Sunday, November 9, 2008

An Autumnal Festival of Faith and Hope

By Richard P. Holm MD

There is a very old Greek, then Roman, then Christian story of three pre-teen girls: Faith, Hope, and their younger sister Charity. They were tortured and killed with their mother while traveling along an early Roman highway. This apparently became the reason for an ancient yearly autumn festival to celebrate faith and hope in the face of suffering. 

The relief of suffering certainly was about the most important job of those first Greek physicians, and it remains so for physicians today. What's more, we are still using some of the same medicines they used back then, with opium-based narcotics to dull the pain of illness and injury.

We now know more about these important morphine-like pain relievers. Scientists have discovered that narcotics work by attaching to special pain relieving receptors in the brain, and we know that our brain makes its own pain relievers, called endorphins, when the occasion calls for it. 

We have even discovered an antidote to narcotic overdose called naloxone (Narcan), which works by displacing or pushing narcotics off from opiod receptors in the brain. I remember a big burly fellow, in a city hospital emergency room years ago, who was almost not breathing from what we presumed was heroin overdose. Right after I injected the naloxone, he came up almost off the table to try to choke me. I think he was angry for losing his "high".

One study about pain relievers has always intrigued me. In analyzing medicines for the relief of pain following childbirth, they found codeine gave about 80% relief, aspirin 70%, and placebo (a sugar pill) 60%. The amazing finding came when they gave naloxone to the patients receiving pain relief provided by a sugar pill (placebo) and it brought back the pain. 

How about that! Not just morphine, but also faith and hope work by providing pain relief through turning on the endorphin system, which we can measure and even reverse.& So when they say, "it's all in your head" you know that's the truth. 

Thus, in understanding narcotics and something more about Faith and Hope, we are better equipped to relieve suffering.

Take home message:
1. An autumnal festival of faith and hope came from an ancient story of suffering;
2. Narcotics have relieved suffering for thousands of years;
3. All kinds of narcotics and even the pain relieving effects of a placebo sugar-pill are reversible with a narcotic antidote or antagonist named naloxone;
4. Having faith and hope that a medicine will work is an important part of providing pain relief.

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