Dear Dr. Bill,

I'm a recovered addict who has been clean and sober for nearly five years. Two months ago, I had major surgery and had considerable post operative pain. I had told my doctor about my past history. As a result, he gave me very little pain medicine. I can't begin to tell you how much pain I had and how scared I am of ever having surgery again.

Thanks to my 12 Step program and a lot of prayer, I got through this without suffering a relapse. Can't something be done for pain relief for people like me?

F.G.-Tenafly

Dear F.G.,

Physicians have long wrestled with the dilemma of how to relieve a patients's suffering while avoiding the potential for addiction to a powerful opiate pain medication. Many doctors under-prescribe powerful analgesics because they overestimate the potential for patients to become dependent on these painkillers which include opiates such as morphine and codeine, and natural and synthetic substances closely related to morphine, called opioids. Doctors know that for many people, these drugs carry a high risk of physical dependency and that abuse of these and other opiates, have long been a problem. Knowing your history, I suspect your doctor felt that he had to take a very cautious route...probably too cautious, as he, like many other physicians is probably not aware that these drugs are rarely abused when used strictly for medicinal purposes, as opposed to so-called "recreational" use.

Several studies indicate that most patients who receive opioids for pain, even those undergoing long-term therapy, do not become addicted to these drugs. Nonetheless, although relatively few in number, there are patients who do develop rapid and marked tolerance... most are those who have a prior history of substance abuse. This fact alone demands that physicians who prescribe drugs must take a carful history, not only that of a patient's own usage but also must include a thorough family history of possible addiction.

According to a number of studies reported by the National Institute of Drug Abuse (NIDA) when doctors limit pain medication, thousands of patients suffer needlessly. The dilemma over the prescription of powerful pain relievers continues whole NIDA-funded researchers seeking new painkillers that are effective but nonaddicting.

In the meantime the problem of under prescription of opiates and opioids prompted the Federal Agency for Health Care Policy and Research to issue guidelines in 1992 to assist physicians in decisions regarding the treatment for pain. These guideline recommend morphine as the first drug of choice to treat postsurgical pain and, for proper pain control and good recover, the medication should be given regularly, every 4 hours for example, the first 24 hours after surgery...rather than on an "as needed" basis which encourages abuse. Or, instead, use intravenous drug "pumps" which allow patients to self-administrate the medication during each time period (e.g. 4 hours) under strict dosage control of the physician in charge.

As one who has also suffered some mighty painful surgery, I am full aware of the need for postoperative pain relief and do not agree with my AA friends who, out of fear of relapse, suggest that members refuse all medication. Up to date anesthesiologists are aware of the dangers of addiction and should wean all patients off pain medication a day or two before discharge particularly if there is any history of addiction. But, I suggest that every recovering addict stay in close contact with his or her AA or NA sponsor before and after discharge to assist in overcoming any possible relapse symptoms.