Pain isn't only a miserable discomfort for hospital patients. It can be a killer, and it can rob a patient of dignity. But while good pain-killing medicines are available, doctors aren't prescribing them as often as they should, says Dr. Perry G. Fine.
It's not as if physicians are "actively trying to torment people and obstruct good care," added Fine, who is an associate professor of anesthesiology at the University of Utah Health Sciences Center.He spoke this week during the ninth annual Intermountain medical ethics conference, held at the Utah Law and Justice Center, 645 S. 200 East. About 160 experts in medicine and ethics attended the conference, "Final Plans: Ethical, Legal and Medical Ways to Direct Care at the End of Life."
An unreasonable fear of addiction concerning the use of opioids is so great that "it's become a ball and chain," often preventing the pain relief that patients should get, he said. Society must deal firmly with that fear, Fine added.
Studies with mice show that pain relief can prolong life and improve the ability to fight disease. Mice with lung tumor cells live longer if they get pain relief, because their bodies are better able to prevent the tumors' metastasizing.
During a Deseret News interview following his talk, Fine said physicians should "rid themselves of a long history of this opioid-phobia." Opioids are drugs that bind to the opioid receptors in the brain, preventing pain. These drugs generally are morphine and its derivatives.
Use of opioids should be like that of other prescription medication, Fine said. Physicians must properly assess the situation, monitor the patient and follow up. They should prescribe only for good medical indications, "no matter what the drugs are."
Pain relief is important "to improve functioning, relieve symptoms and improve dignity," he said. "How can anybody live in dignity if they're in pain all the time and feel they have to beg for relief?"
Physicians are the gate keepers in use of these medicines, and "we don't want to open the floodgates," he said.
"But we want to be far beyond where we are now."
What about the question of addiction? According to Fine, addiction is a psychological process that has no connection with pain relief. The difference between an addict who abuses drugs and the patient who needs drugs for pain control is easy to spot, he said. With addicts, "their quality of life goes down" while with patients who are prescribed pain-relief medicine, "their quality of life goes up."
Also, with an addiction the dosage goes up. But new studies show that patients needing pain relief "can take their medicines for years and years and not affect their functioning." At the same time, he said, if the disease does not progress, "the dose generally stays the same."
The picture is gradually brightening, he said. Yet, Dr. Susan W. Tolle, professor of medicine at the Oregon Health Sciences University, Portland, one of the conference speakers, pointed out that Utah physicians aren't prescribing opioid pain relief as much as those in most other states.
That "suggests we're being overly stringent for whatever reason in our prescribing practices," Fine said.