There is an amazing post by JuniorProf on this subject, Go and read.
The truth is that while there are effective classes, all of them have one of three potential issues:
1) Cognitive fogging and addiction
2) Increased risk of gastrointenstional bleeding and/or myocardial infarction and/or fractures
3) Liver toxicity
Now, because pain is hard to measure and these other outcomes are easy to meaure, it is easy to end up under-treating pain in order to reduce the rate of hard outcomes. Needless to say, this is a dreadfully sub-optimal treatment equilibrium. Even worse, these cases can lead to criminal charges when errors occur or even just due to cocnerns over the large doses that some patients require for routine management.
Clearly a new class of pain medications would be a solution to these issues. There is also, however, a cultural piece, that involves the stigmatization of people in legitimate pain that could be addressed.
All in all, an area that really deserves more attention.
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