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Dr. Chris Magryta: Codeine — do we need it at all? 

By Dr. Chris Magryta
Salisbury Pediatric Associates
Codeine is an opioid alkaloid medicine derived from the poppy plant that produces opium, heroin, morphine and other narcotic medicines and drugs of abuse. Medical practitioners have been using codeine and acetaminophen with codeine along with the much stronger nightmare narcotic medicines for many decades to control pain in children and adults. Recently, we all been witness to the ravages of these medicines once they become abused. So the biggest question facing us as patients now is, do we need them? Do we need to wipe away pain?
Why is pain so hated as a sensation that helps us avoid further injury? Why do we all try to avoid pain once it arrives? Why don’t we realize that what we really need to do is to understand what pain really is? We need to understand the concept of pain as a physiologic process of healing. Then and only then can we truly understand how to heal the broken physiological process. Pain is the best teacher for our poorly chosen actions.
For example, if I kick or punch a wall in anger and break a bone, the pain will be impressive. Why? Because your intuitive nervous and musculoskeletal system realizes that that action has caused damage and is screaming at me not to repeat the behavior that led to the injury and also allow it to heal by resting. Smart system!
Giving codeine or narcotic medicines will surely blunt the pain and make you feel better which is nice in the short term, but robustly not useful in the long term if you reuse the injured body part because of the lack of pain inhibition.
Net serious negatives for narcotic medicines:
1. Lack of a pain sensation causing increased use of the injured body system worsening the healing process
2. Potentially leading to narcotic addiction for a child, an adult or most frustratingly, an addicted newborn born to an addicted mother
3. Respiratory depression leading to death in rare but terrible cases
Pain needs to be a point of emphasis for cause and treatment. Find the root cause then offer physical therapy, accupuncture, chiropractic, massage and other modailities first with surgery and drugs as last resorts.

When children are young, we should embrace the learning opportunity that arises around pain where possible. For example, when I have a patient with pain, I take the opportunity to search for causes of the imbalance that has set off the pain. There is always a starting point where the change of function occurred. This is usually the point that needs the most attention to repair the damage.

How and why are they suffering? Are there interventions that are available to prevent further damage and heal that which has occurred.

The answer is almost always rest, nutrition, sleep and time.
Avoid the use of narcotics in all children and especially those under the age of 12 years old.

Dr. Chris Magryta is a physician at Salisbury Pediatric Associates. Email him at newsletter@salisburypediatrics.com .

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