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I wholeheartedly concur with Chorley, McGrath and Finlay, and their observations and conclusions about the pain associated with treatment that we inflict on our patients.1 I would add a similar consequence of our treatment: habituation and addiction to the narcotics we inflict on some patients whose pain we try to alleviate. Often the pain that we first believe is acute transpires to be chronic. Once the dose of a drug has been titrated in pursuit of a level of relief that seems to become ever more elusive, the patient develops numerous adverse symptoms, including hyperesthesia, constipation, hyperhydrosis and endocrine disorders, such as testosterone suppression. Habituation often leads to addiction. But when we awaken to the situation, we are confronted with the prospect of having to induce most uncomfortable withdrawal symptoms. Who then can blame us for occasionally turning a blind eye to patients in pain rather than risk such an outcome?
For the full letter, go to: www.cmaj.ca/cgi/eletters/182/7/732#360829