Your excellent editorial1 and figures reported by the BBC recently that as many as 1 in 11 adults are prescribed an addictive medication2 suggest that we are in the midst of a sea change in our thinking about chronic pain. For years we have been steadily climbing the defunct WHO analgesic ladder, inexorably gaining more and more medications and their inevitable side effects. It is time for a change.
I am reminded of the wonderful children’s book by Julia Donaldson, A Squash and a Squeeze. In it a woman living in an idyllic rural location is frustrated by her lack of space. She calls a wise old man to help. One by one he introduces more and more animals into her house — first a hen, then a goat, a pig, and finally a dairy cow. Chaos ensues, and the house feels ever smaller and the woman more and more alarmed until she throws her arms into the air, ‘I’m tearing my hair out, I’m down on my knees.’ Yet the wise old man has a plan, for one by one he withdraws the animals … the chaos lifts and the woman is struck by the newly appreciated space in her house.
So I urge you to take off the fentanyl patch … stop the gabapentin … and tramadol … and dihydrocodeine … and codeine. … and see if the fog and chaos lifts. These painkillers are a squash and a squeeze, and it is time for us to act like the wise old man or woman that our patients expect.
- © British Journal of General Practice 2018