Pain Treatment

Pain Treatment
As rheumatologists, we see a steady stream of patients in pain. Some patients respond quite well to anti-inflammatory medicines, but unfortunately there is no perfect solution. Some patients have kidney disease, ulcer history or are on anti-coagulants and cannot tolerate these medications. After Darvocet was taken off the market, the only non-narcotic drug remaining was Tylenol and Ultram (tramadol). Tramadol has since been reclassified as a controlled substance. It joined the narcotics: Tylenol with codeine, Vicodin, Percocet, dilaudid, Fentanyl patch and morphine sulfate as controlled substances.

For years doctors were encouraged to treat pain in addition to post operative pain as well as pain related to malignancy. More than anything, this had led to our current opioid epidemic. Currently, more Americans die each year from drug overdoses than all the American soldiers killed in Viet-Nam, Iraq and Afghanistan combined.

We are now in major dilemma trying to alleviate pain without habituating our patients. In addition it is no surprise that giving narcotics to the elderly is associated with an increase in hip and compression spine fractures.

We are desperate for solutions. Acupuncture can be helpful in the right hands. Anti-depressants can sometimes help control pain but can cause sedation among other problems.

In Colorado and California, it is fairly easy to prescribe marijuana for pain. Medical marijuana can be made so that the “buzz” or high is not as severe as when marijuana is smoked rather than in pill form (i.e. Marinol). It may not be as powerful as many narcotics but it is less addicting. Our understanding is that in Pennsylvania with some exceptions, marijuana is generally not approved unless the patient has vomiting from chemotherapy being administered for cancer. That limits the number of potential patients who could benefit form marijuana significantly.

Given Harrisburg’s conservative bent, I doubt our elected officials are going to see the light in the near future. Trying to stop the influx of narcotics at the border is not a solution to the opioid epidemic. As is often the case, the patients get the short end.

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