BehindTheMedspeak: Modern methods of pain control can kill you

Color me old–fashioned but if I should happen to have surgery and then require serious pain medication post–operatively, I will refuse any and all modern inventions such as patient–controlled analgesia (PCA), continuous epidural infusion or narcotic skin patches.

Why?

Because these new, "better" methods of relieving pain have a dark side not appreciated by the great majority of patients and physicians who use them: they can kill you and they have a much higher likelihood of doing so than an old–fashioned, low–tech shot of morphine or Demerol in the butt every three or four hours when it starts to hurt again.

But guess what: there's zero profit in the old drugs and methods; the new developments mean huge profits and income for doctors, hospitals and, above all the drug companies manufacturing the components required for the more modern methods.

Here's the problem in a nutshell: because all of the new methods are not under direct human supervision or control but rely instead on technology, they are only as good as the technology.

And guess what: sometimes technology doesn't work like it's supposed to.

Like the PCA pumps that mistakenly deliver ten or a hundred times more narcotic than prescribed because they were incorrectly programmed or because someone wasn't paying attention when they put the narcotic into the infusion bag.

Like the epidural pumps that suddenly infuse a huge bolus for the same reason.

Or the skin patches that inadvertently are placed too close to a source of heat, increasing blood flow to the skin and resulting in an unintended delivery of a bolus of narcotic to the patient's bloodstream and brain.

Bottom line: a large dose of respiratory depressant in the form of a narcotic is delivered to the breathing centers in the brainstem; they respond appropriately — in a physiological sense — and shut down respiration.

You know the rest.

Issues with the narcotic patch recently caught the attention of the FDA: yesterday it issued a warning that "painkilling skin patches could cause drug overdoses," according to Denise Grady's story in today's New York Times.

Here's a frightening statistic: The FDA is currently investigating 120 deaths said to have occurred since 1990 as a result of the use of Duragesic patches, which contain the very powerful synthetic narcotic fentanyl, fully 100 times as potent as morphine.

Let's do the math: that's 8 deaths a year.

And those are just the ones reported, probably a tenth — at most — of those that occurred and weren't reported or were attributed to other causes.

And that doesn't include the far larger number of people who incurred brain damage due to cerebral anoxia but didn't die as a result of their overdoses.

But perhaps you'll understand why the FDA's not looked into this up to now when you consider another bit of math: the fact that Duragesic had sales of more than $2 billion last year, according to Grady's story.

As I said, call me a Luddite but I'll take my shots, thank you very much.