Quote from dankimal
Not all sources of pain show up on a conventional test
In my practice I have encountered several instances of objectively addicted pts being prescribed massive amounts of narcotic medications. May I make it clear that these are not pts with low pain tolerances, these are confessed addicts with telltale signs and symptoms of narcotic addiction. They will manipulate, exaggerate symptoms, fabricate symptoms, and will go to great lengths to have more meds.
My question/comment is this: After all physical causes of pain are ruled out, isn't it simply enabling to allow this population to remain admitted with increasing amounts of pain meds to satisfy ever increasing self reports of pain?
Perhaps our mantra of "pain is whatever the pt says it is" should be modified to "pain is whatever the pt says it is until objective signs prove pt reports of pain to be unreasonable."?
. I can understand the concern, but I also think that if there's that much concern, refer them to an addictionologist/pain specialist (who isn't in it for a constant selection of paying patients) for an evaluation, and get feedback about appropriate medications. And don't depend on some test for all answers. A migraine doesn't show up on a test, but can lay someone out for days. Cluster headaches can't be found by bloodwork- but I've seen grown men in the fetal position with them. Sickle cell crisis (which can be diagnosed- but often scoffed at) is horrific for the patient- and through no fault of their own, the patient needs increased doses because of repetitive crises and physical tolerance (not addiction). Some medications cause pain- can't measure that. Fibromyalgia can't be seen on an MRI or lab work.... still hurts BAD. Peripheral neuropathy is often diagnosed by verbal history... hurts a lot from patients I've seen w/it.
I took care of a guy on methadone maintenance, who also had a decub the size of a dinner plate in is sacrum/back.... could count vertebrae...
I don't care how addicted he was- he hurt
. And the doc refused to give him anything but the 'usual' dose of methadone that wasn't being used for pain control at all- it was cruel. I refused to be assigned to him if I couldn't treat him humanely. The guy didn't manipulate at all- just was in agony, and nobody who could do anything cared. I'd try to get meds for him on the weekends I worked- but the doc put a stop to that, so that was it for me. Wanted no part in deciding who was dealing with "real" pain.... I know this is different in some ways- but forcing the patients to "prove" how bad they hurt isn't going to help them.
This is from the FWIW pile.... I have had chronic pain for 15 years- various causes; never a pain free day in that time- some better than others, but never gone. If I have available meds at home, I'm more likely to NOT take them
, because I have the ability to take them if I can't deal with the pain in any other way- there's not the anxiety of not having something that helps
. Often, a non-narcotic helps just fine- but if it doesn't, I have something. Not anything "major"- but 'enough'. And I guard those meds. I'm afraid of the pain... that's different than craving drugs
A month's rx of a mild narc lasts at least 2-3 months...but I get the refill monthly, so I know that I'm covered if I can't get to the pharmacy.
Yeah- nobody wants to enable an addict. But who wants to be a party to someone NOT getting some sort of relief for pain? We can't always know who is or isn't being manipulative-- sometimes the fear of the pain can make folks sound pretty desperate, and that is judged by healthcare professionals as "proof" they're just looking for drugs.... People with pain DO want relief- is that so weird?
When I worked drug/alcohol rehab, the patients still got narcotics for a short period if they had medical procedures (many had neglected their teeth, and had dental procedures that would have been cruel to not deal with). Addicts can hurt, and those who hurt a lot can sound desperate- which can be perceived as drug-seeking (and in a way they are- but for the right reasons).
If the docs are prescribing oxycodone for a hangnail, that's a problem with the doc- not the patient
If someone is medicating emotional pain, of course narcs won't help- but you can't get a test to prove that pain is ONLY emotional.... you might get more info from them with some sort of questionnaire about past trauma- both physical and emotional- and if it's something they can fill out, without the inadvertent sound of judgment in someone asking questions, you might get all sorts of info about the real cause of any type of pain, and either be able to treat it better, or send for referrals .... jmho