Letters

From the April 1997 issue

Pain Reactions

Reading Jacob Sullum's "No Relief in Sight" (January) brought back some literally painful memories for me. In 1992, following minor surgery, I was given a prescription for codeine. Since the pain proved much less severe than my surgeon predicted, I used only one of the 30-pill supply. A year later, however, I became truly incapacitated with a lower- back pain: unable to walk, sit, sleep, or do anything but pound the pillow and cry. Assuming it was just a back injury, I began taking the codeine at night to get some sleep. It worked like magic.

A month later, when I ran out, I tried using over-the-counter analgesics, with no success. Eventually, I went to a doctor, begging for some relief. When I mentioned codeine, his face froze. I could see his thought process: He uses codeine, therefore he is an addict, therefore he is malingering. He prescribed, instead, some other painkiller that did virtually nothing to ease the pain.

Over the next two months, I saw two other doctors; both had the same reaction, and both prescribed ineffective medications. It was not until September -- four months after the pain began that I was finally diagnosed with lymphoma, which responded admirably to treatment.

The result of these doctors' paranoia about opiates? Three months of unnecessary agony for me, and permanent nerve damage from the undiagnosed tumor. If they had not been so certain that I was only faking the pain to get recreational drugs, all this could have been avoided. Many times I thought about suicide; each time I told myself, "Just one more day." If I had known at first how long it would last, I doubt that I could have survived.

By the way: I obtained (illegally!) a small supply of codeine a year ago, which I am keeping in reserve. Relapses are all too common in lymphoma, and I do not want to endure that torture again. In the past year, I have felt no temptation to take even one of these pills. So much for theories of addiction.

Like many of your articles about government power grabbing, this one made me weep tears of frustration. I only wish that the bureaucrats at the FDA, DEA, and elsewhere were capable of seeing human suffering. In fact, I'd like to see them experience some of it.

Scott O'Hara
San Francisco, CA

I wanted to comment on Jacob Sullum's wonderful article, "No Relief in Sight." Chronic pain is an epidemic in the United States. It is often misunderstood and frequently mistreated. While opioid treatment remains controversial, it is clear that governmental regulations often create a chilling effect and a true barrier for patients and clinicians to work together. Articles like yours make a difference by making the public aware of this problem.

The American Academy of Pain Management credentials multidisciplinary pain management clinicians through board certification and program accreditation. In addition, we publish a directory of board-certified pain management clinicians, accredited programs, and a directory of pain clinics. This information is free on the Internet or may be obtained through a mailed directory. Our e-mail address is [e-mail], and our Web address is http://www.aapainmanage.org

Richard S. Weiner, Ph.D.
Executive Director
American Academy of
Pain Management
Sonora, CA

"No Relief in Sight" deals with a topic of general interest, as indicated by a recent 60 Minutes report on the same subject. Unfortunately, not only was the topic similar but the author also used many of the intellectually bankrupt methods typically employed by that TV program.

Before I begin a critique, it is appropriate that I indicate my qualifications. I have M.D. and Ph.D. degrees from Washington University Medical School in St. Louis and was a faculty member at Yale University, the University of Minnesota, and the University of Cincinnati. Toxicology and therapeutic drug monitoring was an area of clinical practice when I was a member of the department of laboratory medicine at these various institutions. Currently, I do research at a biotech company.

The premise of the article -- that physicians underutilize narcotic analgesics -- has a component of truth which I shall endeavor to place in perspective. However, most good lies also have a component of truth which significantly contributes to their credibility. Perspective is important here, for all drugs have benefit and toxicity, and the former must be judged against the latter. A fatal fault in this article is the failure to provide the reader with the information and perspective necessary to make a rational judgment. Facts are omitted or slanted, anecdotes are told to create empathy for the author's thesis, and "expert" comments are applied out of context or are not representative of the field.

If I were to write an article of the opposite bias, I might begin with a mirror-image anecdote to gain sympathy. Recently, Larry King interviewed Johnny Cash, who had a series of operations to correct a jaw injury. This famous singer could barely talk, let alone sing, without medication of the type described by the author. However, unlike any of the characters in the author's article, Mr. Cash became addicted to these drugs. He has been in and out of treatment for this addiction ever since. Mr. Cash is only one of many celebrities who have required treatment for addiction to painkillers, yet none of them appeared in the article.