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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.
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Subject: Re: Fiorinal I and so many, many other sufferers of migraines are so weary of being told by doctors that we are taking too many Fiorinal and, even if we can go a week or two without taking any at all, we are probably addicted to them. They are non-narcotic, right? I suffer more from rebound headaches from Imitrex and Zomig than Fiorinal. Most of us can't function without some sort of medication every day. I know the doctors are also trying to cover their asses but we get so tired of begging and putting on a dog and pony show just to get 30 or 60 tablets a month from them. Nothing else works as well. We have tried everything. Except Demerol or morphine tablets which I KNOW we couldn't get unless we could PROVE that we were dying from the pain. That's the problem. No one DIES from migraines (except for suicide) so they are not taken seriously.
___ Dear Judy, I agree with you that severe chronic migraine headaches are a serious medical problem. One of the most talented mental health professionals I've ever known ended his life during such a headache. So there is little doubt in my mind that anyone with severe chronic migraines needs to be taken very seriously. Fiorinal, although not a narcotic, contains butalbital, which is a barbiturate - a controlled-substance in the sedative-hypnotic category (so-called "downers"). Whenever possible, it is always preferable for physicians not to prescribe addictive medications for treatment of a chronic condition. The risk of doing so is that the patient goes from having one medical problem (the chronic condition) to 2 medical problems: The original condition and an iatrogenic (which means "caused by a doctor") drug dependence. In cases such as yours, it's usually a good idea for the prescribing physician to try to treat the medical problem with non-addictive medications before considering treatment with addictive meds. If the non-addictive medications are not effective, then I would recommend that doctor and patient have a frank and open discussion about the pros and cons of treatment with addictive medications. In the best situation, physician and patient are able to agree on a mutually acceptable treatment plan (which may or may not include the addictive medications, depending on the particular details of the case) at the end of their discussion. If you and your doctor cannot reach such an agreement about your pain management plan, you could consider seeking a second opinion. I'd consider a headache specialist, especially one who is familiar with addiction issues. You might take a look at Medhelp's Neurology Forum to get more information about this. Good luck. Steve Adelman, M.D. - (a.k.a. DrSteve) This information is provided for general medical education purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. keywords: migraine, sedative-hypnotic, barbiturate, iatrogenic addiction
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