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Andrea G.'s picture

Underprescription of Pain Meds

A lot of people have brought up the issue of prescribing pain medication and the problematic situation of a doctor having to decide whether a patient is in enough pain to merit the use of narcotics.  It often seems as though pain medication is being overprescribed, with all we hear about people addicted to painkillers, drug seeking at every area hospital until one doctor realizes what's going on and cuts the person off.  In reality, though, studies show that narcotics are generally underprescribed.

In one study I read (http://www.bmj.com/cgi/content/full/314/7073/23), doctors underrated the pain level of just over 50% of their patients with HIV.  Of the patients who rated themselves as being in severe pain, only 15% were prescribed narcotics, while 50% were not prescribed any painkillers at all.  The same pattern held for those patients who rated themselves as having moderate pain.  Correlated strongly with not being treated adequately for pain was a measure of quality of life in these HIV patients.

This study, along with many others, shows the need for doctors to look past fears of the DEA and the potential for addiction and treat their patients' pain, especially in the case of chronic, potentially end-of-life, situations.  The trade off between a terminal cancer patient being relatively pain-free during their last weeks or months of life and the same patient possibly becoming dependent on whatever narcotic they've been described seems clearly worth the risk.  It becomes slightly fuzzier for chronic, non-terminal diseases, where a dependence on opiates could cause serious problems later in life, but for end of life situations, I see no reason why doctors shouldn't continue to prescribe narcotics at whatever dose is necessary.

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