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Nothing to Fear but Pain Itself

Are You Opio-Phobic?

New Drug, Old Fears continued...

The U.S. has a history of opio-phobia that stretches back to legendary newspaper publisher William Randolph Hearst, says Bennett, who used his newspapers to campaign against the dangers of opium almost 100 years ago.

In the current environment, opio-phobia is flourishing because both physicians and patients are uneducated about pain and pain treatment.

"The average physician has less than two hours of formal training in the treatment of pain," says Bennett, assistant clinical professor at the University of Colorado Health Sciences Center in Denver. "Yet, the number one reason for visiting a doctor is because of some painful problem."

Dependence Doesn't Equal Addiction

Even though pain leads people to seek medical help, too many patients suffer needlessly because they have misplaced fears about the use of opioid medicines, says Akshay Vakharia, MD, a pain management specialist at the University of Texas Southwestern Medical Center in Dallas. Those fears often stem from confusion about the difference between dependence and addiction.

Patients who are treated for long periods with opioid medicines like OxyContin -- meaning more than two weeks -- will experience physiological dependence on the drug. That means, simply put, that if the patients abruptly stopped the drug they would have symptoms of withdrawal, such as tremors, nausea, diarrhea, and sweating. In many cases the symptoms are mild and not like Diana Ross' bathroom histrionics in "Mahogany." And if the patient is gradually tapered off the drug, there are no symptoms and, most importantly, there "is no relapse, no drug-seeking behavior," says Vakharia.

Bennett says he and other pain experts want to get the message out that addiction is not a significant risk when drugs like OxyContin are used to treat pain. Moreover, he says that the whole concept of tolerance, meaning that patients get used to the drug at a low dose and then need higher and higher doses to overcome pain, is flat-out wrong.

"If the patient is started on an opioid and the dose is adjusted to a level where pain is adequately treated, the patient can be maintained on that same dose for the long-term," says Bennett. When a patient complains that pain has returned "it usually means that either the disease has progressed or there is something else, another condition," he says.

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