War on Drugs, War on Doctors Journalism archives  ;  War on Doctors Academic Literature archives
See also:
Dr. Fisher Comments on Dr. Fishman’s LTE -
Frank Fisher; Pain and Social Policy listServ; PRN; 2007-07-29
The Pathological DEA: Aftermath of the DEA FAQ Debacle - WAR ON PAIN SUFFERERS Collection #11; 2006
The Trials of Dr. Fisher: the Cost of Exoneration - WAR ON PAIN SUFFERERS Collection #7; 2006
War on Doctors and Pain Crisis Weekly - RSS feed:
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The Letter to the Editors of the Wall Street Journal by Dr. Scott Fishman (below) is in response to the following 48 word column (ABSTRACT) by Laura Landro under the headline: “Patients Press Doctors on Pain Issues;” Section D; page 5; column 1; 2005-07-14:

“The Informed Patient column looks at resources to help chronic pain sufferers; reports that by most estimates, chronic pain affects more than 50 million people and is the leading cause of disability in America, costing employers more than $60 billion in lost productive time annually (M)”

Drug abuse and undertreated pain are both serious public health crises, but the solution to one should not worsen the other. Laura Landro's July 13 article, "The Informed Patient: Patients Press Doctors on Pain Issues," brought forward some of the more relevant issues faced by physicians who treat patients for pain.

It was refreshing to read an article that addressed these topics head on, especially in regard to the legal risks that many physicians perceive as they consider prescribing strong medicines for pain. The lack of pain-care education for general practitioners is partially responsible for hesitancy in prescribing opioid medications, leaving patients with cancer and other acute and chronic disorders undertreated due to overcautious physicians. Appropriate education for physicians as well as for patients can relieve many of these fears of addiction.

Although medicine has succeeded at curing diseases and extending life, your article highlights the fact that we have not done as well at improving quality of life. It was noted that chronic pain is estimated to affect more than 50 million Americans, and recent polls have shown that the majority of these individuals are older people -- suggesting that our "cure-focused" medical system is now at risk of creating victims of our own success.

Your readers should know that there is a specialty branch of medicine with physicians who are experts in the care of hard-to-treat pain. This specialty, called Pain Medicine, uses a comprehensive and integrated approach that applies a variety of techniques from different areas of medical expertise. While your article focused on medications, medications are only part of the arsenal of pain-reliving treatments, which spans from psychological approaches (such as biofeedback, hypnosis and behavior modification) to injections and even surgically-implantable devices in the spinal cord. This is a new and growing specialty that needs increased public recognition and an official place within organized medicine.

If patients are to have the option of pain control when it is needed most, we must avoid unnecessarily putting physicians in the middle of two heated health- care crises. Neither the serious epidemics of drug abuse nor undertreated pain are helped by trying to solve one problem at the expense of the other. Shifting governmental roles in pain care from health agencies to law enforcement -- focusing on preventing drug abuse rather than easing suffering -- is unlikely to help either of these problems.

Targeting doctors as criminals has an unfortunate chilling effect on the average willingness to treat pain and suffering. Appropriate medical decisions, including those involving legitimate use of strong pain relievers, should not be dictated by the actions of the DEA or other branches of law enforcement, but must remain in the hands of medical professionals. That way, patients can trust that their physicians are free to respond to their suffering and prescribe medicines that are in their best interests.

Scott M. Fishman, M.D. Chief, Division of Pain Medicine Professor of Anesthesiology University of California, Davis Davis, Calif.

(Dr. Fishman is president of the American Academy of Pain Medicine, author of "The War on Pain" and co-author of "The Massachusetts General Hospital Handbook of Pain Management and Essentials of Pain Medicine.")

[Full Text of this Article in PDF format]



Dr. DeLuca's Addiction, Pain, and Public Health Website

Alexander DeLuca, M.D.

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Originally posted: 2005-07-29

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Most recently revised: 2006-06-26
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