I read an article published in the New York times and published yesterday. In the article a doctor named Colin Fernandes tells of the inadequacy of drugs offered to treat some diseases notably trauma and back pain.

As an example, the author describe the case of young veterans, frequently in their 20s, coming back from combat. They mostly have chronic pain and traumatic brain injury, untreated post-traumatic stress disorder, and sleep and mood disorders.

The challenge he faces if to find a balance between pain relief and side effects; For example the only treatment available for these problems is giving opioid painkillers (Percocet or Vicodin). But these drugs affect mood and sleep and he finds himself in the unenviable position of limiting access to pain medications if their use will lead to functional decline.

He he is sobered by the fact that the only study of efficacy of these drugs is a 16 weeks test where in practice the use of these drugs are often maintained on opioids for years or decades.

Colin Fernandes also note that trials suggest that on average, patients given opioids experience an improvement of only 2 to 3 points on a pain scale of 0 to 10 [=not much compared to the side effects]. Side effects and risks are many: chronic constipation, sedation and somnolence, a worsening of mood, opioid-induced hyperalgesia (a paradoxical phenomenon in which pain medications actually increase pain), hypogonadism (impaired endocrine function) and addiction [sic]. Recent studies also suggest an adverse effect on immune function.

Colin concludes that the guiding principle learned in medical school “First do no harm” is easy to understand but as a doctor saying to your patient “There is nothing more I can offer you” is very hard.

Feel free to tell me of your experiences in comments below..