Letters Bad medicine: pain

Ignorance, opioids, and bliss

BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c458 (Published 26 January 2010) Cite this as: BMJ 2010;340:c458
  1. Michael H Basler, consultant1
  1. 1Glasgow
  1. michael.basler{at}ggc.scot.nhs.uk

    Spence says: “Pain clinics have pursued a hospital model of care for pain without fully appreciating the implications of generating a ‘pain disability’ and opioid dependence in the community.”1

    As a practising pain clinician for over 10 years, I have spent most of my time trying to keep patients out of hospitals and away from inappropriate surgery, as well as weaning them off the strong doses of opiates that colleagues, often faced with intense distress and anger (not pain), have prescribed. I have dealt with a host of patients in the community taking persistent and large doses of tramadol hydrochloride and codeine (the general practice drugs of pain dependence) who have been referred for non-specific pain symptoms and distress.

    The risks of opioids have been highlighted in documents from the British Pain Society for over 10 years. Whose fault is it if GPs choose not to read them and to be duped by drug companies and a few of their invited speakers? It took 20 years for Spence’s local health board to fund a pain management programme, and the lack of multidisciplinary resource in all the pain clinics in Scotland has been highlighted in four national reports. Spence and any of his GP colleagues who are really interested should audit the number of patients in their practices with repeat prescriptions of simple analgesia stronger than 8 mg codeine and get back to me. Then they can stop them all, if they are brave enough, and pay for the physiotherapists, psychologists, and administrative staff who are desperately needed in many pain clinics.

    We have made the same mistakes as the Victorians, who took “tincture of opium for neurasthenia.” As to who will help patients out of their mess, I think Spence may find that pain clinics have more of a role than he would give them credit for.


    Cite this as: BMJ 2010;340:c458


    • Competing interests: MHB has occasionally spoken on behalf of pharmaceutical companies that market opioid analgesia but not for the past five years.


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