COMMENTARY

Gaps in administration mar advances in treatment of pain

1/9/2012

Physical pain is part of the human narrative. All of us, at one time or another, have suffered from it.

Although it is unpleasant and irritating, pain is essential for our continued well-being. It is often the harbinger of diseases that, if they are not treated in a timely fashion, could cause irreparable damage and even death.

In the ancient world, pain was considered a punishment for transgressions against the gods. According to Greek mythology, Poine, the goddess of revenge, meted out punishment to mortals for their human follies. She gave her name to the word "pain."

Beyond myth and fancy, we in the medical profession have learned the significance of pain and the need to alleviate it. And generally, we do a good job at that.

As we continue to learn about the genesis and mechanism of pain, we offer remedies, medications, physiotherapy, and nerve-stimulating devices to blunt or eliminate pain, the single most common symptom for which patients seek medical advice.

There are still gaps, not as much in our understanding of pain as in our ability to treat pain in a seamless manner, so that patients have adequate pain medications for the duration of their illness.

A time that still causes problems for patients comes immediately after they are discharged from the hospital. A patient who needs pain relief is handed a prescription for medication, but the onus is on him or her to get it filled.

Why can't the hospital provide at least a week's worth of pain medications -- or any other essential medication -- at the time of discharge? The distance between the hospital bed and the patient's own bed should not have to be lengthened by a stop at the pharmacy.

Patients also sometimes run out of medications while they recover at home. In most cases it is not the fault of physicians, but an oversight on the part of the patient.

It usually takes a day or two to get a prescription issued and filled during the week. It can take much longer over the weekend, when the only choice the patient has is to go to a hospital emergency room or to an urgent-care facility to address the immediate need. It is an unnecessary waste of resources.

It is easy to blame the patient for not taking charge of his or her health, as is the wont of doctors and hospital officials. But sick people can be forgetful, and should therefore be excused. And blaming patients does little to relieve their pain.

I am also surprised at the rigidity of pharmacies in emergent situations. It is a rare pharmacist who will bend the rules to accommodate a person in need.

A number of years ago, my wife, Dottie, was going through the painful, terminal stages of ovarian cancer. One evening, she realized that she was out of pain medication. Her physician was not easily accessible, and her prescription for a narcotic painkiller was for one time only and had to be rewritten.

A local pharmacist allowed me, a licensed physician, to write a prescription for enough medication to get her through the night. That was a rare exception.

It is not against the law, but the practice of routinely prescribing medications for family members is frowned upon -- for good reason. The good judgment of a physician could be clouded by the proximity of a loved one in pain.

The pharmacist in my case saw the need and responded. He also was pleasant and sympathetic, which is not always the case. Many pharmacists are rather stern and unsmiling.

It has taken a long time for the medical profession to understand the deleterious effects of pain and the need to relieve it in timely fashion. Pain is now regarded as the fifth vital sign, along with pulse, temperature, breathing rate, and blood pressure. Many states now mandate pain education for physicians.

But the gaps in our ability to relieve pain consistently and seamlessly remain. Closing those gaps requires that all health care providers -- physicians, pharmacists, nurses, and hospital administrators -- work in concert for the benefit of patients.

Dr. S. Amjad Hussain is a retired Toledo surgeon whose column appears every other week in The Blade.

Contact him at: aghaji@bex.net