RSD Puzzle #084

H. Hooshmand, M. D.

DIPLOMATE AMERICAN BOARD OF PSYCHIATRY AND NEUROLOGY

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INTRACTABLE NEUROLOGY

EPILEPSY, PAIN, MS

An International Referral Center dedicated to Treatment, Education and Research

RSD PUZZLE #84
More On Dependency To Drugs

The greatest researchers and professors who are experts in surgical procedures and in the latest advances in mechanism of diseases know very little about dependency to drugs. As a matter of fact the higher quality the university or research center the more likely they are to prescribe morphine agonist narcotics and to try to get rid of the pain with surgical procedures doomed to fail. The best example is the doctors in cancer institutes who advocate the same pain medicines for cancer patients as they do for RSD patients. The cancer patient has a few months to live, and as a mercy act, should receive any of the strongest pain medicines or any surgical procedure that provides her a few months pain relief.

The RSD patient has quite a few decades of life ahead of her and should not be exposed to such gross treatments. The treatments are worse than the disease.

The pain specialists in the cancer centers who advocate drug dependent medications for RSD would agree the fact that there is nothing in common with acute pain, cancer pain, and Chronic Regional Pain Syndrome (CRPS/RSD). Acute pain -examples- fracture of bone or acute heart attack- and cancer pain both have the acute recent tissue damage in common. The cancer pain is also a combination of acute damages and chronic scars of the cancer. Regardless, both acute and cancer pain require surgical treatments and strong narcotics. The chronic pain of RSD requires strong non-addicting narcotics such as Nubain, Talacen, Buprenex, Stadol, and Ultram. They are as strong if not stronger than the first group yet they don't suppress the endorphins, growth and sex hormones. Chronic pain RSD rarely requires surgery (examples Fracture of bone, torn meniscus in the knee). Otherwise conservative treatments will do much better without leaving scars behind. However, that does not prove that they are practicing good medicine when the surgical procedures fail or the pain medication becomes a new source of pain due to withdrawal. I inherit these problems on a daily basis and have to try to fix them. I rarely ever see a virgin RSD patient. I see the patients who have been to large centers whose treatments have failed which have made their RSD worse with spread and other complications.

We have rehashed the subject of safe versus unsafe narcotics ad-nauseum. Why would anybody with simple common sense opt to take an unsafe narcotic that causes physical dependence? Withdrawal Pain refers to the fact that when we did the research on dogs - and when Dr. Basbaum does research on rats or other animals- a perfectly normal animal treated with morphine starts self-mutilating (attempts to chew its perfectly normal leg) due to the fact that a few weeks intake of morphine has left the animal with no natural cerebral endorphins.

This is the type of pain which happens in a perfectly normal animal only because of treatment. Why do the RSD patients fight for getting such medications just because the cancer centers or the standard medical community allow such treatment?

One other factor is "money talks and everything else walks". HMO's and other insurance companies fight to death not to allow the patients to use the more expensive and safer non-dependant type of narcotics. They give the patient a few choices of Methadone, Morphine, Lortab, or Percocet which are all cheaper than newer safer drugs.

I usually explain to my patients that saving money for HMO companies is no reason to use harmful drugs and to take harmful medicines.

It is the physician's duty to keep the patient out of harms way rather than pleasing the insurance company that pays his salary (in the case of HMO's) or insurance refund.

Please do not call Dr. Basbaum for treatment advice. He is a great researcher on the subject of pain and does exclusive animal research. That doesn't imply that any patient is an animal.

Type of Pain	Surgery	Morphine Agonist	Morphine Antagonists	Agonist Antagonist Combination
Acute Pain	Yes	Yes	Yes	Never
Cancer Pain	Yes	Yes	Yes	Never
Chronic Pain (e.g., CRPS)	*Rare Exceptions	No	Yes	Never

* Examples of exceptions for surgery are Non-Union Fracture, Torn Meniscus or Ligament in the Knee, or similar conditions.

The material on the Neurological Associates Pain Management Center Homepage and all it's associated, linked or reference pages is for informational and education purposes. It is not meant to take the place of your physician. Before starting, changing, or stopping any treatments or medicines consult your physician. H. Hooshmand, M.D., Neurological Associates Pain Management Center and Associates will not be held liable for any damage or loss as a result of information provided on this page or associated documentation. Again, this WEB SITE is simply published as an information source and should not be used to treat or make judgments on RSD/CRPS. All associated material on this web site may not be copied, reproduced or quoted without expressed written permission from the owner; Copyright © 1999-2006 H. Hooshmand, M.D.