Where does it hurt????
Susan Sontag 1933-2004
Illness is the night-side of life, a more onerous citizenship. Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place. Sontag
Irene Tracey is Nuffield Professor of Anaesthetic Studies at the University of Oxford. She is also head of the Department of Clinical Neurosciences too. In a recent radio interview Professor Tracey said that one in five people living in economically developed countries suffer from ongoing, chronic pain. Furthermore, she continued, many medications for this condition are largely useless.
One of the great merits of psychoanalysis is that it has questioned radically the distinction between the sick and the well -especially in that dimension of life now referred to as "mental health". The notion that most human beings need to be slightly neurotic, maladjusted, or off-centred in order to survive and adapt to the demands of Western civilisation seemed at first take rebarbative and somewhat insulting. Later -particularly after one massive dynastic war followed quickly by another with factory slaughterhouses for jews, communists, gypsies and gays- Europe seemed to have departed radically from “normal” civilisation, progress, prosperity, and humane values.
So maybe it was inevitable as the twentieth century wore on, that some psychoanalytic commentators were even more radically pessimistic about any reassuring "hard and fast" division between insanity and civilisation. They doubted whether it was true that only psychotics held a monopoly rights to “delusions” . Might delusional thinking accompany more seemingly “ordinary” phantasizing: whether it be about oneself, others, religion, country or one’s socio-political beliefs?
Two other common place binaries relativised by psychoanalysis are those of
2. pain//pleasure
Daniel Feeld is a movie writer and anti-hero in Dennis Potter's last television series Karaoke and Cold Lazarus. Remarkably in the history of UK television they were first televised on both Channel 4 & BBC 1 during 1996. Feeld is a sleazy, ill-tempered, obese, drunkard, who chain smokes and becomes obsessed with a much younger female called Sandra. Not an attractive being at all. However he firmly believes Sandra, a rough-diamond from the east-end who works in a Soho Hostess and Karaoke Bar, is speaking dialogue from a play Feeld is currently writing. Soon Daniel becomes a hundred per cent convinced that Sandra is not only speaking words he has written, but acting out the the actual plot of his drama in her everyday later. Is this really happening, is this a paranoid delusion of Feeld's, or may be a bit of both?
Daniel begins to suffer from crippling bouts of pain eased but a little by heavy drinking. Eventually a hospital doctor says he is terminally ill, with just a few months to live. Feeld remains erotically attached to the much younger Sandra; deeply in love with her for the remainder of his now shortened life. He revises his will leaving the majority of his wealth to Sandra. His head and brain were donated to an experimental cryogenic laboratory.
The sequel, Cold Lazarus, takes place centuries later in a dystopian Britain governed by the interests of financial conglomerates and business oligarchs. The cyro lab, with its collection of frozen bodies and heads, is now controlled by a media tycoon. Scientists working at the laboratory amazingly discover that Feeld's centuries' old head starts to respond with twitches when electrical and chemical stimuli are administered. Intermittent bouts of neural activity to occur. Eventually the head begins to relay music, speech, scenes from a life and society that no longer exists. This offers an incredible business opportunity to the media mogul who owns the laboratory. He plans to digitalise memories and scenes from Daniel's head, marketing them to a global audience.
The staff at the cyro lab begin to wonder. Are the ancient brain and head actually conscious and somehow alive? Do the memories now relayed to a huge cinema-style screen correspond to actual experiences and events? Is Daniel Feeld still a person?? Is he attempting to communicate with them? Their doubts, anxieties and questions intensify even more when the head relays scenes of physical and sexual molestation dating from Daniel's childhood. Astonished laboratory staff now become witnesses to profound physical and emotional trauma of a person's memories, who is somehow both dead and alive.
Last year a number of colleagues talked to this association about pain and trauma … how it might (or might not) relate to clock time, geographical places, bodies, experiences, and brains. It is my own belief that human beings live in a variety of histories and spaces simultaneously. Take time. One might experience time passing quickly when enjoying a good movie. Walking leisurely on an Autumnal stroll, one suddenly may recall vividly, long forgotten incidents from times past. On other occasions time may be experienced as dragging or pushing or monotonous. Space likewise. In a crowded elevator or waiting in airport queue one might feel hemmed in; yet visiting a spacious cathedral like Liverpool’s famous circular Catholic building, one may feel one’s body-space expand. As well as times past, there are spaces past I still recall. Every time I visit Liverpool's Anglican cathedral I am aware of the spacial configuration at its side entrance. Old multi-racial tenements once crowded round. From gothic vast space, to crowded dwellings was a massive spatial contrast (or more correctly, shock) for me that I still recall. Within living memory these buildings containing an entire neighbourhood, as well as an Islamic place of worship, were bull-dozed because of slum-clearance orders. Eventually they were replaced by exclusive buildings for cathedral staff and universities; a very different social configuration of space.
Maybe people lead lives encompassed within lots of different co-ordinates or “sub-universes”, some of which may be more obvious and accessible to the individual than others. One central coordinate will alway's be one’s body -along with the real, imaginary, ideal, and symbolic bodies that embody its "me". Pain is “located” in, and distributed though, any -or all- of these somatic/psychological sub-universes.
There are copious amounts of humour and in Potter's Karaoke and Cold Lazarus. For example,
Both Karaoke and Cold Lazarus are rich in irony. Love changes the drunkard and aggressive Daniel into a likeable human being. For the the first time in his life he falls in love: for the few remaining months of his life. Even his moral code shifts from total self-centredness, to bravery and altruism. Both plays contain tragedy and copious amounts of comedy alongside pain, pleasure, hurt and tragedy. My previous remarks about the relativisation of pain and pleasure brought by psychoanalysis does not support a cynical view that people suffering enduring, chronic, and terminal pain are really having a surreptitious joke maybe or a “good time” at the expense of their medics and loved ones. I use Potter's plays to illustrate how the borders of pleasure//pain and pain//pain-free are often fuzzy. This has been known well in medicine with the notion of secondary gain. In hard times necessity may be turned into a virtue.
Daniel begins to suffer from crippling bouts of pain eased but a little by heavy drinking. Eventually a hospital doctor says he is terminally ill, with just a few months to live. Feeld remains erotically attached to the much younger Sandra; deeply in love with her for the remainder of his now shortened life. He revises his will leaving the majority of his wealth to Sandra. His head and brain were donated to an experimental cryogenic laboratory.
 |
| DVD COVER: KARAOKE & COLD LAZARUS |
The sequel, Cold Lazarus, takes place centuries later in a dystopian Britain governed by the interests of financial conglomerates and business oligarchs. The cyro lab, with its collection of frozen bodies and heads, is now controlled by a media tycoon. Scientists working at the laboratory amazingly discover that Feeld's centuries' old head starts to respond with twitches when electrical and chemical stimuli are administered. Intermittent bouts of neural activity to occur. Eventually the head begins to relay music, speech, scenes from a life and society that no longer exists. This offers an incredible business opportunity to the media mogul who owns the laboratory. He plans to digitalise memories and scenes from Daniel's head, marketing them to a global audience.
The staff at the cyro lab begin to wonder. Are the ancient brain and head actually conscious and somehow alive? Do the memories now relayed to a huge cinema-style screen correspond to actual experiences and events? Is Daniel Feeld still a person?? Is he attempting to communicate with them? Their doubts, anxieties and questions intensify even more when the head relays scenes of physical and sexual molestation dating from Daniel's childhood. Astonished laboratory staff now become witnesses to profound physical and emotional trauma of a person's memories, who is somehow both dead and alive.
Last year a number of colleagues talked to this association about pain and trauma … how it might (or might not) relate to clock time, geographical places, bodies, experiences, and brains. It is my own belief that human beings live in a variety of histories and spaces simultaneously. Take time. One might experience time passing quickly when enjoying a good movie. Walking leisurely on an Autumnal stroll, one suddenly may recall vividly, long forgotten incidents from times past. On other occasions time may be experienced as dragging or pushing or monotonous. Space likewise. In a crowded elevator or waiting in airport queue one might feel hemmed in; yet visiting a spacious cathedral like Liverpool’s famous circular Catholic building, one may feel one’s body-space expand. As well as times past, there are spaces past I still recall. Every time I visit Liverpool's Anglican cathedral I am aware of the spacial configuration at its side entrance. Old multi-racial tenements once crowded round. From gothic vast space, to crowded dwellings was a massive spatial contrast (or more correctly, shock) for me that I still recall. Within living memory these buildings containing an entire neighbourhood, as well as an Islamic place of worship, were bull-dozed because of slum-clearance orders. Eventually they were replaced by exclusive buildings for cathedral staff and universities; a very different social configuration of space.
 |
| Artist's impression of former working class dwellings in front of Liverpool's Anglican Cathedral http://www.strawberryfieldsart.com |
There are copious amounts of humour and in Potter's Karaoke and Cold Lazarus. For example,
Both Karaoke and Cold Lazarus are rich in irony. Love changes the drunkard and aggressive Daniel into a likeable human being. For the the first time in his life he falls in love: for the few remaining months of his life. Even his moral code shifts from total self-centredness, to bravery and altruism. Both plays contain tragedy and copious amounts of comedy alongside pain, pleasure, hurt and tragedy. My previous remarks about the relativisation of pain and pleasure brought by psychoanalysis does not support a cynical view that people suffering enduring, chronic, and terminal pain are really having a surreptitious joke maybe or a “good time” at the expense of their medics and loved ones. I use Potter's plays to illustrate how the borders of pleasure//pain and pain//pain-free are often fuzzy. This has been known well in medicine with the notion of secondary gain. In hard times necessity may be turned into a virtue.
I am not going to speculate about the causes or origins of pain: more about its presence and distribution. Despite a women recently discovered to be genetically predisposed to experience minimal pain, her phenomenon does not imply all pain is determined and caused by genetic variation. Nor does it imply that all pain is going to be eliminated by genetic therapies. As far as I understand, most pain consultants and scientists like Professor Tracey, seem to teach that pain is a multidimensional experience -or series of experiences- involving body, beliefs, social networks, emotionality, expectations.
Pain therefore is experienced in different ways by varied subjects: nevertheless I would suggest that pain is a near universal feature of all embodied beings.
The Macmillan Cancer Support Website, for instance, mentions different types of pain:
- an operation
- a broken bone
- an infection.
Acute pain is usually short-term, but it can sometimes last for weeks or months. Most acute pain will go away when the reason for the pain has been treated or the tissues have healed. If acute pain is not relieved, it may become a chronic pain.
Chronic pain lasts for a longer period of time. It’s usually caused by the cancer itself, but it can sometimes be caused by the longer-term effects of cancer treatments.
Breakthrough pain is a sudden pain. It sometimes ‘breaks through’ when chronic pain is being well-controlled with long-acting painkillers.
It may be brought on quite suddenly by an activity, such as moving or coughing. It may happen when the effect of the regular painkiller wears off. Sometimes it’s not clear why someone has breakthrough pain. Breakthrough pain is common, but it can usually be successfully managed. It is treated with short-acting painkillers.
Bone pain If cancer is affecting a bone, it can cause pain. The cancer may have started in the bone (primary bone cancer) or spread there from another part of the body (secondary bone cancer). The pain may be a dull, persistent ache that doesn’t go away. It can happen during the day as well as at night.
Soft tissue pain is pain we feel when our organs, muscles or tissues are damaged, injured or inflamed. An example is when the liver becomes enlarged, causing pain and discomfort in the tummy (abdomen). Soft tissue pain is also called visceral pain.
Nerve pain is caused by nerve damage. It may be due to the cancer or cancer treatments. The pain can often continue even when the cause has been treated. Nerve pain is also called neuropathic pain. Like many types of pain, nerve pain can come and go. Often the area feels numb or more sensitive. You may describe it as:
- burning
- stabbing
- shooting
- tingling.
- There are specific medicines and treatments used to treat nerve pain.
Referred pain. This is when pain from an internal organ can be felt in a different part of the body. For example, if the liver is enlarged, it can cause pain in the right shoulder. This may happen because pain messages from the liver travel along the same nerve pathways as messages from the skin. The brain confuses them and thinks the pain is coming from a different place.
Phantom pain is when the brain ‘feels’ pain in a part of the body that has been removed. It can sometimes happen after surgery to amputate an arm or a leg, and occasionally after a breast is removed (mastectomy). Phantom pain may feel like cramping, stabbing or burning, but can cause many different pain sensations. Many people find that phantom pain gets better with time and may eventually go away. But some people find that the pain can affect them for a long time. It is important to let your doctor or specialist nurse know about phantom pain because there are specific medicines that may help.
Total pain is a term doctors and nurses use to describe all the different parts of a person’s pain. This includes how the pain affects, and can be affected by our:
- emotions
- behaviours
- spiritual beliefs
- social activities.
A parent asking a child “where does it hurt?” is of necessity asking a simple question. However the “whereof?” of pain is intrinsically complicated, particularly from a psychoanalytic perspective. The same applies to its "whereunto".
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“Where does it hurt?” as well as referring to physical pain and its language that is organised by fantasies, trauma, social conventions or expectations, dysfunctionalities etc. there is also another -more-or-less statistically organised- concrete reality; namely that where? of social geography. I refer to the chart from the Sunday Times in February this year (2019).
https://www.thetimes.co.uk/article/britains-opioid-crisis-we-are-sleepwalking-towards-carnage-in-our-communities-7tjlzzq7x
There are considerable differences amongst opioid death rates amongst UK regions from 1.8 in London to 6.2 in the North East. You will also see that prescribing rates for opiates are higher in areas of England and Wales from the midlands upwards. The only southern city appearing in the top ten is Yarmouth. So why this vast difference? Why does it hurt more in Blackpool than in London?
A second, more general question, relates to the now very common word "painkillers". These are substances prescribed by doctors or purchased at pharmacies or, more clandestinely, on the dark web or black market, with the hope of eliminating pain -if only temporarily. They do not “kill pain” because pain in many acute conditions are bound to return when neutralising effects wear off. They are Lazarus-like in their effect. Maybe "pain controllers" or "pain relievers"
or "pain modifiers" are more accurate descriptions than the deceptive adjective “killer”. Be that as it may, many of these substances do in fact kill when taken regularly or in sufficiently high doses. Sometimes this happens in palliative care when the person who is already being killed by disease, has life expectancy reduced even further by prescribed opiates to numb pain and (perhaps) consciousness too. In addition to palliative care, people do overdose and kill themselves -whether intentionally or not- by using pain control substances.
or "pain modifiers" are more accurate descriptions than the deceptive adjective “killer”. Be that as it may, many of these substances do in fact kill when taken regularly or in sufficiently high doses. Sometimes this happens in palliative care when the person who is already being killed by disease, has life expectancy reduced even further by prescribed opiates to numb pain and (perhaps) consciousness too. In addition to palliative care, people do overdose and kill themselves -whether intentionally or not- by using pain control substances.
A third question is this. Who are these people that are hurting so much? One may wish to categorise them amongst the ranks of "traditional junkies" or heroine users. The trouble with this characterisation is that people who started to use street drugs decades ago are now older. They have relatives -husbands, wives, partners, children. In both Scotland and towns of the USA entire families are wiped out. Furthermore there are many who are not traditional “junkies” but, for example, your parents, grand-parents, or great-grand parents suffering from a variety of chronic complaints related to ageing -such as arthritis, fractures, back pain, rheumatism, diabetes, incontinence, muscular degeneration, post-treatment conditions (following surgery, chemotherapy etc). For many chronic sufferers the trendier alternatives …..like acupuncture, mindfulness, short-term counselling, meditations, cognitive behavioural recipes, and massages..... are not available and not affordable. Hard-pressed GPs working in areas where demands for pain control are overwhelming …may feel that tablets are the best thing they can offer in the circumstances: even though the risks associated with addiction are greatly increased.
A fourth question is this: what impact does the presence of enduring pain and medication have on -for want of a better word- on mental health? Chronic pain lasting for decades is bound to impact the “mental health” of individuals. It can be an extremely depressing and de-spiriting accompaniment to life for ageing populations throughout the globe (not just Europe and America). Recalling the warning of Professor Tracey, the efficacy continued opiate dosing for chronic pain lacks strong evidence -in fact the reverse is the case. Though opiates are brilliant for acute and terminal pain, long term use regularly produces other effects such as reduced fertility, low sex drive, irregular periods, erectile dysfunction, depressed immune responses, and, paradoxically, increased levels of pain.
It seems to me fake or delusional notions about health and suffering are demanded by populations and have been retailed by governments, therapy trainers/providers, various psychology experts, as well as international pharmaceutical companies whose complicity in causing misery is now being tested in law courts . These canvassed the view that pain and suffering -whether physical, emotional or mental- can easily be altered by cheap, quick and inexpensive therapies -particularly psychological ones- or the administration of drugs commercially advertised on a massive scale.
My final observation is this. Pain, mental health difficulties, physical suffering, are as much political issues as they are individual concerns. It is absolutely imperative that they remain so and that psychotherapies -or pharmacological substances- do not allow themselves to become a political opium for the masses promoting quietism. Pain and sufferings are not simply issues for psychoanalysis, theory, counselling, pharmacology. They are urgent political and social concerns. In the words of the Daily Express reporter, Chris Riches in his article Pill hell: The poor are prescribed most painkillers (15 January 2019)
Nearly 24 million opioids, such as codeine, fentanyl and morphine, were prescribed in 2017 - equivalent to a staggering 2,700 packs an hour. The drugs can help with pain after major injuries or surgery - but are often unnecessarily doled out for arthritis or back pain instead. Researchers at the universities of Manchester and Nottingham analysed which areas of England saw the most opioid painkillers prescribed.
GPs in Blackpool, Lancashire, and St Helens in Merseyside, prescribed the highest levels of opioids in the whole of England, the study found. Public Health England's (PHE) "Health Profile for England 2018" revealed residents in Blackpool have the lowest life expectancy in England. PHE data found residents of the seaside resort only lived to an average 76 years and 11 months, five years less than the UK average of 81 years and seven months. Meanwhile, those in the wealthy London borough of Kensington and Chelsea lived the longest, on average for 85 years and one month.
GPs in Blackpool, Lancashire, and St Helens in Merseyside, prescribed the highest levels of opioids in the whole of England, the study found. Public Health England's (PHE) "Health Profile for England 2018" revealed residents in Blackpool have the lowest life expectancy in England. PHE data found residents of the seaside resort only lived to an average 76 years and 11 months, five years less than the UK average of 81 years and seven months. Meanwhile, those in the wealthy London borough of Kensington and Chelsea lived the longest, on average for 85 years and one month.
https://www.express.co.uk/news/uk/1072717/pill-alert-study-painkillers-poor-patients-health-NHS
References and Notes
The quotation is from the introduction to Sontag’s Illness As Metaphor 1978 FSG. See also Regarding the Pain of Others 2003 FSG
Irene Tracey interviewed on the World Service Monday 22nd July 2019 https://www.bbc.co.uk/programmes/w3csz4y. An incredibly adventurous brain scientist, Professor Tracey testifies that the actual experience of a subject's pain is bound to differ from individual to individual according to experience, history, personality and beliefs. She received a very unfortunate nickname "The Queen of Pain". In 2016 BBC News, the Guardian, and Daily Mail reported on a study suggesting that as many as 50% of the adult UK population suffer chronic pain. https://www.bbc.co.uk/news/health-36574299
A NICE report in 2018 stated:
There is no medical intervention, pharmacological or non-pharmacological, that is helpful for more than a minority of people with chronic pain, and benefits of treatments are modest in terms of effect size and duration.
Additional morbidity resulting from treatment for chronic pain is not unusual, so it is important to evaluate the treatments we offer for chronic pain, to focus resources appropriately and to minimise iatrogenic harm.
The complexity of chronic pain and the association with significant distress and disability can influence clinical interactions. People often expect a clear diagnosis and effective treatment, but these are rarely available. GPs and specialists in other fields find chronic pain very challenging to manage and often have negative perceptions of people with pain. This is despite the fact that in every specialty there are some people with chronic pain. This can have important consequences for the therapeutic relationship between healthcare professionals and patients.
https://www.nice.org.uk/guidance/gid-ng10069/documents/final-scope
The IT in "where does it hurt" may also be capitalised. Here the It, of course, refers to Das Es in Freud's mature mapping of the psyche. Though unpopular amongst some psychoanalysts, I have often found many people do in fact refer to themselves, their pains, desires, fears, conflicts, or difficult emotions as IT. See Freud's famous The Ego and the Id and the introductory article on this topic in Wikipedia https://en.wikipedia.org/wiki/The_Ego_and_the_Id. Check also No Subject for a lacanian approach to Ego https://nosubject.com/Ego
Universal Delusion.
Universal delusion refers to the theorising of Jacques Lacan in later work, but equally well explored in countless works of literature and not just by James Joyce. Samuel Becket in Waiting for Godot for example, maintains we are born mad and remain so for the rest of our lives. Lacan’s formulation from dated October 1978 states tout le monde est fou, c’est-à-dire, délirant; everyone is mad, that is to say delusional. Much debate has been inspired by this phrase….for example, what are the differentials between clinical psychosis and ordinary delusional thinking if any? In reality this debate oscillates between two perspectives on subjectivity. The Subject as complex speaking/writing/ thinking/embodied being and, second, Subject as structure.
Dennis Potter (1935-1994) used his considerable talents as a journalist and dramatist to investigate physical illness, memory, subjectivity, pain, and traumatic life events in both Karaoke and Cold Lazarus of 1996. Whilst writing these plays Potter nursed a wife suffering from breast cancer. Shortly after she died, Potter himself died from pancreatic and liver cancer.
Experiencing little pain due to genetic variation. See the recent accounts and testimony of Jo Cameron: https://www.bbc.co.uk/news/uk-scotland-highlands-islands-47719718
Opioids are morphine and morphine-like medicines such as tramadol, oxycodone, fentanyl, buprenorphine and tapentadol are known as opioids. One group is termed natural, another synthetic. For the clinical uses and limitations of opioid treatment check the website of the Faculty of Pain Medicine https://www.rcoa.ac.uk/faculty-of-pain-medicine. There is a detailed section for clinicians and public entitled Opioids Aware. My list of side effects associated with long term opioid use is taken from the website above. One of the earliest patients of the nascent psychoanalytic talking cure, Anna O, was addicted to prescribed medications. See my blog about the psychoanalytic case history.
Finally, I need to mention that psychoanalysis has its follies too. One author (Reich) felt that Sigmund Freud’s own mouth cancer was caused by sexual repression. Another colleague and friend of Freud’s, George Groddeck (1886-1934), believed all and every physiological symptom of his patients (including cancer) as arose from the unconscious and, or, other psychological factors. In treatment he used both massage, hypnosis or his own form of psychoanalysis. He called this treatment integrationist. It seems to me he was not only doctoring, but offering a doctrine of salvation … or in modern terms, total happiness. Psychoanalysis, he thought, taught exactly the same as Jesus. Nevertheless many notable people claimed to have been healed by Groddeck. His unusual book of 1923 Das Buch vom Es took the form of a series of letters addressed to an imaginary girlfriend. Groddeck too wrote novels. Der Seelensucher. Ein psychoanalytischer Roman of 1921 was probably the first psychoanalytic novel ever published (anticipated, though, by Freud's early case histories)
Groddeck's presumption that all physiological symptomatology originates in the unconscious, seems a little extravagant to me. Sometimes a cold is just a cold.
Pain and Mental Health. A recent NICE report reckoned that around half the people diagnosed with chronic pain also suffer depression.
https://www.nice.org.uk/guidance/gidig10069/documents/final-scope
https://www.theguardian.com/commentisfree/2012/jul/16/mental-health-political-issue
UPDATES
1.Reports from health observers in Scotland suggest some 1,187 people died from drug-related problems last year. The New York Times reported how these deaths occurred mainly amongst "The train-spotting generation", meaning long-term users of opioids and benzodiazepines, now in their forties. One pharmacist comments “We’re seeing diseases that you would associate with old age in a lot of these middle-aged men with a long history of drug use .......What your body tolerates at 18 it doesn’t tolerate at 38 or 48.” See The New York Times 8 August 2019
2. Companies that marketed "pain" medicines in the USA are now receiving increased judicial attention. It is alleged such commercial organisations were well aware they were creating more individual suffering as well as massive social problems. See for example, Johnson & Johnson Twisted the Truth. New York Times August 29 2019.
3. Public Health England published a report on 10/9/2019 on regularly prescribed medicines linked to pain control and depression. These were:
Z-drugs (insomnia)
gabapentinoids (neuropathic pain)
opioid pain medications (for chronic non-cancer pain such as low back pain and injury-related and degenerative joint disease)
antidepressants (depression)
https://www.gov.uk/government/news/dependence-on-prescription-medicines-linked-to-deprivation
During 2018 one in four adults had received a prescription for one of these medicines. The report confirmed the link to deprivation and also indicated that prescribing rates are much higher amongst women and elderly adults. Trends suggest most of these are being prescribed less, but there increased use of anti-depressants and medicines for neuropathic pain.
c.Simon Fisher September 10th 2019
