Editor, The News:
Re: Pain of prescription change (The News, June 3).
Dennis Kulbaba’s front page story encapsulates the problem with the pendulum whose name is ‘medical standards.’
A decade ago, the experts were all touting the appropriateness of long-term narcotics in the control of chronic, non-malignant pain.
This medical jargon referred to treatment of patients who had painful conditions that were not expected to cause death.
It was felt that few of these patients would become addicted, and what did it matter if they did, as long as they were comfortable, able to function, not escalating their doses, and not selling their prescriptions on the street?
I’d like to think that last sentence would have described all of the small number of patients I maintained years ago as a general practitioner, on long-term narcotics.
I recall one elderly man who was taking a potent anti-inflammatory medication for severe back pain. Not a benign drug, it was worsening his blood pressure, his kidney function, and his tendency to stomach ulcers.
He was wary about narcotics (wariness is a reassuring trait in patients about to start narcotics), but after some educating, he agreed to try.
He did well, and possibly lived longer than he might have otherwise.
Now the experts, in the face of addiction issues and deaths, have swung the pendulum in the opposite direction.
Doctors are fearful of censure if they prescribe narcotic drugs.
We need a middle ground, where patients like Mr. Kulbaba can be treated and live in some degree of comfort.
Unfortunately, there is not much in the way of a pharmacological alternative to narcotics for severe pain.
Pain clinics can aid some patients via non-pharmacological means.
Fortunately, our experts have not yet decided that cancer patients must do without these extremely useful drugs.
The torment of precautions often exceeds the dangers to be avoided.
It is sometimes better to abandon oneself to destiny.
– Napoleon Bonaparte.