Health Information

One of the building blocks of medical treatment is the need for the patient (that’s you) to consent to whatever treatment is proposed. Hopefully, the doctor gives you a good explanation of the all costs and benefits, and this allows you to make a properly informed decision. The problems with this in the real world come on both sides of the equation. Some doctors act as if they walk on water and you should do whatever they tell you and be grateful they were actually prepared to speak to you. Some patients come with prejudices and, no matter what the doctor tells them, they don’t want to hear anything that conflicts with their own beliefs. In the middle come the doctors who are bad at explaining and the patients who struggle to understand. The result is that many pain management clinics fail to give a comprehensive and satisfactory range of treatments to every patient, i.e. many patients are left in pain.

So what are people afraid of? The most common is the legitimate concern that there’s a risk of addiction with some drugs. Some doctors believe they should be protective and not prescribe some painkillers. Some patients refuse to take anything where the risk exits. This has produced an irony. Hospitals have trained thousands of nurses and support staff in the management of pain, but they are not allowed to prescribe drugs. So even when the nurses and the patients may agree on a particular treatment, they have to wait for the attending physician to appear with no guarantee he or she will agree. The traditional physicians are still worried about addiction. This is changing as the new doctors come through training with more understanding of the multidisciplinary approach to managing pain.

In an ideal hospital and clinic, all the staff would cooperate, i.e. the physical and psychological specialists will talk to each other positively, allowing for the possibility of error in diagnosis or treatment, and involving physical therapy, counseling and a range of alternative treatments to play their part. Indeed, even the spiritual should be involved with in-house staff and local churches offering counseling and support for patients in pain.

One of the key problems at every point is to decide whether the doctor is treating pain or depression. This makes a big difference to the selection of drugs. Equally important is to treat the underlying cause of the pain alongside the pain itself. If you are complaining of continuing pain, you are entitled to something more than some extra Tramadol or something stronger. You are entitled to have someone question why you are still in pain. This assumes, of course, you are being honest about how severe the pain is. Unfortunately, some are trying to game the system, e.g. to get more compensation because of an accident or to manipulate relatives in some way. Pain management can involve psychiatric assessments and social workers investigating a patient’s background to get as complete a picture as possible. In all this, the routine drug is Tramadol. It offers more support than any of the NSAIDs and has fewer problems of addiction than the more powerful drugs. This is not to say that Tramadol will be given to everyone, but it is genuinely effective in relieving moderate to severe pain.

It’s always sad when a great story fails to stand up to the historians. We all like Longfellow’s version of the ride but, it seems, he was only one of many and never uttered the now famous warning about the Brits. Unfortunately, the modern warning will stand up to the test of history. It’s a matter of fact that there was a Boom in births between 1946 and 1964. Worse, it’s also a matter of fact that the so-called Hippie generation is more heavily into street drugs like marijuana and the legal highs of prescription drugs than any other group in the US. Ask anyone connected to the federal Substance Abuse Administration and they will tell you the same story. The number of people aged 50 and more who abuse drugs is rising fast. Why should this matter? Well, the healthcare service includes drug-treatment programs that are supposed to help people through the pain of withdrawal and to teach coping strategies for life after dependence. As the population ages, a wave of people who have consistently used a significant range of different substances is going to begin encountering health problems. You cannot abuse these substances indefinitely and avoid the adverse physical consequences. The expectation is that the treatment programs will collapse unless, at a minimum, the number of treatment facilities doubles over the next five to ten years. Worse, the older people are, the more expensive it is to treat them.

What is the main health problem going to be? As bodies age, everything slows down. In particular, the liver and kidney lose efficiency and do not clear drugs from the blood stream as quickly. If older people are also starting up new treatments, say for high blood pressure, the drugs could interact and cause major adverse side effects. There could also be problems for physicians as they try to diagnose diseases and disorders. For example, there is clear evidence that the long-term use of marijuana causes some memory loss. How is this to be distinguished from the memory problems stemming from the early onset of Alzheimer’s? At present, there is no clear evidence as to how often physicians ask their patients about substance abuse. Just as important, there is no evidence about how honestly patients answer questions about their sometimes illegal drug use. It is obvious to the federal government that there should be routine screening of all patients aged 50 or more. This would cover the spectrum of substance abuse from alcohol and nicotine to painkillers. All patients should be counselled on the need to quit. But patients may fear admissions of illegal drug use may end up on their records. At the least, this will damage their reputation, but it could result in prosecution.

In terms of prescription drugs, the most often abused are the anti-anxiety and treatments for insomnia, mainly ambien. There is a reflex in physicians when their older patients report problems in sleeping. This is an expected aspect of growing old. People lose their jobs. They start feeling socially useless. This leads to stress and some depression which interferes with normal sleep patterns. Only a few physicians are trained in geriatrics. They neglect to ask about lifestyles and just write the standard prescription for ambien. While none of this changes the facts about ambien which remains the best of the drugs to treat insomnia. It should alert all Boomers about the need to review lifestyle with their physicians and, if possible, cut down or quit nonessential drug use.