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EMPOWERMENT You can control pain, doctor says



Published: Sun, July 28, 2002 @ 12:00 a.m.



'If severe pain were uncontrollable, that would be a tragedy. That it is controllable, but is so seldom properly controlled, is not a tragedy, but a scandal,' Dr. Eric M. Chevlen said.

By WILLIAM K. ALCORN

VINDICATOR HEALTH WRITER

"Power over Pain: How to Get the Pain Control You Need," by Dr. Eric Chevlen (The International Task Force on Euthanasia and Assisted Suicide, $12.95).

YOUNGSTOWN -- Horrific pain.

Overwhelming, unrelenting, blinding, mind numbing, grinding, bone-deep.

The level of sustained pain that destroys quality of life; the kind of torture that causes people to writhe; and even leads some to long for death.

Whatever the cause, that degree of pain does not have to be, and euthanasia is not the answer, says Dr. Eric M. Chevlen, in his book, "Power over Pain: How to Get the Pain Control You Need."

Dr. Chevlen, oncologist and director of palliative care at St. Elizabeth Health Center, co-authored "Power Over Pain" with Atty. Wesley J. Smith, an author and consumer-patient advocate from California.

Dr. Chevlen and Smith were commissioned to write "Power Over Pain" by the International Task Force on Euthanasia and Assisted Suicide, with headquarters in Steubenville.

Their book, published this year, can be ordered by sending check or money order to The International Task Force, P.O. Box 760, Steubenville, Ohio 43952.

The Web site www.poweroverpain.com contains reviews of the book, information about the authors, a place for comments and information about how to buy the book.

Easy read

The book is an easy read, written in laymen's language with medical terms clearly and simply explained. It contains numerous case histories, in the form of vignettes called "From the Doctor's Journal" -- some humorous, some poignant, but all relevant to making Dr. Chevlen's point that no one has to live with debilitating pain.

Perhaps most important, "Power Over Pain" offers hope, as well as a wealth of practical information for physicians and patients on how to communicate with each in order to relieve pain from cancer to migraines, from gout to phantom limb.

Dr. Chevlen and Smith have appeared on national TV programs and written numerous articles for scientific journals and national publications such as Newsweek, The New York Times, Wall Street Journal and USA Today.

"If severe pain were uncontrollable, that would be a tragedy. That it is controllable, but is so seldom properly controlled, is not a tragedy, but a scandal," Dr. Chevlen said.

Most scandalous of all is that much of the cause of this "medical under-performance" is the result of prejudice and ignorance resulting from lack of training for doctors about the most effective family of pain-controlling medications available today -- opioids, the best-known of which is morphine, Dr. Chevlen says in his book.

Coincidentally a National Institutes of Health Consensus Panel concluded this month that efforts to manage the symptoms of cancer, specifically pain, depression and fatigue, have not kept pace with research into the disease's causes and cures.

"Too many cancer patients with pain, depression and fatigue receive inadequate treatment for their symptoms. Fear of cancer and its consequences must be ameliorated. All patients with cancer should have optimal symptom control from diagnosis throughout the course of illness," the panel said.

Though Dr. Chevlen was not on that panel, he might well have been, given the similarity of its conclusions and his beliefs.

Here's the problem

Most doctors do not receive adequate training in medical school or residency in the proper use of opioids to control pain, Dr. Chevlen said.

"I had to unlearn lessons that I had been taught before I could become a good pain doctor," he said.

Too, he said, many of the roadblocks to successful pain management are erected by the government in the form of federal and state regulations that govern the use of "controlled substances," and the plethora of accompanying required paperwork.

Patients themselves can create barriers to good pain treatment by not communicating thoroughly and frankly with their doctors in describing their pain, and failing to take the prescribed medication, he said.

Also, he said some patients, and their health care providers, erroneously fear they will become addicted if opioids, the word that replaced narcotics, are used for pain relief.

Too, nurses and other support staff may worry that proper dosing of morphine in hospitals is improper, leading them to resist cooperating with proper medical protocols.

alcorn@vindy.com




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