]If you wish to converse with me define your terms.
There is a lot of importance placed on the definition of "addiction" when discussing pain management for chronic pain.
I tend to use the definition that goes: "Physical and Psychological dependence" but there are others.
Here's an example:
Addiction is a neurobiological disease that has genetic, psychosocial, and environmental factors. It is characterized by one or more of the following behaviors:
- Poor control over drug use
- Compulsive drug use
- Continued use of a drug despite physical, mental and/or social harm
- A craving for the drug
think that in many cases the waters are muddy with respect to applying the term "addiction".
Given that patients must sign contracts with pain clinics that attempt preclude drug seeking behavior (see below) it seems that many chronic pain patients are considered to be, at least, at risk for addiction.
Many chronic pain patients fit the various definitions of addiction.
I'm one of these people who considers proper use of words to be, in many cases, vitally important. Calling something by the wrong name can lead to gross immorality for example. (Calling murderous thugs "Freedom Fighters" has caused people to support murderous causes as one example)
When dealing with important matters it's important to use words properly in order to discuss ideas clearly. Using more pleasant sounding, 'less threatening' sounding terms for "addiction" can lead people to think that a serious problem is less serious.
Overprescription of pain pills has reached epidemic proportions in this country by all accounts. I'd say that when speaking of the causes it's important to speak realistically about a very serious problem.
If anyone wants to show that I'm wrong that would be great. I encourage people to attack my assertions but I request that you don't attack me.
There is a difference between attacking an idea and attacking the person who put forth the idea.
Quote from SocratesJohnson
There is, of course, complete hogwash in the world of addiction in academia.
n many cases outward actions are all we have to go on.......Intense brain investigation isn't practical for everyone who comes into the ER exhibiting drug seeking behavior.
We, to a very large extent, treat what we see.
Of course - but it's the conflation of physical dependance - as in the development of withdrawal symptoms without the drug - with addiction that creates the problem. Addiction is primarily a behavioral
degeneration that is both triggered and complicated by physical changes in the brain.
This is why pain management in the addicted patient is so difficult. It requires intense care-planning and strict consistency to work and even then it can be a nightmare. Acute care nurses just don't have that kind of resource. This is why so many posters opt to medicate rather than engage in a power struggle over it. They have decided that they are treating the pain, not the addiction.
I am curious as to what parameters might be substituted for self-reports that would change this dynamic. If it's behavior (agitation) or vital sign changes, I don't see how that would improve things. Addicts quickly learn how to change behavior to get what they want - that's what manipulation is
, after all. We all learned how to simulate a fever when we didn't want to go to school, so I wouldn't be surprised if junkies had a few ideas about vital signs, too. A good temper tantrum to elevate bp and pulse spring to mind.
It seems like the model for "legitimate" pain is based on symptoms exhibited by healthy people with no chronic pain issues undergoing acute, sudden onset of severe pain. Any other presentation is invalidated ... and this is wrong and is probably the underlying concern when expert insist on validating self-reports.
Forty years ago, in caring for that 35yo sickle-cell patient, I read that it is true that addicts will lie about pain in order to get opioids. The author pointed out that invalidating a self-report will not change an addiction. It will, however, deny
relief to people suffering from pain that does not present in the preferred "model". We simply have to decide which is more important.
I believe that what we do in the acute settings described by the OP has little to no effect on the rate of addiction in this country. Strategies made possible by EMRs and linked pharmacy and er records can be very helpful in curbing abuses of the system. Good support from admin. can go a long way towards curbing misbehavior in the clinical setting. But making sure a junkie doesn't get high on your watch will do nothing but frustrate you and escalate the junkie.
Last edit by heron on Nov 25, '13
: Reason: clarity