Well, Kathy was staying with her in-laws and, as is the way of folk in small towns, they were the proud owners of some guns. As Kathy put it, the emergency room needs to see a life-threatening situation, so she decided to give them one. With impressive bravery, she took a gun and shot herself in her already injured shoulder. When the deed was done, her mother-in-law called in a shooting and the ambulance came. As she was spirited off to hospital, the police joined up the dots and concluded a self-inflicted wound.

Given the continuing opposition of the GOP to the reforms now called Obamacare, it should come as a shock to see one of the more than one million uninsured in Michigan resorting to bullets to get medical treatment. What are people to do when the pain is too severe for Tramadol on its own to bring relief? This is not a suicide attempt. This is a protest against a healthcare service that will only fix uninsured people if there’s a real emergency. Surely, in a civilized society, no one should be driven to such extreme measures. Worse, of course, is the threat she may also be prosecuted for shooting herself. That really would add insult to injury.

So there we have it. When the routine painkillers like Tramadol are just not strong enough to deaden the pain, desperation sets in. Perhaps we should look to excuse her because of the pain. People don’t always act quite so rationally when in pain. Or perhaps we should say she’s courageous and prepared to let nothing stand in the way of getting treatment. Whichever, the reality is she’s had the bullet removed and is now lined up for surgery on the damaged shoulder. While she’s waiting for the dust to settle, the hospital has said it will talk terms on installment payments, and has given her some free Tramadol to manage the pain. This is all better news for her even though the drugs may not be strong enough. We will just have to hope the pain does ease. Now the $64,000 question. If you were uninsured and in pain, how far would you go to get treatment? Kathy turned the gun on herself. Perhaps she should have committed a crime like robbery. People awaiting trial in custody are entitled to free treatment. What’s your answer?

So what are people afraid of? The most common is the legitimate concern that there’s a risk of addiction with some drugs. Some doctors believe they should be protective and not prescribe some painkillers. Some patients refuse to take anything where the risk exits. This has produced an irony. Hospitals have trained thousands of nurses and support staff in the management of pain, but they are not allowed to prescribe drugs. So even when the nurses and the patients may agree on a particular treatment, they have to wait for the attending physician to appear with no guarantee he or she will agree. The traditional physicians are still worried about addiction. This is changing as the new doctors come through training with more understanding of the multidisciplinary approach to managing pain.

In an ideal hospital and clinic, all the staff would cooperate, i.e. the physical and psychological specialists will talk to each other positively, allowing for the possibility of error in diagnosis or treatment, and involving physical therapy, counseling and a range of alternative treatments to play their part. Indeed, even the spiritual should be involved with in-house staff and local churches offering counseling and support for patients in pain.

One of the key problems at every point is to decide whether the doctor is treating pain or depression. This makes a big difference to the selection of drugs. Equally important is to treat the underlying cause of the pain alongside the pain itself. If you are complaining of continuing pain, you are entitled to something more than some extra Tramadol or something stronger. You are entitled to have someone question why you are still in pain. This assumes, of course, you are being honest about how severe the pain is. Unfortunately, some are trying to game the system, e.g. to get more compensation because of an accident or to manipulate relatives in some way. Pain management can involve psychiatric assessments and social workers investigating a patient’s background to get as complete a picture as possible. In all this, the routine drug is Tramadol. It offers more support than any of the NSAIDs and has fewer problems of addiction than the more powerful drugs. This is not to say that Tramadol will be given to everyone, but it is genuinely effective in relieving moderate to severe pain.