Pain Management and Chemical Dependency - Evolving Perpectives: New York Conference
November 21-23, 1996
Speakers from several disciplines agreed that chronic pain is often under-treated. Many patients suffer needlessly due to 'opiophobia' on the part of the medical profession. Evidence was presented that the risk of dependence in those prescribed narcotics for pain was virtually zero. One large study of over a thousand cases could not find one patient who developed addiction behaviour. Another criticised concept was the use of 'PRN' ('when necessary') orders for both cancer and non-cancer pain. One delegate re-defined 'PRN' as 'please restrict narcotics' (!) which is a common result of this type of order. The success of 'on-demand' morphine in post-operative pain may well have lessons in the treatment of chronic pain.
Two large groups which delegates considered to be under-treated were those with HIV/AIDS or those with previous histories of drug abuse. Chronic methadone maintenance has no analgesic effect, such patients often needing substantially higher analgesic doses to obtain adequate pain relief. The WHO 'ladder' system of pain management was questioned by some speakers, especially when questionable invasive (and irreversible) procedures were sometimes used prior to a trial of long-acting morphine such as Kapanol or MS Contin. Some doctors still seem to believe that almost anything would be better than a life taking narcotics. Many patients would argue the reverse, when their lives have been changed for the better with the judicious use of opioids.
Innovative treatments also discussed included the 3 day transdermal fentanyl patch, 'long acting' methadone (LAAM) as well as the controversial ultra-rapid detoxification under anaesthetic. Further research is awaited in these interesting areas.
The conference was held at the Crowne Plaza Hotel on Broadway and 48th Street, New York, NY, 10036. November 21-23, 1996. Convenor: Dr Hermon Joseph.