Pain management without pain treatment is the shortcoming of the dea and David
bronheim et al.
The lancet p.106 jan 14 ,1978 describes the treatment in Boston by Eugene j ratner of mrs j Edward spike jr for causalgia.
Ratner treated the cause of pain and incidentally thereto wrote narcotics prescriptions.
I still recall with great pleasure telling a state investigator on 125 th street that if he had any questions about a particular patient to go talk to the dea.
Ratner worked for many years for the us, the veterans administration, and treated many cases of the suicide disease trigeminal neuralgia. Many were made functional or better.
Pain management is now in the hands of the people as all of us grow our morphine producing Yeats which we may refine into heroin. When such no longer serves the purpose we synthesize fentanyl derivatives, each more potent, than the next. The us sadly did not make great use of ratner's work. The us prefers morphine producing yeast in every kitchen.
Sadly dr mark altschule's prophesy to ratner after seeing ratner cure mrs j Edward spike jr has come true. Ratner did not live long enough to see his work widely adopted or explicated.
Ratner treated the director of publications at cold spring harbor laboratory, nancy ford,
Nobel prize winner james Watson knew ratner and cannot explain why and how ratner's treatment for causalgia worked.
Help Those Who Have Chronic Pain but Limit Addiction
Recent narcotic overprescription resulted as a reaction to historic undertreatment of pain due to concerns over addiction.
Defense attorney Harvey Silverglate claims, on the basis of two prosecutions (only one of which was successful), that federal drug-enforcement officials are “terrorizing” doctors for alleged overprescribing of narcotic pain medications (“When Treating Pain Brings a Criminal Indictment,” op-ed, June 13). This is sheer hysteria.
Whether to prosecute physicians for overprescribing controlled substances for pain is debatable; that more than a few physicians are overprescribing narcotic pain medications is not.
While mindful of patients’ reports of pain, physicians must also address the problem of narcotic seekers in their patient population and must resist acceding to every request by patients for opioids, stimulants, drugs for anxiety and other medications with a high propensity for dependence. Those physicians who dole out an addictive pill for every ill are a blight on the medical profession.
Mr. Silverglate should at least acknowledge the pandemic of narcotic-seeking behavior.
Alan Blum, M.D.
Tuscaloosa, Ala.
Recent narcotic overprescription was a reaction to historic undertreatment of pain due to concerns over addiction. Starting in the 1980s and culminating with pain being labeled the “fifth vital sign” in the mid-1990s, concerns over addiction were minimized as overblown, and physicians were encouraged even by our government to liberalize their use of narcotics. When it became clear that narcotic addiction was occurring more commonly than expected and that medications were subject to diversion, the government then sought to limit access, resulting in a criminalization of an addiction cause by pain treatment initially encouraged by the same entity.
A more useful approach would be better physician education on managing chronic pain while limiting narcotic usage, the provision of ready access to treatment for drug addiction and the decriminalization of narcotic use, instead of treating it as a medical problem.
David Bronheim, M.D.
Mount Sinai
School of Medicine
New York
I am an anesthesiologist practicing pain management for the past 13 years in Elmira, New York. We are closing our practice for economic reasons, i.e., reimbursement to a properly managed private office is insufficient to cover expenses.
Our difficulties in having the referring physicians or any other physician take overprescription of opioid medications for our former patients are astounding. The three hospitals in our region own almost all of the medical practices.
Almost 98% of referring doctors won’t write pain prescriptions. The hospital medical groups have instructed these physicians (whose practices are dictated by hospitals) not to write for stronger pain medications.
Of the dozen or so pain physicians in our area only three will write prescriptions for medications.
The hospitals have rescinded the workers' compensation agreements of most primary care physicians. Therefore these physicians cannot treat patients for workers’ compensation injuries. Almost none of the occupational medicine doctors who see these patients will write prescriptions for treating pain.
We are left struggling to have the few physicians who prescribe pain medications accept as many referrals as possible and weaning those we cannot refer off their medications.
David L. Mevorach, M.D.
Elmira, N.Y.
