May 1998
Volume 62 |
Number 5
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VENTILATIONS
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| A Painful History
Lesson |
"Pain has seized my body. May God tear this pain out."
Four thousand years ago, this quote appeared in cuneiform writing
on a clay tablet from Nippur, Babylon, and is the prayer of the
king's daughter. It is the first known written record of pain's
anguish. A few weeks ago, an Oregon physician prescribed a barbiturate
cocktail for a mid-80-year-old female patient with advanced breast
cancer to end her life to "be relieved of all the stress [she
had]." It is difficult to fathom that over these past 4,000 years,
we doctors have exhausted all therapies and failed to concoct
suitable treatments (pharmacologic or otherwise) so that the only
option for this octogenarian to relieve her stress at the end
of life is to sip a lethal dose of medicine.
Behan states in the preface of his book, Pain:
"Pain is universal and is present in practically every
disease ... The patient then comes to the physician, who, unless
he is well-versed in the interpretation of pain phenomena, may
be at a loss to interpret the symptoms which are presented to
him."1
Physicians who readily admit that they cannot adequately
assess pain or treat it are more inclined to favor physician-assisted
suicide to ease the suffering in their patients.2
Eighty percent of office visits in the United States this
year will be made to address pain complaints, yet less than 10
percent of all medical schools have a formal course on pain management
and even fewer residency programs offer a lecture on the topic.
The discovery of anesthesia by Morton, Wells, Long and
Simpson (I hope to be politically correct) signified man's triumph
over pain because now surgery could be performed without whiskey
and a gag. Today, the American Society of Anesthesiologists (ASA)
and the American Society of Regional Anesthesia (ASRA) are in
the forefront of a movement to adequately assess, treat and measure
the outcome of such therapies on pain. In other pain societies,
the majority of their members are also anesthesiologists who collaborate
with other medical specialists, nurses, psychologists, scientists,
pharmacists and other allied health professionals to attack this
primordial symptom of disease with a multimodality and multispecialty
approach.
Pain and suffering will be adequately addressed and virtually
eliminated in our lifetime so that future generations will have
little need for lethal
potions and Jack Kevorkian as desperate alternatives. It is
only too sad that for the intervening 4,000 years, humans lived
and died in unrelieved pain. Perhaps we could have prioritized
it sooner.
Editor's Note: I would like to thank the membership
for responding to some of the more provocative and controversial
articles over the past four issues by writing letters and sharing
their views. It is heartening to know that the "CRNA and HMO wars"
have not exhausted our spirits and depressed our enthusiasm for
engaging in healthy dialogue.
- M.J.L.
References:
1. Behan R. Pain: Its Origin, Conduction,
Perception and Diagnostic Significance. New York: D. Appleton
and Co; 1915; page vii.
2. Cleeland CS, et al. Pain and its
treatment in outpatients with metastatic cancer. N Engl J Med.
1994; 330(9):592-596.
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