Pain that is perhaps the most common symptom of human’s illnesses and sufferings is only a symptom and sign, not a disease. Although many practitioners and over-the-counter business focusing on symptomatic treatments, the real and scientific medicine aims to identify the causes of a disease and treat or remove the causative agent of an illness. For example in medicine, we do not treat the “cough” by “cough medicines”, but we treat the microbes causing the cough and upper respiratory infections by antibiotics, or if viral, we may use vaccines for prevention, or simply let the body immune system work out the infection, if there is not proper anti-viral medication for the illness.

The history of pain treatment has been perhaps the worst such bad medicine in the whole field as instead of identifying the cause(s) of pains, many practitioners, on the top “Physiatrists” prescribe narcotic medications to alleviate pains. Physiatry or Physical medicine and rehabilitation is a branch of medicine aims to restore functional ability and quality of life to those with physical injuries, impairments or disabilities. The term “Physiatry” was coined by Dr. Frank Kursen in 1938 and was accepted by the American Medical Association in 1946 after the World War II to accommodate the large number of injured soldiers. Pain medicine that is a branch of Physiatry, over years has dominated this field and the focus of the physiatrists at least in the primary care clinics have become mostly controlling chronic pains by the use of prescription narcotics.

Over the past two decades, there has been dramatic increases in narcotic e.g. opioid analgesic use by physicians, mostly phsyiatrists that has recently led to the governmental health agencies control in US, Canada and elsewhere on the use of prescription narcotics. This is still in spite of the support of various organizations supporting the use of narcotics e.g. opioids in large doses, and aggressive marketing by the pharmaceutical industry. The narcotic prescription that could be only scientifically and medically justified for the alleviation of severe and acute or dying pains have more and more become a mainstay of treatment of chronic pains, based on unsound science and blatant misinformation, and accompanied by the dangerous assumptions that opioids are highly effective and safe, and devoid of adverse events when prescribed by physicians. “Results of the 2010 National Survey on Drug Use and Health (NSDUH) showed that an estimated 22.6 million, or 8.9% of Americans, aged 12 or older, were current or past month illicit drug users, The survey showed that just behind the 7 million people who had used marijuana, 5.1 million had used pain relievers. It has also been shown that only one in 6 or 17.3% of users of non-therapeutic opioids indicated that they received the drugs through a prescription from one doctor. The escalating use of therapeutic opioids shows hydrocodone topping all prescriptions with 136.7 million prescriptions in 2011, with all narcotic analgesics exceeding 238 million prescriptions. It has also been illustrated that opioid analgesics are now responsible for more deaths than the number of deaths from both suicide and motor vehicle crashes, or deaths from cocaine and heroin combined. A significant relationship exists between sales of opioid pain relievers and deaths. The majority of deaths (60%) occur in patients when they are given prescriptions based on prescribing guidelines by medical boards, with 20% of deaths in low dose opioid therapy of 100 mg of morphine equivalent dose or less per day and 40% in those receiving morphine of over 100 mg per day. In comparison, 40% of deaths occur in individuals abusing the drugs obtained through multiple prescriptions, doctor shopping, and drug diversion.” {Manchikanti L(1), Helm S 2nd, Fellows B, Janata JW, Pampati V, Grider JS, Boswell MV. Pain Physician. 2012 Jul;15(3 Suppl):ES9-38. Opioid epidemic in the United States.}

Finally it is needed to emphasize that the use of narcotic medicine to control pains has not ever done so, but has “chronicized” the pain as whenever the patient stops the narcotic medication(s) , there would be a withdrawal of the pain(s)! Moreover narcotics causes addiction and increase of the dose over time to the point of some cases of overdose and deaths. Narcotic medications that just control the perception of the pains at the brain, not treating the cause(s)of pain(s) at the local site(s), do not just suppress the perception of the pain(s) at the brain site, but suppress many other brain functions, including cognition and other high faculties of the brain as they are all CNS (Central Nervous System) Depressants!  

Dr.Mostafa Showraki, MD, FRCPC                                                               Lecturer, University of Toronto,School of Medicine,Author: “ADHD:Revisited” Book “adhdrevisited.com”/”medicinerevisited.com”

References:

1. Garland EL(1), Froeliger B, Zeidan F, Partin K, Howard MO.The downward spiral of chronic pain, prescription opioid misuse, and addiction:cognitive, affective, and neuropsychopharmacologic pathways.Neurosci Biobehav Rev. 2013 Dec;37(10 Pt 2):2597-607.

2. Sehgal N, Manchikanti L, Smith HS.Prescription opioid abuse in chronic pain: a review of opioid abuse predictors and strategies to curb opioid abuse. Pain Physician. 2012 Jul; 15(3 Suppl):ES67-92.

3. Manchikanti L(1), Helm S 2nd, Fellows B, Janata JW, Pampati V, Grider JS, Boswell MV. Pain Physician. 2012 Jul;15(3 Suppl):ES9-38.

4. Fischer B(1), Argento E.Prescription opioid related misuse, harms, diversion and interventions in Canada:a review.Pain Physician. 2012 Jul;15(3 Suppl):ES191-203.

5. Amari E, Rehm J, Goldner E, Fischer B.Nonmedical prescription opioid use and mental health and pain comorbidities: a narrative review. Can J Psychiatry. 2011 Aug; 56(8):495-502.