Monday, October 10, 2011

Lauding Laudanum

"Of all the remedies it has pleased almighty God to give man to relieve his suffering, none is so universal and so efficacious as opium”, Thomas Sydenham1624-89

Sometimes it feels like we need a dispenser outside surgeries – press.....
1.      UTI sx – press 1 get 3 days of trimethoprim.
2.      UTI symptoms not better after (1) – press (2) and pass some urine into the pot.
3.      Pain in your joints/head/back/foot – get 100 paracetamol
4.      Option (3) not working – get some co-codamol 8/500
5.      Option (4) not working – get some co-codamol 30/500
6.      Option (5) not woking – add amitriptyline at night
7.      Option (6) not working  - add gabapentin
8.      Option (7) not working – change (7) to pregabalin
9.      Option (8) not working  - refer to pain clinic
Ok I know it simplifies things a little, and in the meantime we might have done the odd mssu or blood test, but sometimes it feels like “the pain ladder” is little more than a game of snakes and ladders but without the snakes
In days gone by we didn’t have codeine, oxycontin, fentanyl or pethidine, only the natural derivative of the poppy plant, opium which was made up of morphine, codeine, and thebaine. Use of this dates back to several thousand years BC, although in western medicine only back to the 1500s. Its use increase once it was discovered it could be dissolved in alcohol (it is not water soluble) to form laudanum.
In days gone by it was used as a panacea – to treat all sorts of pain and suffering, diarrhea, colic and so forth
But sometimes I wonder just how far we have come in 6000 years. Yes we have more refined opiates, mostly now formed synthetically. But although they are more refined, we still don’t have much different to treat human suffering; sure we can prolong it and treat illness and disease, but when it comes to chronic pain – the pharmaceuticals may be more refined, but the treatment hasn’t moved forward much
It’s not as doctors that we are doing wrong; we just want to alleviate the suffering of our patients. But for all modern medicine has to offer – are we really “modern”.

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