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Some of the benefits of relieving pain may be described as psychological. Pain, after all, is depressing (and depression makes pain worse). Because of the complex interplay between emotion and physiology, experts on analgesia have learned that it is useless to make distinctions between mental and physical pain. "We never say, 'It's all in your head,' " explains Dr. Charles B. Berde, director of the pain service at Children's Hospital in Boston.
Many physicians now concede that patients have been undermedicated for decades, suffering needlessly. One reason was concern that big doses of opiates could depress respiration, but a large part stemmed from an exaggerated fear that patients would become addicted. This fear, which continues to hold sway over American medicine, is basically unwarranted. A landmark study, published in 1982, followed almost 12,000 Boston hospital patients who had been given narcotic pain-killers. After eliminating those with a history of addiction, researchers found that only four became addicted to the drugs they received as patients. "You don't see cancer patients running around robbing shopping malls to support their habits," notes Carr.
NO GROUP OF PATIENTS HAS SUFfered more from undermedication than young children. For years, many doctors insisted that babies under six months didn't feel pain and those just above that age didn't experience much discomfort. Both ideas are now discredited. Nonetheless, cautions Bruce J. Masek, head of behavioral medicine at Children's Hospital in Boston, "society is still hysterical about making a four-year-old a heroin addict."
Fortunately, technology, improved drug protocols and changing attitudes toward pain management have come to the rescue of children and adults. Skilled pediatricians now routinely give morphine to children and infants to ease postoperative pain. Oxymeters, which monitor breathing, alert nurses to early signs of respiratory problems. When morphine is inappropriate, large doses of local anesthetic work well. Pediatric-pain specialists use a plastic scale of happy to crying faces to help young children express how they feel. And doctors have learned to recognize certain infant sounds, grimaces and motionlessness as signs of suffering.
Cancer-pain management has also changed dramatically. Physicians today give megadoses of morphine without great risk of depressing a patient's breathing. Sloan-Kettering's Foley estimates that the morphine doses she prescribes for chronic cancer patients, usually as time-released tablets, are at least ten times the amount she gave a decade ago.
Furthermore, doctors have learned that a given dose of morphine packs more punch when combined with local anesthetics like Bupivacaine or with the newest nonsteroidal anti-inflammatory drugs (the category to which Tylenol and aspirin belong). That strategy also helps patients avoid the side effects of opiates, such as nausea, constipation, hallucinations and itching.