More aggression against pain urged
By D. Q. Haney - AP Science Writer (3/6/92)

Boston (AP) - For people in pain and the doctors treating them, a new set of federal guidelines can be boiled down to a simple suggestion: Sometimes it's OK to say yes to drugs.

The guidelines make clear that millions of Americans have been suffering needlessly after medical procedures, largely because doctors and nurses are irrationally afraid patients will become addicted to drugs.

Narcotics such as morphine are the mainstay of pain control. Yet both patients and those treating them are often reluctant to use these medicines effectively, because they confuse them with street drugs.

About 23 million operations are performed in the U.S. each year. Surveys show that between 30% and 50% of hospital patients suffer more pain than is necessary after surgery, medical procedures and accidents.

The effectiveness of the "just say no" anti-drug campaign is widely cited by experts as a major reason why pain is poorly controlled.

"People think the mere exposure to these drugs will cause someone to be enslaved by them. And that's not true. It's crazy," said Dr. C. Stratton Hill Jr. of M.D. Anderson Hospital in Houston.

In fact, studies show addiction is almost unheard of among people getting pain medicines. And even if a patient becomes physically dependent on narcotics, headaches and nausea can be avoided by gradually withdrawing the drugs over 5-10 days.

The DHHS on Wednesday issued the book-length guidelines on techniques for dealing with pain.

Among other things, the guidelines urge doctors to give pain medicine before pain occurs, such as after operations, to give high enough doses to stop pain and to ask patients about their pain.

One idea behind the new guidelines is that pain is more than unpleasant. It also slows healing.

"Pain is not a healthy state for us to be in," said Dr. Richard Chapman, a psychologist at the University of Washington. "It's not just something in our heads.“

Pain prompts the body to release stress hormones, such as adrenaline. These, in turn, increase blood clotting, raise metabolism, promote the breakdown of tissue and have other unwanted effects. Animal studies even suggest that pain weakens the body's immune system protection against infection.

Those who receive aggressive pain treatment have fewer complications, recover faster, go home sooner and have lower hospital bills.

Experts cite several other reasons for failure to stop pain:

• Pain isn't recorded on patients charts, like blood pressure or temperature, and many doctors don't know about it. "A lot of doctors don't ask questions about pain, and patients don't bring it up, because they want to be seen as good patients and not take up time with this," said Diane Blum of Cancer Care, a NY social service agency.
• Knowledge of pain management has grown dramatically over the past 20 years. However, medical schools give it little attention.
• Doctors fear narcotics will suppress patients' breathing. But research has shown that pain offsets the effect of narcotics on respiration and breathing isn't weakened.
• Many patients believe there is something admirable about enduring pain. "Patients say, I'm macho. I'm tough." But this is unnecessary and can be detrimental," said Dr. Arthur Lipman of the University of UT College of Pharmacy.