The case for opiate use

Ask Dr. Keith Roach M.D

The case for opiate use

DEAR DR. ROACH: I hope you will offer your opinion on my experience with opiate medication. My wife is now on a combination of morphine pills to address chronic shoulder pain resulting from a fall. The reason it became chronic is because of a misdiagnosis, followed by errant X-rays and three unnecessary surgeries. She has been in gripping pain all that time, and the pain remains acute and can increase with too much use of her arm. That's why I refer to it as 'chronic.'

While there is a growing fear of opiate treatment for pain, it probably has saved her life. This all began about 20 years ago, and she is now 60. Most mixes and matches of painkillers left her either with little pain and little function, or too much pain. The saving grace was the result of an offchance conversation with doctor practicing at a learning hospital. He mentioned a new timerelease morphine that is now available. That, along with an optional booster pill if needed, filled the need. Constipation has become something additional to deal with, although manageable. I write to you to offer hope to someone who is experiencing chronic pain, and to ask lawmakers to leave room in their discussions on opiates. People's lives can remain productive, or at least livable, with measured opiate medication.

ANSWER: While it is true that there is an epidemic of abuse of prescribed pain medication, it is important to remember that there are some people for whom opiate pain medications are safe and effective. The current backlash against prescription pain medications does raise the risk that some people's lives will be made more difficult by the administrative obstacles put in place to combat prescription drug abuse.

I don't think opiates are firstline treatment for non-cancerrelated chronic pain. Very often, non-opiate options, prescribed by a skilled and experienced provider, can treat chronic pain more effectively, with fewer side effects. However, I am publishing your letter since I do agree with you that opiates need to remain an option if used wisely in appropriate patients.

DEAR DR. ROACH: I understand that bile assists in the digestion and absorption of fats and is responsible for the elimination of certain waste products from our body. Could you please tell me what happens to a female who has had laparoscopic gallbladder surgery? I'm having a difficult time losing weight. — M.F.

ANSWER: Bile, which contains bile salts such as cholic acid, are secreted by the liver and stored in the gallbladder. They are essential in the digestion of fat, where they act chemically to emulsify fat (emulsification allows fat to dissolve in water, similar to soap breaking up fat when cleaning). Ninety-five percent of bile acids are reabsorbed, normally, in the intestine, allowing them to be reused. The gallbladder releases bile in response to a fatty meal (which is why people with gallstones develop pain after a fatty meal – the gallbladder constricts, causing pain if the duct is blocked by a stone).

Without bile, fat cannot be properly absorbed, leading to steatorrhea ('steato' for 'fat,' and 'rhea' for 'flow'), a fatty diarrhea, and often weight loss.

However, after gallbladder surgery — open or laparoscopic — in most cases the liver learns to release the bile appropriately in response to a meal within a few weeks of surgery. There are many reasons for inability to lose weight, but it shouldn't be related to your gallbladder surgery. Thyroid disease may be the most common cause. *** Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell. edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall.com.