By Tom Abate
"The major, major change in pain management is the understanding that addiction is rare."
Some 2,000 pain care specialists from 45 countries converged on San Francisco for the first Worldwide Pain Conference, a weeklong exposition of the latest techniques for relieving chronic pain.
The conference, which ends Friday, was organized by Dr. Elliot Krames, a San Francisco pain care specialist who says millions of Americans suffer needlessly because they're afraid of becoming addicted to painkillers or because their physicians are reluctant to prescribe powerful drugs.
"Chronic pain is undertreated," Krames said, adding that medicine has treatments that patients and doctors are afraid to use.
Chronic pain is defined as a severe, recurring discomfort that can cause physical and emotional distress, estrange a person from family and friends, and make it difficult or impossible to hold a job.
About 95 percent of chronic pain is caused by back, neck or spinal cord ailments which, together with osteoporosis and other symptoms of aging, can make daily life agonizing. Only 5 percent of chronic pain stems from cancer, AIDS or other life-threatening diseases.
Doctors Fear Prescribing Painkillers
Because most chronic pain is not associated with a deadly disease, Krames said doctors have been reluctant to prescribe powerful painkillers, such as Demerol, which belong to the opioid family. Opioids are synthetic compounds that mimic endorphins, the body's natural pain-supression chemical.
Krames said doctors have been reluctant to prescribe opioids because these medicinal drugs, which are related to heroin and morphine, create physical dependencies that can, in about 3 percent of medicinal uses, lead to psychological addiction.
"The major, major change in pain management is the understanding that addiction is rare," Krames said, which has in turn prompted "a greater willingness on the part of physicians to prescribe opioid painkillers."
Experts at two health insurance firms echoed the view that many chronic pain sufferers would be better off taking opioids than trying to grimace and bear it.
"There's no question that medical literature supports what this conference is promoting," said Dr. Sandra Aronberg, a statewide medical director for Blue Shield of California.
Addiction is Rare
Dr. Justin McKendry, a pain management specialist with Kaiser Permanente, took time out from listening to a lecture at the conference to concur that while dependency is a potential side effect of opioid painkillers, addiction is quite rare.
"There has definitely been a move within the medical community toward the greater prescription of opioid medications," McKendry said.
In addition to advocating greater use of painkillers, the conference demonstrated new devices that can be implanted under the skin to suppress pain signals before they reach the brain.
"The central nervous system operates on two primary processes, electrical-conduction and chemical-information messengers," said Scott Ward, an executive with Medtronic Corp. of Minneapolis. "Implantable devices that use electricity or drugs can intercept the pain signals as they transit the spinal cord."
Ward said one device for people with chronic lower back pain consists
of two electrodes implanted on either side of the spinal cord. A battery
implanted under the skin delivers a slight electrical charge that modulates
pain signals. The system costs $10,000.
Copyright 2000 San Francisco Chronicle
(This story was posted on 21 Jul 2000)