Sunday Surkhi-painkillers

This is the physician's window.
About a decade or so ago a new "vital sign" was added,
The PAIN
From one to ten, the level of pain must be recorded, (along with the usual pulse, temp. and BP). Never mind the fact that it is the patient's statement you are recording and not, like pulse or BP, that you have measured with some instrument. There was a 'circular' that pain treatment should be directed towards relief no matter what (or so, I understood) Not that I was not treating pain before but I had a 'built-in' hesitation to prescribe nacotics for chronic pain. I am not talking about acute pain syndromes where there is usually no problem for the physicianto prescribe a narcotic for a limited period of time.
A patient who has suffered from , say, low back pain (extremely common pain in human beings--some price to pay for being upright, speaking from evolution point of view) for years and who is demanding nacotics because Tylenal, Nsaids etc. are all like 'candy' to him/her. So what would you do, prescribe narcotics?
You sit down and talk to the patient about all the side effects and addiction and whatnot about their use (and he knows it all as so many previous physicians have explained to him already) Says yes I know doc but i am hurting and cannot work, have lost my job and my family is suffering. So you succumb to these 'requests'.
It is not any easier if you know the patient because he has known you too so he can convince you one way or the other and you end up taking care of that prescription which you try to limit for one or two weeks rather than a month at a time.
You feel 'guilty' when you prescribe (am I making him an addict?) and you feel guilty because you do not prescribe (I have not helped my patient)
There is a report in the Sunday paper today of increased death rates from use of Methadone, which is an excellent pain killer as well as adictive and also used for treating addiction as you can place the drug on easy stepwise reducing dosage scale. etc. etc.
Report indicates that many physicians are not aware of the possibility of toxicity as the drug has a tendency to accumulate and a small dose over a certain period of time may become lethal. However when you prescribe a narcotic like methadone or morphine or dilaudid and give one week or two weeks supply to the patient you have no idea what dose the patinet will actually take. There is always that risk the the patient will take more than the prescibed dose,(because smaller dose did not help)
I am just reminding everybody how difficult it is to treat chronic pain syndrome with or without the existence of pathology. It is very easy to 'blame' the doctor, as was the case when Elvis died (I was in NC at that time. I forget the whole detail of all the medications he was taking and it may not be painkillers).
I guess these are "professional hazards". Many patients come to my mind whom I have prescribed narcotics in my life, rightly or wrongly--hard to judge and I have refrained from relating my experiences for ethical and moral reasons.