HI.

I think, for what it's worth, that the opinions of others must take a low priority to effective pain relief. Chronic long-term pain can completely destroy your life if it's not dealt with properly, but many people don't understand this at all. Usually, of course, because they have had no personal experience with pain of that nature and can't relate to it.

11 years ago my mother was diagnosed with terminal cancer. She quite rapidly developed severe pain as a result of the tumor, pain which the chemo exacerbated. Our GP, who was a wonderful old guy, had the attitude that there was no excuse for someone to be in severe pain, when there were many very efficient methods for dealing with it in most cases, once you got over the idea that these methods were somehow wrong.

He had no hesitation in immediately prescribing diamorphine in low doses, along with a laxative to deal with the only real side effect. Although the tablets were as I recall only 5mg, his advice to her was to more or less take as many as were needed to make sure she was comfortable, mentioning only a safe upper limit per day (which was fairly considerable). The more she took the more likely constipation was, and over the long term a physiological dependency would occur, but as he said, these effects were readily dealt with if she recovered, and if she didn't, it wasn't a problem.

The effect of the morphine was so powerful compared to any other painkiller she had been given that it allowed her to live out 90% of the 8 months she ended up having pain-free and active, doing everything she felt she needed to before the end. Without it, she would have probably been bedridden or crippled to the point of inactivity, which would have added insult to injury.

The problem with opiates is really one of perception, equating use with abuse. They are, as a class, the most effective painkiller there is, and in most respects the safest. There are few side effects other than the shutting down of peristalsis in the gut, hence the constipation that often occurs. The physiological dependency that usually occurs with long-term use is dealt with by tailing of the usage slowly rather than abruptly stopping, and as far as I have been told in the vast majority of cases causes no problems. Addiction isn't really any more likely than with many other, often more common drugs such as tranquilizers. Considering how many people nowadays seem to be on Prozac, for instance, I'm surprised morphine is disencouraged like it is.

My old GPs attitude was unusual for an ordinary doctor, but I have met a number of pain specialists who said he was completely right. Pain can be dealt with in almost every case, and if a doctor can't help with it, you need to hunt around until you find one that can.

I guess one part of the problem is that there isn't any really objective way of measuring how much pain someone is actually experiencing. What might be acceptable to one person is unbearable to another, and if the first is doing the prescribing to the second, you may well end up with substandard results.

If your friends think your wife is complaining too much about pain, perhaps you should find another friend, one who hurts a lot and can sympathise

pca