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Logical thinking about pain

There is nothing quite so debilitating as living with chronic pain. Now a federal government panel has confirmed what millions of people have known for years. Doctors don't do enough to treat pain.

The panel was appointed to write new guidelines for pain management. It concluded doctors often underestimate and therefore undertreat chronic pain, such as a cancer patient might suffer. Women, minorities, the elderly and children tend to suffer most from inadequate treatment because many doctors still believe the incredible myths that women and minorities overstate their pain and children and the elderly don't feel pain as acutely as others.

The panel suggests that narcotics such as oral morphine be prescribed for cancer patients in extreme pain, even if the patients aren't living under constant medical supervision. There is no evidence, the group said, that such treatment leads to addiction. Other experts, including the American Cancer Society, concur.

What stops many doctors are outrageous and indefensible barriers to aggressive treatment. Medicare won't reimburse patients for $100 worth of oral morphine taken at home but will reimburse thousands of dollars for pain treatment in hospitals. State medical boards closely monitor prescriptions for powerful painkillers to guard against diversions for illegal use. This stops many doctors from aggressively prescribing narcotics because they fear becoming targets of criminal investigations.

No one involved in the study suggests narcotics be administered when simpler therapies are effective. But when pain is so intense that nothing less will alleviate it, obstacles to narcotics prescriptions should be removed. Doctors must be free to do what's best, without fear of saddling patients with heavy expenses or endangering their own practices.

Now that new guidelines have been issued for legal narcotics, the next step should be careful study of claims that smoking marijuana can alleviate the pain of some eye diseases and can ease the nausea of chemotherapy. At this time, any use of marijuana is illegal. That should not stand in the way of legitimate study to determine if marijuana is more effective than legal substances already on the market. If it is found to have worthwhile medical properties, there's no reason to treat marijuana differently from morphine and codeine.

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