Tramadol is a key part of all pain management strategies

There’s one thing no one can ever deny. When you feel pain, you know about it. OK, so that’s the point. Pain is a warning system to tell you to move away fast from a source of injury or to get help for something else wrong. This is a great survival tool. Except once you have the message, it would be better if you could switch it off. As it is, you can do everything right. Go to the Emergency Room, get treatment from a great doctor, have wonderful nurses take care of you, and still feel pain. It’s just not fair. More importantly, it makes pain a problem in its own right justifying separate treatment. Just as you get treatment for the cause of the pain, you should also get treatment for the pain. As it is, you end up under the care of the doctor specializing in the particular injury, disease or disorder. If you complain of the pain, all you get is an analgesic. If you complain the pain is still there, you get a more powerful drug. Before you can say, “Holy pills, Batman” you’re suddenly on the most powerful, and often quite dangerous, drugs.

In Washington State, there’s a direct challenge to this system. Government is developing new regulations to curb the routine prescription of the narcotic painkillers. The cornerstone of these proposed regulations is a requirement that, if the patient is not responding well, the doctor must get a second opinion from a pain management specialist. As it is, there’s a national epidemic of deaths from prescription drug use. It’s the second most common cause of death after traffic accidents — in some states, it’s actually the highest cause of death. With almost 8% of all prescriptions being for the narcotic painkillers, there’s a real need to step in. Not only is it dangerous to have so many people addicted and suffering the side effects of long-term use, but it will also reduce an avoidable cause of death.

Needless to say, doctors in Washington state are resisting this attempt to control their prescribing habits. That many prescriptions are going for recreational use and the rest may be causing avoidable deaths seems not to worry them. In reality, most of the best research from around the world suggests the use of a less powerful drug like Tramadol is usually adequate when combined with cognitive behavioral therapy and, in appropriate cases, guided physical therapy. The best strategies aim to give the best quality of life possible for each individual. The opiate painkillers may still be appropriate for the patients with cancer and other terminally painful conditions. But everyone else should learn a more positive outlook on life and cope with the physical problems. This leaves Tramadol as one of the front-line drugs of choice, available to treat moderate to severe pain. The rest of the US is looking on with interest as Washington tries to control the medical profession. Quite why doctors should resist controls to reduce the number of addicts is unknown.