Alexander DeLuca, M.D.
Addiction, Pain, & Public Health website   
[Home] [Library]  [Slides]  [Search]  [Medline]  [Links]
Statement of Purpose; Privacy policy; Email Confidentiality Policy; Statements of Ownership & Sponsorship; Advertising policy

A Fight for Full Disclosure of the Possible Pain

by Jane Brody; Personal Health column; New York Times; Section F; Page 7; 3/8/2005
Originally posted 3/8/2005: [www.doctordeluca.com/Library/Pain/FullyDisclosePain-Brody05.htm]
Source: [http://www.nytimes.com/2005/03/08/health/08Brod.html]
 
See also:
When It Comes to Severe Pain, Doctors Still Have Much to Learn; Jane Brody; NYT; 2005-02-15
 
A New Set of Knees Comes at a Price: A Whole Lot of Pain; Jane Brody; NYT; 2005-02-08
 
Major Media on the War on Doctors and the Pain Crisis, 2005; compiled by Alexander DeLuca; 2005-12-12
 

[PDF print format]

The dozens of letters, phone calls and e-mail messages I've received since writing my recent columns on total knee replacement and pain management reveal that I struck a chord.

Some readers chastised me for scaring potential patients away from this surgery, which, when healing is completed, can greatly enhance quality of life. But many others praised me for "telling it like it is" about an often painful and difficult recovery that surgeons don't warn patients about.

Clearly I've not been alone in having prolonged, debilitating postoperative pain that was not adequately treated.

Obviously, many people have had total knee replacements without experiencing the kind of pain I suffered.

I knew going into surgery that a friend 10 years my senior had both knees replaced at once, as I did, and was dancing after four weeks. I could not walk down stairs using both legs at nine weeks after surgery despite prompt and intensive physical therapy. Another friend, a woman in her 80's, said she had almost no postoperative pain.

An Ohio man who had both knees replaced at age 77 wrote: "After surgery, my pain was very tolerable, and I took minimal pain medication. I now walk everywhere, miles, over hill and dale, all without pain, and I'm hoping to return to the tennis court. I would encourage those who need knee replacement to 'go for it,' even both knees at the same time."

Since I entered surgery slender and in top physical condition, I expected a similar recovery experience, and my surgeon reinforced that expectation.

Who can explain it? Not me or my surgeon.

A Patient's Right to Know
To those readers who fear that I unduly frightened some prospective knee replacement candidates away from this life-enhancing surgery, I must say that was neither my intent nor my message.

My message was that whatever procedure a patient faces, full disclosure is imperative. People have a right to know what they may encounter, not just what the surgeon hopes will happen.

An orthopedic surgeon called after reading my article to say that he tried to fully inform patients who asked about knee replacement.

As a result, he said, he scares some people off, and the chief of surgery at his hospital has complained that he does not do this operation often enough.

This is outrageous, and just reveals the monetary motives behind much of modern medicine. The patient be damned; just bring in the bucks.

So here's the good news: at 10 weeks post-op, I insisted that the surgeon take another look at me because I was convinced - as I had been for weeks - that there was something wrong with my right knee.

The left, the most severely afflicted with arthritis going in, was at last healing nicely, but the right continued to keep me tied to potent painkillers.

As it turned out, I had tendinitis, a seriously inflamed tendon across the outside of the knee cap that was aggravated with every bend of that knee. All it took was a shot of cortisone to bring relief and get the healing process back on track.; I just wish that my weekly complaints of disabling pain in that knee had been acted upon much sooner.

The day after the shot, I was able to walk half a mile each way to my local Y and resume my daily swim. In just four days I was swimming three-fourths of a mile and feeling almost fully human again.

Yes, I still take medication, but much less than before, and I still have to rest from time to time. But I now anticipate the day when I can resume riding my bicycle and walking around the park, hiking and ice skating with my friends.

I am certainly not alone in wishing I'd been prepared for a difficult recovery.

A Need for Planning
Here's what one reader who had total knee replacement wrote: "I wish I had known how incapacitating the recovery period would be so that I could have planned accordingly. It would not have changed my resolve to have the procedure - only my planning for its aftermath."

Is this too much to ask of the medical profession?

I had set aside six weeks to recover and done all my work in advance for that period, only to find that I needed twice the time to return to normal daily activities, including getting to the subway, on it and off it.

Another surgeon wrote to me about doctors' fear of legal action over prescribing narcotics. Yes, the government has unfairly attacked some pain management specialists who treat dozens of patients with chronic pain.

Dr. Jennifer P. Schneider, the author of "Living With Chronic Pain," has testified on behalf of such doctors who were unjustly accused of feeding the habits of drug addicts.

An Uprising Overdue
This is hardly the case, and a mass uprising by doctors and patients in support of legitimate pain treatment is overdue.

It is also not true that pain patients get hooked on narcotics, craving ever greater doses of them. Addicts get hooked; pain patients need increasing doses only when their pain worsens, as often happens to those with advanced cancer.

And as Dr. Laura Lewis Mantell of New York wrote to me, "The use of opioid analgesics (narcotics) need not be avoided out of concerns that addiction will ensue, because the incidence of addiction arising out of postoperative exposure to opioids is negligible. "When faced with the kind of pain I experienced, doctors must treat it properly and not act like frightened children when it comes to prescribing narcotics, by far the best drugs for dealing with severe pain.

A narcotic like OxyContin is not abused by pain patients but by drug addicts. I feel no euphoria, just pain relief, and I'm having no problem weaning myself off it now that I am in much less pain.

The American Academy of Pain Medicine, the primary organization for physicians who treat pain, is alarmed by the interim policy statement issued by the United States Drug Enforcement Agency, which threatens to make it even more difficult than it now is for legitimate physicians to prescribe adequate pain relief for their patients.

Undertreatment of pain is already a public health crisis and the government should act to improve the situation, not make it worse.

Undertreated pain destroys lives. As one young woman put it in an e-mail message: "The effect of pain had an insidious effect on my life, my outlook, my well-being and my relationships in every sphere of my life. Pain is a funny thing. Unless you're the one feeling it, it's basically meaningless."

The time is long overdue to instill empathy, not fear of persecution, into the nation's physicians.

[END]