[I love my cat!]

Article;
Risks for Painkiller Abuse Do Not Outweigh Benefits in Chronic Pain

Excerpt:
"As controversy swirls about proper clinical use of opioids and other potent pain medications, research reported at the American Pain Society annual meeting shows that, contrary to widespread beliefs, less than 3 percent of patients with no history of drug abuse who are prescribed opioids for chronic pain will show signs of possible drug abuse or dependence."

"Raja noted that fifty years ago, a commentary published in the Journal of the American Medical Association recommended that opioids should be avoided in treating cancer pain because of possible addiction, and 20 years ago it was believed infants didn’t feel pain and shouldn’t receive anesthesia.

“We abandoned such faulty beliefs as scientific evidence proved otherwise,” he said. “Now I hope history repeats itself in changing professional and public attitudes as we now know opioids are effective for treating chronic non-cancer pain and that very few legitimate pain patients abuse their medications."

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I am glad more and more information like this is being published. Unfortunately, many people will continue to resist these findings.
I work with several Nurses who (I feel) are overly worried about patients becoming addicts and that continue to believe that if a patient asks for more pain meds, they are only asking for more to get "high". They continue to forget that pain is what the patient says it is.
Plus, there still continues to be a lot of confusion regarding a true addiction, tolerance and dependence.

[nyapa]

Case in point: I looked after a man who was an 'itinerant' and a previous IVDU. He had metastatic cancer, can't remember the primaries etc now as it was a while ago.

He never complained, never asked for pain relief. Us nurses made a point of asking him, and eventually got it out of him that yes, he was in severe pain, but didn't want to ask for any because of his previous history.

The doctors had only written him up for NSAIDs and acetaminophen/paracetamol. He was refusing chemo; he said he had seen his mother go through chemo, and he knew how sick it made her, and he didn't want to go there. But because of his history they wouldn't write him up for anything more appropriate.

We know he wasn't getting anything illegal as he never left the ward, and never had visitors. Nursing staff from the manager down advocated on his behalf, but the doctors continued to refuse while he wouldn't accept treatment.

Suddenly he said he would take treatment - I think this was a test - and they were all over him like a rash, offering him every form of pain relief under the sun. Then he changed his mind; so did they, and they discharged him the following day with no followup.

I felt ashamed to be a part of the system that would allow this to happen. Just because someone has had a history of illicit drug abuse, does not mean they don't feel pain...I felt I had let this man down.

[Noryn]

So here is my question. Regarding addiction many are now stating that it consists of actual physical and chemical (rewiring is a frequent term) changes in the brain that occur. But if you have chronic pain these changes do not occur?

[nightmare]

My feelings on the matter.If someone is in a terminal condition or a condition that is never likely to get any better,which is the worst case scenario.they become an addict but are pain free and able to lead a fairly normal last few months of life or they live the last few months of life in constant pain in case they become an addict?I know which I'd rather be!

[ksilty]

Originally Posted by nightmare

My feelings on the matter.If someone is in a terminal condition or a condition that is never likely to get any better,which is the worst case scenario.they become an addict but are pain free and able to lead a fairly normal last few months of life or they live the last few months of life in constant pain in case they become an addict?I know which I'd rather be!

I totally agree, but the medical community has become so opiod-shy lately that it hurts some genuinly needy folks. I work as a case manager and spend a lot of time with people who are addicted to opiods. Most of them became addicted because their doctor(s) didn't know how to say no. It is a terrible way to live, constantly searching for medication everytime a provider decides that he has prescribed enough, but offers no alternatives. I have been working for months with a patient who has been addicted for years. With the new "rules" she was miserable. Primary providers have referred her to Pain Managers who have discharged her because she cannot follow the rules. Local ER docs all know her and will not give her meds. I finally managed to get her off methodone and percocet and she is a different person. She is re-engaged with life, has become more social and active and only calls me once a day to "check in" instead of 5 times a day to whine and complain. I think docs should use pain meds as a last resort, but cancer pain should definatly be treated with any drug or strength necessary to provide relief.

[MLOS]

Originally Posted by Noryn

So here is my question. Regarding addiction many are now stating that it consists of actual physical and chemical (rewiring is a frequent term) changes in the brain that occur. But if you have chronic pain these changes do not occur?

I wonder about this as well.

In this post I'm excluding terminal patients, CA patients, and those with advanced arthritic conditions.

I'm thinking about the countless (yes, countless) patients we see in the ER who state they have some type of chronic pain. Back pain x 2 years, abd pain without any significant findings in repeated lab or radiology studies,etc. These are not street junkies. But is their functional capacity not significantly reduced by multiple trips to the ER each month with administration of IV narcotics and 10-day scripts of Percocet/Vicodin/Dilaudid?

[fenders]

This is why research is sooo important to practice and why the degree is important to have as a practicing nurse.

I also did some research/paper on pain meds and 3 percent is correct. It is not common for patients to become dependent on the pain meds in the hospital. And I also found that tylonel is more harmful to your system (liver) then the opioids were.

Some of the new physicians are aware of this but you get the older ones who you have to beat with a baster to get them to increase dosages etc.

[tencat]

Pain is whatever the patient says it is, even if they are drug seeking. I don't see it as my job to try to figure out who is 'lying' and who is in 'real' pain. I've taken care of IV drug addicts who had painful dressing changes and only one lortab prescribed for medication for pain. That is just plain cruel as we know an IV drug user is going to need more than that to adequately control the pain. I do think that someone with chronic pain needs to be treated by an appropriate practitioner (pain specialist) as there are both non-pharmacological and pharmacological methods for treating pain.

As a side note, my brother-in-law (history of illicit drug use) claims to have chronic pain and is probably an addict who seeks drugs from physicians. Obviously he has some kind of pain (mental or physical). But there is no good way to specifically, scientifically measure pain. Until there is, the best we can do is treat it based on the patient's perceptions.

[CaseManager1947]

As a chronic pain patient, and working (that is to say employed) person, I have to respond to this thread. I have had at least 3 level deg disc disease since 2000. I have gone to work every day with pain... until Friday. I had repeatedly requested a repeat MRI of my back from my PCP. No dice... (think $$$$$). I have a script for one lortab 5 at hs. Which I do not abuse. I feel that patients with pain, esp. chronic, unremitting, never goes away pain (try living with that for 8 years and still work) are 1.) under treated 2.) not heard 3.) and often ignored, largely due to the "addiction factor" that has been mentioned. On this past Friday, I could no longer function. Past 3 days I had been crying off and on all day with my pain. My doc, reluctantly put me on Neurontin 300 tid. and nixed a new MRI.I said enough. I found a new doctor, who listened to my change in sx, and agreed I needed a repeat study to see if there are changes. Patients with pain (esp back) are seen as drug seekers, pains in the neck (and elsewhere). I agree, some use and abuse the available system, but not everyone is doing so. Heck, I need and want to work, I just can't do it hurting. So there is my story; we will see what the evidence-based medicine (MRI) will show. I rated my pain as a 20 on Friday, and work most every day with level 8-10. Now, do I fit the definition of an addict?? I don't think so. I don't take in doses greater than prescribed, beat the Dr.s door down for more at 10 days into the bottle, or solicit for meds on the street; but I sure as heck still hurt all the time. Pain IS undermanaged in the US., still,even though the Joint sez we are supposed to be doing a better job of it (5th vital sign and all that). Walk a mile in my moccasins some day.

[destinyz]

For the past 3 years I have suffered from chronic back pain due to two problematic operations for scoliosis. My biggest problem is that most prescribed pills (tylenol, percs, etc) do not take away the pain but get me <really> high. Either way, the only drug I have found to actually help the pain is marijuana. Unfortunately, since I am only 19 I am unable to find a doctor to sign for my license (they keep telling me it's addictive and hazardous, but I don't <need> to take it, it just makes the pain go away and I'm getting it expensively off the streets anyway). Sometimes drug abuse can be a problem, certainly, however especially in my case, the benefits completely outweigh the hazards. On the other hand, my father suffers from migraines due to enlarged veins in his brain (sorry, Im trying to translate from my language) and he takes 8+ tylenols/day (he's taken up to 17!!!) to no result. In my dad's case, the abuse is obviously much more hazardous especially since the drugs don't help him.