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"That you have to endure pain is nonsense!"
Prof. Gottschling, if you read your new book *, Germany seems to be a developing country when it comes to pain therapy. How can that be?
Not only Germany is lagging behind in this medical field! In three quarters of the world, pain therapy hardly has the status it has for the people affected.
But every doctor has already experienced pain first-hand and knows how much it can affect the quality of life.
We have all experienced pain due to illness or medical treatment. Most of them - and most of them too! - have internalized, pain is simply part of it. That is of course the first nonsense! Nobody has to torture themselves through unpleasant examinations, nobody has to endure greater pain after an operation and nobody has to torture themselves because of an illness. We can do something about that!
How can it be that even doctors don't know better?
For a long time, pain therapy played a far too minor role in medical education. Most doctors are completely unsophisticated when it comes to pain medicine. Fears of opioids were fueled, while other painkillers such as ASA or ibuprofen were touted as harmless. It is exactly the other way around!
What is sold over the counter without a prescription can do a lot of damage.
Solid! If it were up to me, there would be no over-the-counter pain relievers at all. That sounds very restrictive now. But we know of several thousand bleeding deaths in Germany, we know of dialysis patients who would not have been if they had not fed this stuff. The fact that such active ingredients are freely available sends the wrong signal. It suggests a harmlessness that is not given. Many people take hundreds of pain pills a month without being critical.
In my experience, doctors themselves are not exactly squeamish about painkillers.
Right. I find it shocking how carefree even professionals are. I have a colleague who really likes jogging, but because she gets knee pain, she takes a painkiller beforehand. I said to her, 'Are you completely insane? The risk that your kidneys will run out is huge! Nämlich Painkillers plus fluid loss are a treacherous combination. She looked at me like a car.
On the other hand, there are also people who torment themselves unnecessarily because they don't want to take anything.
Right. For some, any drug is poison. They prefer to crawl around on all fours before taking painkillers - and of course that's not the right way to go.
On the other hand, fears are particularly great with opioids.
The barriers are actually too high for opioids because they are often the best alternative. The term 'narcotics prescription' alone is a deterrent and stirs up fears among people. They want to be rid of their pain but not to be numbed. If it says so on the recipe ... In Austria these things are even called `` addictive recipe ''.
But it's true: Opioids can be addictive.
You have to distinguish between addiction and dependence. Almost every drug is physically addictive. The body reacts to the removal of a substance that it has received for a long time, initially offended. If you suddenly stop taking your antihypertensive drug, it will blow your blood pressure through the roof. That is why most drugs have to be tapered off, i.e. the dose has to be reduced in small steps. Addiction, on the other hand, is the psychological aspect of addiction. Addiction only arises with substances that are fun for the mind. With this kick that they give you.
How can I imagine such an opioid kick?
When I inject morphine into a vein or a patient uses fast-acting opioids such as fentanyl as a nasal spray, it really pops in the brain within a few minutes. You start to fly, the pain is blown away, you get a blissful smile on your face. That is a feeling that most people would like to have again. This is exactly what can be addicting.
When do you use such substances?
After operations, for example, or to treat severe tumor pain. But many doctors who do not know what to do prescribe them wrongly. There are so many old ladies who are put on tramalt pots that only work for about two hours. The patients fluctuate steadily between kick and withdrawal, kick and withdrawal. This is of course problematic.
What's the alternative?
A retarded opioid should be used, i.e. a preparation that releases the active ingredient over a period of hours with a time delay. That takes the pain away, but it doesn't have that kick effect.
In Germany, it usually takes years for a patient with chronic pain to come to the pain medicine specialist who will advise and recruit them individually.
That's right. In Germany we only have around 1,000 trained pain therapists who also work as such. So that's where the cat bites its tail. But there is reason for hope: since 2016, medical students have only been allowed to start their practical year if they have completed a graded course in pain medicine. When they are in positions of responsibility in a few years' time, something will finally change!
* Prof. Sven Gottschling has made it his life's mission to relieve sick people of their pain and give them a better quality of life. The 45-year-old is the chief physician at the Center for Palliative Medicine and Pediatric Pain Therapy at the Saarland University Hospital. And he's a bestselling author. His current book “Pain Losing - Why So Many People Suffer Needlessly and What Really Helps” will be published by Fischer-Verlag in September.
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