April 27, 2004 By: Various The New York Times (NY)

To the Editor: Re “Drug Makers Hope to Kill the Kick in Pain Relief” (April 20):

The article notes that doctors are being told how to monitor suspicious patients with urine tests and that doctors and drug companies are spending time and money on finding ways to torture people.

One method of countering abuse involves mixing capsaicin into pills, so that anyone who grinds them up will get “a burning feeling in the chest, face, rectum and extremities, as well as paroxysmal coughing.”

Not only has “First, do no harm” gone by the wayside, it seems, but now we are being asked to police our patients with urine tests.

This is not medicine, this is social control.

DR. ALICE D. MICHTOM Ithaca, N.Y.

To the Editor: The article “Drug Makers Hope to Kill the Kick” plays down an important issue: the undereducation of physicians in the management of pain.

Most physicians receive little to no teaching on pain and the use of opioid analgesics either in medical school or in postgraduate training programs.

This, not the fear of addiction cited in the article, is the real reason pain is often poorly treated and no doubt plays a significant role in the misuse of opioids.

DR. STEVEN A. KING New York The writer is a physician in the Pain Center at the Hospital for Joint Diseases.

To the Editor: As a nursing student, one of the biggest hurdles I face in providing care is educating patients about pain relief and helping them overcome their fears of addiction to painkillers (”Drug Makers Hope to Kill the Kick”).

Patients should speak with their care providers about their concerns and fears. They should take an active role in their own pain management.

Many people do not realize that there are ways to control pain without taking pills.

Using medications to treat discomfort or suffering does not make people addicts. It makes them responsible patients. In pain control, the right dose is the dose that works.

JESSE W. WENNIK San Francisco