When Killing The Pain Does Harm

Prescription painkillers now kill more Americans than heroin and cocaine combined, according to the CDC. Physician Celine Gouder confesses that she, like other doctors, often struggles to make the right call when patients request painkillers:

Doctors have a duty to relieve suffering, and many of us became doctors to help people. But giving that help isn’t straightforward, especially when it comes to chronic pain. Try explaining the downsides of narcotics to a patient while declining to give him the medication he wants. He might accuse you of not understanding because you’re not the one in pain; he might question why you won’t give him what another doctor prescribed; he might give you a bad rating on a doctor-grading Web site. He might even accuse you of malpractice. None of this is rewarding for doctors: we’re frustrated that we can’t cure the pain, and that our patients end up upset with us. …

I sometimes think of the patient who asked me for OxyContin early in my career; I continued to prescribe the drug. But I also referred him for physical therapy and helped him get bariatric surgery to lose the weight that was putting extra stress on his spine and joints. Unfortunately, even after he lost about a hundred pounds, he wasn’t able to stop using narcotics or go back to work.