[Fwd: New Mexico Medical Board Attacks Dr. Lewis]
From: dtouch (dtouch@bellsouth.net)
Thu Jan 3 21:31:39 2002
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Hello Everyone: I hope I am forwarding this correctly as we chronic
pain suffers are eventually going to only be told to take
anti-inflammatories and tylenol for our pain while the junkies and
recreational users continue to help us legitimate people to get proper
pain relief. Please write your senators and congressman and other
representatives and make them aware of the necessity to have the pain
relief our doctors feel we need without fear of punishment.
Dolores in Louisiana dtouch@bellsouth.net
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Dolores,
Just keep talking to people about the problem with pain management and law
enforcement. When a critical mass of people become aware of it, it will
change. Winning my case will have a large impact because it will reveal
that law enforcement actually impedes pain management. Hardly anyone
believes this yet.
I have pasted on some basic information you might already know. It might be
useful to circulate it.
Frank
Opioids
Patient and Family Information
Opioid analgesic pain medications are recognized by the Medical Board of
California as the cornerstone of treatment for chronic pain. Their use is
limited mainly by widely held beliefs about their dangers, most of which are
false. What follows is basic information about these substances and their
role in the treatment of chronic pain. This information is directed to
patients and the people who associate with them.
Addiction
This is the bogeymman. It is generally feared that exposure to opioids will
invariably lead to addiction and this would be so terrible that many
terminal cancer patients refuse morphine and die in agony as a result.
Large studies have repeatedly revealed that this is simply not the case, and
that addiction to opioids in pain patients is actually rare. Addiction is
defined as the combination of cravings for a substance combined with self
destructive behaviors leading to harm, with continuing use in spite of the
harm.
Dependence - This term means the fact that if a patient has used opioids
they are likely to have a flu-like withdrawal reaction if they stop the
medication abruptly. This can prevented by gradually tapering the dose of
the medication. Dependence does not signify addiction as it occurs in
almost everyone who takes opioids.
Respiratory Depression/Tolerance - When an individual unaccustomed to taking
opioids takes too large a dose it can slow or even stop breathing. When a
patient has had their dose of opioids gradually raised, they can and do take
dosages that would kill an individual not accustomed to these doses. This
is called respiratory tolerance. Pain also promotes respiration, making it
doubly hard for opioids to harm a pain patient.
Tolerance also quickly develops to the "high" caused by opioids. Within as
couple of days to weeks the patient returns to feeling completely normal,
although they may be taking enormous doses of medication.
Titration - This term describe the process of gradually raising the dose of
opioids until the patient reaches their best level of functioning.
Fortunately, once this is established it is seldom necessary to keep raising
the dose as not much tolerance to the pain relieving properties of opioids
occurs. Most patients will require a variation is their dosage from day to
day depending on their pain levels and activities. The range of possible
doses needed to control pain varies from one patient to another more than
with any other drug in the entire field of Medicine, which means that some
patients will receive dose of a size that is staggering to the uninformed
observer.
Alcohol/Tranquilizers - It is dangerous to drink alcohol or overdose on
tranquilizers such as Valium or Xanax while taking opioids because these
substances reduce respiratory tolerance. The majority of deaths attributed
to opioids actually occur in combination with these other central nervous
system depressants.
Security/Diversion- Opioids present a public health risk when they are
diverted into the hands of non-patients who intend to abuse them. These
individuals are often not protected by either tolerance of pain against the
respiratory depressant effects of opioids and are likely to combine them
with the depressants mentioned above. The results can be tragic. For these
reasons the bulk of a patient's supply of opioids must be kept locked in a
safe and never given, sold, or traded to anyone else.
Toxicity/Side Effects - Opioids are not toxic to any organ system in the
body. They do not do any damage even with long term use. While an array of
different side effects is possible in a patient taking any given medication,
the only side effect commonly observed is constipation, which is easily
anticipated and treated.
Pain Relief/Functioning - Opioids reliably reduce pain levels in chronic
pain patients, however they seldom make the pain go completely away as they
do in patients with acute pain who do not have a tolerance. Patients can
live with this residual pain as long as their dose is titrated to a level
where they can function. The way this works is that at higher levels
opioids act as antidepressants in chronic pain patients, and although they
can still feel the pain if they think about it, the depression cause by the
pain is alleviated allowing them to carry on with the activities most of the
rest of us take for granted. This is the major benefit of opioids in
chronic pain. They allow the patient to function is spite of the pain.
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