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Questions posted in the
The Addiction Forum have been answered by
Steven Adelman, M.D. and by Richard C. Bozian M.D. F.A.C.P. of Harvard Vanguard Medical Group.
Question Title: HydrocodoneForum: The Addiction Forum
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I suffered a severe fracture of the right proximal humerus in October 1998. This has resulted in severe chronic pain in my neck, shoulder and arm. Nerve studies (EMG and nerve conduction) have confirmed nerve damage in the brachial plexus. The pain has been managed with Hydrocodone/APAP (7.5/750). Dosage started out at 4-5 per day for the first 2 months after the injury and has since been reduced to 2 per day (spaced out very evenly; 1/2 tablet every 6 hours). This dosage has been the result of "trial and error" in determining the minimum dosage of hydrocodone which controls my pain to a level where I can work and perform most normal daily activities. I am also taking Physical Therapy twice a week. Are there any significant medical issues that I should be concerned about with respect to being on a low level narcotic pain medication for a long period of time? Should other approaches be considered? My pain has been stable and well managed with the hydrocodone but I am open to considering alternatives.
Dear Mike, Hydrocodone is a short-acting narcotic which you are taking in a moderate dose around the clock. Round-the-clock use of narcotics can promote the development of physical dependence, which would be manifest by your developing tolerance (more is needed for the same effect over time) and withdrawal (you would feel increasingly uncomfortable when going without medication, with sneezing, goose flesh, increased pain, diarrhea, etc.). In order to avoid physical dependence, it's always a good idea to make the transition from addictive painkillers to non-addictive ones as soon as possible. One way of doing this would be to alternate the use of hydrocodone with a non-addictive painkiller, thereby cutting down the number of doses of hydrocodone you take each day. Ideally, you would eventually get to a point where you were maintained on the non-addictive pain medication and could fall back on the narcotic from time-to-time if the pain got exacerbated. You and your doctor should be communicating openly and frequently about non-narcotic alternatives to hydrocodone. Non-pharmacological techniques such as acupuncture, self-hypnosis, relaxation techniques, and nerve stimulation should also be considered. All that being said, it is encouraging that your reliance on hydrocodone has diminished over time. When all else fails, some individuals with chronic pain do end up requiring long-term treatment with narcotics. This needs to be carefully monitored by a physician sensitive to the issue of drug dependence, and should only be considered as a last resort. Take a look at my Ask DrSteve web site (conveniently hyperlinked below) for other information about addiction. Good luck with your arm - in this case your chronic pain may sound a little funny (get it, "humerus"), but it certainly is no laughing matter! Steve Adelman, M.D. (a.k.a. DrSteve) This information is for general medical education purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition.
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