Pain Management Experts Have Caused A Lot Of Addiction

Specialties Pain

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Specializes in PACU.

First I'll define terms. When I say "addict" I'm including everybody who is physically dependent on opioids who isn't a terminal cancer patient. I don't see how physical dependence can exist independently of psychological dependence as one can't be physically dependent on opioids with also having a psychological need for them.

Pain management has become based on the absurd assumption that: "the patient's pain is always what the patient says it is".

In most cases that assumption is probably valid but we know, with certainty, that people will lie in order to obtain pain medications. Pretending that report of pain is an objective finding is absurd.

Much addiction has been caused by the current pain management theories. We've been overmedicating many people for years based on pain management theories. There is an underlying assumption in current pain management that treating complaints of pain with large amounts of medication doesn't really have a downside when the fact is that it has a huge downside......We've got a large population of addicts who didn't have to be addicts.

Let me be clear about how important it is to control pain. I'm not saying that nobody should get opioids. They are extremely beneficial if used properly. "

Without a doubt, Sir William Osler, renowned Canadian physician of the late 1800's, was justified by remarking that morphine was "God's own Medicine
" http://www.chem.yorku.ca/hall_of_fame/essays99/morphine.htm
First I'll define terms. When I say "addict" I'm including everybody who is physically dependent on opioids who isn't a terminal cancer patient. I don't see how physical dependence can exist independently of psychological dependence as one can't be physically dependent on opioids with also having a psychological need for them.

Pain management has become based on the absurd assumption that: "the patient's pain is always what the patient says it is".

In most cases that assumption is probably valid but we know, with certainty, that people will lie in order to obtain pain medications. Pretending that report of pain is an objective finding is absurd.

Much addiction has been caused by the current pain management theories. We've been overmedicating many people for years based on pain management theories. There is an underlying assumption in current pain management that treating complaints of pain with large amounts of medication doesn't really have a downside when the fact is that it has a huge downside......We've got a large population of addicts who didn't have to be addicts.

Let me be clear about how important it is to control pain. I'm not saying that nobody should get opioids. They are extremely beneficial if used properly. " " Chemistry Hall of Fame - 1999 - Morphine

Welcome to Allnurses. Your definition of terms is seriously out of step with the larger healthcare community's definition, which clearly distinguishes between dependence and addiction.

And the sharing of your opinion that the notion that "the patient's pain is always what the patient says it is" and "pretending that report of pain is an objective finding" are "absurd" has been the basis of massive, widespread undertreatment of pain over many decades, which is why it has been largely discredited. I don't disagree that, for some time now, there have been far too many clinicians prescribing opioids too casually and freely, but I have to disagree with your basic premises.

http://addictionscience.net/b2evolution/blog1.php/2009/03/30/why-distinguishing-between-drug-dependen

Specializes in PACU.

Physical dependence can't realistically be separated from psychological dependence which is why I use the term "addiction". I don't mind using other terms but I do mind pretending that physical dependence on legally prescribed opioids isn't a huge problem. Using the word "dependence" for someone who spends all their waking hours figuring out how to get more pain pills doesn't get at the magnitude of their problem.

We know, with absolute certainty, that people will lie about pain in order to receive pain medication. We therefore know, with certainty, that the patients pain isn't always what they say it is.

I've had patients tell me that they are going to say that there pain is a 10 in order to get more pain medication. The pain experts are quite wrong about this.

Specializes in Hospice.

So, which is more important - to relieve the pain or to show an addict who's boss? What, exactly, do you imagine you're treating?

You haven't asked my advice, but I'm going to give it to you anyway: consider learning the difference between tolerance, addiction and pseudo-addiction. There's also a body of literature available addressing the problem of pain management in the addicted person.

The "pain management" you're talking about - and overprescribing really does happen and really does put vulnerable people at risk of real addiction - isn't really pain management at all. I don't know what "experts" you're talking about because I've been studying the real experts for my whole career. I can tell you that a cookie cutter algorithm that throws a pill at a symptom and walks away is not what the experts say at all.

Pain is a complex and often mysterious phenomenon. Addiction is one of the toughest behavioral nuts to crack as well. Put the two together and you have a serious challenge that deserves better than (very) inaccurate oversimplifications.

We know how to do this right ... the information has been out there for better than forty years.

I second what elkpark had to say, that your post reflects a knowledge base that needs a lot of work.

I know I'm being testy ... just got home from work and need to sleep. G'night :)

I've seen plenty of terminal cancer patients who are both physically dependant or addicted to various kinds of drugs. Why exclude this population? Does their terminal diganosis somehow mean they don't count?

Specializes in PACU.
to relieve the pain or to show an addict who's boss?

The point is to stop creating addicts.

" consider learning the difference between tolerance, addiction and pseudo-addiction.

I understand those terms perfectly well. Would you call someone who spends all their waking hours worrying about how to get more pills an "addict"?

"There's also a body of literature available addressing the problem of pain management in the addicted person.

There are no easy answers in dealing with postoperative pain in addicted patients. It is, to a large extent, hit or miss. I've had seen people who are just shy of a Dilaudid coma say that their pain is a 10/10 even though they are barely conscious and look extremely comfortable.

I don't know what "experts" you're talking about

The ones who insist that the patients pain is always what they say it is......If that were the case then the patients I just mentioned in their dilauded semi-comas would have to be considered pain emergencies. (I've encountered plenty of real pain emergencies by the way).

"We know how to do this right .

We don't. As I said...Postop pain control in someone who has been eating Percocet like candy for 10 years isn't a known science.

your post reflects a knowledge base that needs a lot of work.

Back at you.

Specializes in PACU.
Why exclude this population?

That's a good question. Because they have dramatically increasing pain and not long to live.

They are different than a 35 year old with a huge Percocet habit who is otherwise healthy.

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Physical dependence can't realistically be separated from psychological dependence which is why I use the term "addiction". I don't mind using other terms but I do mind pretending that physical dependence on legally prescribed opioids isn't a huge problem. Using the word "dependence" for someone who spends all their waking hours figuring out how to get more pain pills doesn't get at the magnitude of their problem.

We know, with absolute certainty, that people will lie about pain in order to receive pain medication. We therefore know, with certainty, that the patients pain isn't always what they say it is.

I've had patients tell me that they are going to say that there pain is a 10 in order to get more pain medication. The pain experts are quite wrong about this.

Welcome to AN! The largest online nursing community!

Are you researching for a class? Writing an article? or Pesonal frustration in your practice at work.

I think lumping all patients with chronic pain and require medication for relief as lying to obtain narcotics is ethically and morally wrong if you are a healthcare professional.

While there are patients that used/abuse their meds seeking a "high" and sense of euphoria and this particular groups of patients can be trying to one's patience....judging everyone by the same brush stroke is ethically reckless.

The pain experts are not wrong about this.

I agree with heron....

heron So, which is more important - to relieve the pain or to show an addict who's boss? What, exactly, do you imagine you're treating?
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
That's a good question. Because they have dramatically increasing pain and not long to live.

They are different than a 35 year old with a huge Percocet habit who is otherwise healthy.

and the chronic pain patient while they may be tolerant to the medication doesn't mean they have a "habit" and need to be denied the relief they deserve.
Specializes in PACU.
Pesonal frustration in your practice at work.

I see far too many patients who are chronic pill poppers. In many cases it could have been prevented by sensible pain control policies.

I think lumping all patients with chronic pain and require medication for relief as lying to obtain narcotics is ethically and morally wrong if you are a healthcare professional.

I do too. I'm doing nothing of the sort. I'm just pointing out that some patients lie about their pain.

.judging everyone by the same brush stroke is ethically reckless.

It is reckless......I would never do that.

The pain experts are not wrong about this.

They are wrong when they say: "the patients pain is always what they say it is". We know, with absolute certainty, that isn't true....I have already said that it's usually true but there is a large population of problem patients......A much larger population than there used to be.

Specializes in PACU.
and the chronic pain patient while they may be tolerant to the medication doesn't mean they have a "habit" and need to be denied the relief they deserve.

It doesn't mean that. The fact is a lot of chronic pain patients are in a very bad way due to all the pills they take....Not all by any means but is a serious problem.

Specializes in PACU.

It's funny.....The ones who lump all patients in pain patients together are the ones who say: "the patients pain is always what they say it is."

I'm the one pointing out that the reality of pain control isn't that simple. We know that some patients lie about their pain. It's silly to accuse me of lumping all pain patients together when I have said otherwise.

There was a case of a woman who went to a pain clinic and lied about her lung cancer in order to get pain pills. She got lots of pills but she didn't have cancer.

Let's talk about "knowledge base"...We know that chronic suppression of pain receptors with opioids causes the receptors to become more active in response to being suppressed. We also know that, in many cases, this results in the patient having more pain than they would have without all the pills.

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