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by Abigail Van Buren

DEAR ABBY: In reference to the letter from the 71-year-old woman who suffered from chronic pain after a car accident: Your advice to see a pain specialist about alternative methods of dealing with pain needs to be heard by all.

At 40 years of age, I was rear-ended. A year later I was in another car accident. I was diagnosed with three neck and back injuries and had surgery on both my hands for carpal tunnel syndrome. I was treated with pain medication, high blood pressure medicine, anti-depressants and muscle relaxants. I was in diapers for two years for incontinence. (Only later did I realize this was a side effect of the drugs!) The only constant in my life was pain and depression. I was under the care of doctors, but finally came to realize that I had to take charge of my life. I had to either change it or end it!

To make a long story short, I heard about hypnosis and biofeedback. I went, and after four sessions, I was pain-free! My blood pressure is now normal, I've lost 40 pounds, and I'm no longer depressed. I love being around people and enjoy living again.

I lost seven years of my life to pain. Abby, please advise your readers to never settle for living in pain. Miracles do happen, thanks to the Lord and my doctor. You may use my name. -- L. BARRAS, ST. MARTINVILLE, LA.

DEAR L. BARRAS: I'm pleased to learn that your recovery was so successful, and I'm printing your testimonial. No one should have to live in constant pain. Read on for another view:

DEAR ABBY: One of your readers recently expressed concern about becoming addicted to pain medication. I agree with your recommendation to see a pain specialist for non-pharmaceutical treatment. Unfortunately, these methods are not always effective. Many patients continue to require strong pain medication for relief.

The vast majority of people who take narcotics for pain do NOT become addicts. Although tolerance (the requirement for bigger doses) and dependence (the development of withdrawal symptoms after sudden discontinuation) are associated with addiction, they do not represent true addiction by themselves.

Addiction is a condition in which people make obtaining and using the drug the centerpiece of their existence. The use of the drug is an end point in itself. Drug addicts withdraw and become less functional when they take drugs. In contrast, chronic-pain patients become more functional when they use their drugs, and are able to join in basic social activities frequently denied them by their pain. It is well-established that chronic-pain sufferers develop tolerance and dependence while on narcotics, but these are expected side effects -- NOT SIGNS OF ADDICTION -- and are not considered indications for discontinuing the drug.

Tragically, tolerance and dependence are often mistaken for addiction, and the drugs are abruptly stopped. It is well known that pain patients sometimes take their own lives when their medications are discontinued. I have come to call this "algocide" -- suicide driven by pain.

Better understanding of true addiction, as opposed to the commonplace occurrence of tolerance and dependence, would help alleviate the daily suffering of millions of people and prevent many deaths per year due to algocide. -- MICHAEL S. GORBACK, M.D., THE CENTER FOR PAIN RELIEF, HOUSTON

DEAR DR. GORBACK: Your philosphy may be viewed by some as audacious, but it's logical and sensible. I was fascinated to learn that in the late '80s, Texas was the first state to pass intractable-pain statutes that grant physicians great latitude in prescribing medication to those who suffer from chronic pain -- and since then, more than half of the other states have enacted similar guidelines. It is also illuminating that the incidence of drug or alcohol abuse in chronic-pain patients is no higher than in the general population.

Perhaps this will put to rest the concerns of chronic-pain patients whose quality of life suffers because they fear chemical dependence.

Everybody has a problem. What's yours? Get it off your chest by writing to Dear Abby, P.O. Box 69440, Los Angeles, Calif. 90069. For a personal reply, please enclose a stamped, self-addressed envelope.

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