ForeWord Reviews

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The Opiate Cure

Pain and the Bipolar Spectrum

Clarion Review (3 Stars)

In The Opiate Cure: Pain and the Bipolar Spectrum, Robert T. Cochran makes this claim: “I have, with opiate therapy, relieved mood-shifting bipolarity, narcolepsy, attention deficiency, obsessive-compulsive disorder, post-traumatic stress disorder, and multiple personality disorder.”

While practicing medicine as a pain specialist, Cochran discovered that when he prescribed opiates, especially methadone, to relieve chronic pain in patients who also had bipolar disorder or other conditions in the bipolar spectrum, such as obsessive-compulsive disorder, attention deficit disorder, or narcolepsy, symptoms improved for both conditions. Some of his patients had more than one of these psychiatric conditions. (He often tried other medications first, of course, including stimulants.) He believes that different people need different amounts of the medication due to variations in opiate receptors and dissimilarities in enzyme systems.

Cochran’s thesis in The Opiate Cure is that opiates can successfully treat pain and bipolar-spectrum disorders in patients who are suffering from both conditions. As evidence, he includes numerous well-written case histories. Cochran’s descriptions of his patients and their lives, including many conversations with his patients, make the case histories powerful and interesting. Cochran also states that the medical literature contains a few reports regarding antidepressant and mood-stabilizing benefits from opiates for patients with bipolar disorder.

This well-organized book includes five chapters introducing Cochran’s theory, three chapters of case histories that present patients with a specific psychiatric diagnosis, and five chapters focused on case histories involving an important symptom, such as flashbacks or cravings. The book also offers charts with examples of different classifications of medications and an index, enabling readers to look up such items as medications, diagnoses, and patient names. Cochran accommodates readers who are not health-care professionals by explaining many medical terms, such as “analgesic (pain-relieving) drugs.”

Unfortunately, the book has an excessive number of sentence fragments. However, in most cases the fragments aren’t distracting. Other errors include missing words and a few typos.

Cochran graduated from Vanderbilt University Medical School and took his neurology and internal medicine residency at Duke University and the University of Texas. He established his independent medical practice in 1963. Cochran’s previous books are Understanding Chronic Pain and Curing Chronic Pain.

Patients with chronic pain, especially those with mental illness who need opiates, will appreciate Cochran’s viewpoint. Doctors like Cochran, who are willing to look beyond established paradigms, move medicine forward.

Norma D. Kellam