Pain does hurt

Press, 28 April 1981, Page 12

Pain does hurt

WHITEHORNS WORLD

Katharine Whitehorn

If anyone still doubts whether doctors have become the priests of our age, I am now in a position to throw the book at him — the book being the newly revised Dictionary of Medical Ethics. It is 450 pages long and will doubtless knock him flat.

Plainly, we have come some way since the days when a doctor’s ethics, as laid down, didn’t go much further than not undercutting his colleagues, not sleeping with his female patients and refraining from asking loudly about a man’s VD in public. There’s the question of who is or isn’t dead, as well as who ought to be; whether it is o.k. to operate for fear of being sued, from sheer curiosity or against the patient’s wishes; to what extent you have to take account of Jehovah’s Witnesses or journalists.

It is at least an improvement on the B.M.A.’s version — 10 paragraphs on strike action to only one on suicide — since this volume has about the same on each: and there’s a section on drugs in sport (no mention, though, of sport in drugs, as preferred by cafe society). One could wade through the book for some days (which I’ve done) or even some months without being able to come up with a neat critique of the whole thing, since doctors are apparently involved in two-thirds of the dilemmas of the age. But one element interested me especially, because it may be a point on which the ethical shift is changing: Pain.

“Doctors don’t understand pain.” a relation of mine said sadly — or at any rate it doesn’t always interest them.

The other day we were paying one of bur frequent visits to Casualty, this time

for a wrist broken in two places. Since my mother had had a pain-killing injection when we’d been there for her broken hip she asked for one again.

“Oh,” they said with surprise; “all right” — but why had it not occurred to them that someone with broken bones would plainly be hurting like hell?

I heard of one woman dying of cancer who was in agony for three days before they gave her the pain-killing kit — "and then she died a day later.” I was told, “it wasn't even used; she needn’t have had those three days at all.”

Dr Cicely Saunders, whose care of the dying has done so much to sophisticate pain? killing, says tartly that it is striking what happens when a doctor has an operation himself; he realises that pain actually hurts. Understandable, I,suppose: in the early days of surgery, when you chopped off a gangrenous leg by pouring half the whisky into the wound and the other half into the soldier, a too-great sensitivity to pain would leave you as incapable of action as a mother too soft to make her spoilt brat take his nasty medicine. The concept of nasty medicine, itself, has been popular, since Bacon said that no treatments were so painful as they that were efficacious — but that was before people operated on inoperable cancer, just in case the relatives should sue. The case against bothering much about pain, too, is that it's like switching off the alarm before you’ve caught the burglar: you mask at your peril symptoms which may lead to diagnosis and cure. What if you can t cure? Or

not yet? The book says roundly: “With individual attention to dosage, frequency, route of administration of analgesics and rational use of other drugs, adequate pain relief can almost always be achieved. This requires time and patience and is not always given the priority it deserves.” I’d like to see that hung up in every out-patients’ in the country — though I'm far from sure that what is meant by "adequate” would do for cowardly me. At least, though, it looks as though pain is becoming respectable. There are 170 pain clinics around the country, and now that they’ve turned their minds to it, the researchers have come up with plenty. Placebos, for example, were always supposed to work by suggestion even where it “really” hurt in the first plac.e

Now they’ve discovered that the placebos can some-

how stimulate the body to produce more of the hormone secretions (enkephalins and endorphins) which act on the nervous receptor — in other words, make it stop hurting. Maybe we should train for pain; ’ maybe we .shouldn’t rely so much on doctors anyway. But the doctors and ourselves. as the last Reith lectures pointed out. are locked in the same dilemmas; and we also live in the same times. Once we thought we could cure everything in society, given better drains, better education, more money and more time; now we know that we won’t, even if we ever get them. The wearisome condition of humanity is, it seems, a chronic one; so we mav as well make it hurt as little as it can.