1999 was about the time pain management became politicized and activists were beating up on doctors for under treating pain. They pummeled us with arguments based 90% on dogma and 10% on science. They told us that the patient’s numeric rating of pain was “the fifth vital sign.” They redefined the concept of addiction to suit their agenda and told us that most instances of drug seeking behavior were in fact “pseudo addiction”, supposedly an indication to give more narcotics. A stable patient verbalizing “eight out of ten” pain was a medical emergency and a mandate for narcotics. Respiratory hazards were downplayed.
At least one expert shares my view. In a recent point-counterpoint in Internal Medicine News William O. Witt, M.D. from the University of Kentucky Medical Center at Lexington opined that today’s widespread opiate use is not evidence based and poses an increasing public health risk. He notes: “Whereas no one is advocating the elimination of opioids as a tool for treating chronic nonmalignant pain, we should demand at least the same rigor that we demand for other treatments.”