I can appreciate the agonies undergone by your correspondent having acute low back pain and the lack of skills by the accident and emergency team in the management of her problem. However, she fails to understand the distinction between acute, chronic and malignant pain. Acute low back pain is recognised as being a national priority in terms of management, because of the rising number of cases reported and unfortunately for Ms Moore hospital admission for analgesia is not recommended. The recent report of a multi-disciplinary Clinical Standards and Advisory Group recommends that people should remain mobile and return to work quickly, so that their condition does not become chronic.
It would appear that your correspondent feels that opiate analgesia should be administered at the drop of a hat even if it is not thought to be effective in managing some types of pain (including cancer pain). There is a distinct place for the use of opiate analgesics, however it should be recognised that there are different types of pain and some pain responds better to non-conventional analgesics than to opiates.
Some pain will never disappear, despite any drugs, operations or nerve blocks. This pain is real and still requires help, but the patient must learn to manage their pain rather than seeking the magic cure. This may require psychological rather than medical intervention .
I accept that pain is a very real problem and is probably the commonest cause for a patent to consult a doctor. However, the real problem is recognising the type of pain and prescribing the correct treatment - this often does not include opiate analgesics.
Dr KEITH A MILLIGAN
Clinical Director, Pain Management Directorate
South Tees Acute NHS Trust