Chronic Pain: In Defence Of Morphine
I've talked about my own chronic pain a couple of times in this space in the past, so I'm not going to go into details of my own condition again. Having dealt had one case of acute pain cured, and now living with what looks like a far more intractable situation, I'm well aware of the difficulties presented by the circumstances of the condition for both the sufferer and their caregivers.
Sufferers of acute non-malignant chronic pain, in other words you're not going to die from it, very often have nothing discernibly wrong with them. Nothing shows up on any type of scan, be it x-ray, nuclear medicine, or any other test they can think of to inflict on the patient. As a result the sufferer is sometimes faced with the additional burden of having to prove the veracity of their claim to illness.
Most Family Doctors are not in a position to treat chronic pain. Even though they can play a key role in the treatment of a patient's symptoms, they simply do not have the wherewithal to do more than monitor pain levels and prescribe analgesics. But if a client's doctor is unsympathetic towards the patient, or of the belief that non-malignant pain is not worthy of proper medication, a person could find them self suffering far more than necessary.
It is quite amazing how when a patient is admitted into hospital, or even held in emergency for any length of time, and experiencing pain, they have no hesitation in giving them morphine to relieve their pain. They never seem to worry about you becoming addicted, even if you spend an extended period of time in their care. They're just trying to make you as comfortable as possible.
The first time I was hospitalized for my pain condition, I expressed concern to a nurse about being given morphine. I have a history of substance abuse and figured the last thing I needed was to risk becoming hooked on anything. She told me that there was nothing to worry about because as long as I was in pain I wouldn't develop a psychological dependence on the drug.
From my own perspective I've never enjoyed taking the drug, and can't see how anybody would want to utilize it for getting high. When taken for immediate relief it will most likely cause you to fall asleep, thus allowing you to escape from the pain that you are in. In some instances it can actually cause you to feel like you are disassociating, separating from your body, so you still know that you're in pain, but don't really care.
The best way to prevent any sort of addiction from happening is to ensure that the body is never placed in the situation of having to crave the medication. In the case of painkillers like morphine it is essential for the client who will be utilizing it on a long-term basis to have a pain threshold established. What amount of the drug will maintain a comfort level for them on a daily basis?
This can easily be established by discovering how many doses a day a client is needing to take of the five to ten milligram pills in order to be comfortable. Once that is established the patient is switched over to a slow release product that maintains their comfort level at all times. They are given a supply of short term medication for periods when the pain peaks – "breakthrough" – but it shouldn't be necessary for those to be taken more than once or twice a day. If they do start having to use the breakthrough medication more often than that, their long-term medication is adjusted accordingly to reflect that usage.
In this manner the person doesn't develop a "need" to take morphine on a frequent basis and the possibility of addiction is removed. Of course that doesn’t mean it won't occur. There are always people who will abuse a situation, and there are doctors who won't make the effort to work out a proper drug maintenance program with their clients, both of which could result in a client becoming addicted.
But since that scenario is a possibility with drugs other than morphine, muscle relaxants and tranquilizers for instance, I really can't figure out why people get so freaked out about it. It's not so surprising from lay people, I was nervous about it because I had believed everything I had been told about how dangerous it was, so why shouldn't others be. What shocks me are the medical professionals who are still perpetuating that myth, and refuse to prescribe it for their patients unless they are dying, and even then they worry about addiction.
I kid you not. I have friends who are palliative care nurses who have had to argue with doctors to increase the dosage of people dying from horribly painful cancers. Here's an instance where the best thing a doctor can do for their patient is to make the passage out of this world as easy as possible, maybe even prescribing them heroin, but they won't because they are worried about them becoming addicted. (In Canada, as far as I know-this may be hearsay- it is legal for a doctor to prescribe heroin in certain circumstances for pain, but because doctors haven't in the past, the pharmaceutical companies won't carry it, so even if a doctor wanted to utilize it for a patient now he couldn't because it wouldn't be available) How ridiculous is that?
Thankfully there are fewer and fewer people in the medical profession who have such antiquated beliefs, but unfortunately you still run up against them now and again. Nothing quite does your self-esteem as much damage as to be in agony and be treated like a junkie at the same time. It's probably no coincidence that these are invariably the same doctors who tend to say things like "It's only a little pain, what's your problem?"
A few years ago my wife was having one of her wisdom teeth extracted. To say she was a little nervous about the procedure was an understatement; she hadn't had very pleasant experiences with dentists prior to this time. Five minutes after he was started the dentist was finished and she hadn't felt a thing. He also made sure to give her a prescription for pain medication in the event that she needed it.
When she made some comment about the difference in treatment that she had received this time as opposed to previous occasions, the dentist responded by saying, "In this day and age there is no excuse for anybody to suffer from pain." Now he was only referring to dental procedures, which is a refreshing enough attitude on its own, but that should be the refrain of the whole medical profession.
With the medications at our disposal, and the increased sophistication of their delivery, (you can now get a morphine patch which works like a nicotine patch and the drug is slowly absorbed into your system that way) there should be no reason why anybody need suffer from untreated pain. Whether you have a chronic condition, or it's only temporary, you deserve to have your suffering alleviated as much as possible.
It doesn't matter if you are suffering from a chronic pain condition, or you are watching a loved one being crippled by pain, there is nothing worse than knowing that the means of reducing that suffering is being denied. Whether pain is a symptom that will clear up when a solution is found, or it is caused by some permanent damage to the system that may never be resolved should be immaterial to it's treatment.
Only recently has non-malignant chronic pain been considered serious enough to warrant specialist attention. But even now the only medical professionals who work in the field are usually anaesthetists. Since they already have one specialty, the amount of time they can put into this work is limited, (the doctor I see has only one clinic every two weeks), and waiting lists to see them can be substantial.
The fact that they have chronic pain clinics is a step in the right direction, but it's not enough. The study and treatment of pain needs to be recognised as a distinct branch of medicine, not merely the secondary practice of already busy people. Until chronic pain is seen as a legitimate illness at all levels of society, and outmoded fears and prejudices are abandoned, people will continue to suffer needlessly.