| JOURNAL HOME | CME HOME | THIS MONTH | PAST ISSUES | ETOC | COLLECTIONS |
| AUTHORS | REVIEWERS | EDITORIAL BOARD | FEEDBACK | RSS | HELP |
| ||||||||||||||
| ||||||||||||||
|
|
|
|
||||||||||||
|
||||||||||||||
Pain Management Research Institute; University of Sydney at Royal North Shore Hospital; St. Leonards, NSW Australia; mcousins{at}nsccahs.health.nsw.gov.au
To the Editor:
We appreciate the thoughtful comments embodied in the four editorials on our article (1). Because our review is congruent with every governmental and professional white paper on the benefits of appropriate pain management, we are not surprised that three of the editorials were strongly supportive. White and Kehlet (2), however (4), give the impression that our article focused upon the relief of pain by opioids as a fundamental human right. The title of our article and its content make it clear that this is not the case. Only one line of the article’s abstract and <15% of its text are devoted to the use of opioids for pain management. Nevertheless the level of opioid administration is universally used as a marker to indicate whether pain management is being given an appropriate priority. In particular, Figure 1 in the editorial by Scholten et al. (3) of the World Health Organization employs per capita opioid consumption as a measure of the quality of pain management in various countries throughout the world.
The current article (1) and prior publications of two of the authors (4–6) make it clear that we regard persistent pain as a multifaceted problem requiring a multimodal approach to management.
For most of the world’s population and in many settings, opioids offer a unique combination of low cost and great effectiveness. The World Health Organization, the other editorialists, and the leading professional and governmental bodies cited in our article share this view. A recent article by Sykes (7), declared that "morphine kills the pain, not the patient." and observed that "professional and public anxieties about the effects of morphine continue to hinder adequate access to analgesia." He summarized abundant, highly credible data from various countries that "found no significant difference in survival according to either absolute morphine dose or change in morphine dose" and noted further evidence that "underprescribing of opioids remains a major barrier to effective pain control." Relevant to our review (1)and the White-Kehlet response (2), he continued that "if ineffective pain management is still an issue in high-income countries, it is nearly universal in low-income countries where access to morphine is limited or absent, but where most people dying of cancer or AIDS reside." He concluded that opioiphobia, fueled by rhetoric favoring expensive alternatives accessible only in the developed countries, would result in the world’s poor getting nothing.
Can any agreement be reached between our article and the White/-Kehlet editorial (2)? We believe so. These shared conclusions include:
This balanced approach is what our patients need, expect and deserve from us.
REFERENCES
This article has been cited by other articles:
|
|
 |
|
  P. F. White and H. Kehlet The Role of Opioids in Pain Management Anesth. Analg., December 1, 2007; 105(6): 1866 - 1866. [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
