I hope that all hospitals will follow the example of St. Michael's Hospital, Toronto, and have pain services work with the surgical teams as described in the Quill on Scalpel article in the April issue (Can J Surg 2005;48:98-9). I support the use of opioid analgesics for cancer pain; it is part of my practice.
What I want to respond to is the idea that we have to accept second-best medicine because the public system does not allow the most optimum treatment for a patient. In patients with arthritis for whom there is a surgical solution that can provide significant, lasting pain relief, I believe we must not accept the status quo of lack of resources but actively press the system to make surgical solutions available. In such cases I believe that the use of opioid analgesics is not appropriate and is therefore making us as medical practitioners acquiesce to the deficiencies of the public system. I am sad that Drs. Chan and Leung did not question the use of statistics presented in the pain literature.1 If surgeons' operations were truly in this day and age causing chronic pain in up to 50% of their operative patients, there would be a public outcry. We do refer patients for treatment after surgical procedures, but I feel that this occurs much more rarely than the figures quoted in the table from the pain literature.2
Michael Gross, MD Professor of Surgery Dalhousie University Halifax, NS
References
- 1.Goldstein DH, Ellis J, Brown R, Wilson R, Penning J, Chisom K, et al. Recommendations for improved acute pain services: Canadian collaborative acute pain initiative. Pain Res Manag 2004;9:123-30. [DOI] [PubMed]
- 2.Fitzgerald JD, Orav EJ, Lee TH, Marcantonio ER, Poss R, Goldman L, et al. Patient quality of life during the 12 months following joint replacement surgery [see comment]. Arthritis Rheum 2004;51:100-9. Comment in: Arthritis Rheum 2004;51: 679; author reply 679-80. [DOI] [PubMed]