Question about Pain Management

[NautyOne]

I've been giving this a lot of thought.  Because opiate withdrawal is not life threatening, doctors are handing these things out like candy.  Yes, you get that little pamphlet advising you that these drugs can be addictive.  The truth is that these drugs were never intended for long term use.  I think it would only take a few minutes out of a doctors time to show you a short video of what these drugs can do over prolong use.........addiction and dependence is a very fine line and showing a short video of what one will suffer as a result of prolonged use (watching someone suffer withdrawal) as a possibility may make the patient make alternative choices.

There is no reason that I can see for doctors to be prescribing medications that at one time were strictly for patients on their death beds.........virtually nobody reads those pamphlets anyway, so where does the responsibility lie?.......If you are informed correctly, then your doctor can accept no blame.

Nauty

[J T Junig, MD PhD]

I have argued that there should be a separate residency in 'opiate prescribing'.  There is no doubt that most doctors do not understand or appreciate the risks of these medications, for the individual and for society.  It will never happen-- but given the huge number of deaths that occur annually from these drugs (most people would be shocked to see the number of young people who die just in their own communities each year), there should be greater attention to the risks from each prescription.

[nick30]

I have to disagree there(although i agree dr's should warn patients more, but that applies to lots of things, not just narcotics).
there's no need to scare people. many people suffer needlessly because they fear an addiction which may never happen.
if someone is in so much pain that they are seriously considering suicide, does that count as 'death-bed' ?
I read ALL the info that comes with the drugs, as well as chking the net for further advice.
the responsibility lies with the patient. take the meds as prescribed. if you can't then you need to tell your dr about it. then he can help you.
If it weren't for strong painkillers, I'd have been dead in my mid-20's.
not much more to say.
hope you don't think i'm being nasty. i'm not.
i just need them to survive, that's all.
take care Nauty

Nick

[rbaz5732]

A related discussion, Pain Management Program Experience was started.

[ChronicPain1]

Here's a good article for those who believe addiction and dependence are one in the same:

http://www.cpmission.com/main/dispelling.html

"Pain patients very rarely become addicted"

Disagree if you must.

[NautyOne]

Thank you Dr. J.  You made the point that I was trying to make.  As stated before, I am not one who is the most  gifted with words, but that is all I was trying to say.  Thank you.

Nauty.................

[J T Junig, MD PhD]

My two cents worth:  There are significant differences between doctors on the issue of narcotic prescribing.  I just came from giving a talk to a group of docs and nurse prescribers-- after the formal talk I had a nice discussion with a nurse from a regional pain clinic.  We talked about how her clinic sees the patients that no other doc will see-- people with chronic pain who need some amount of narcotic to make it through each day.  There are few doctors who will do the work of treating chronic pain the way it should be treated-- who will prescribe pain meds but provide the education and monitoring necessary to prevent problems from developing from tolerance and dependence.  Instead there are the docs who simply prescribe anything that the patient asks for, without taking the time to determine whether the options to narcotics have been tried... then there are many docs who simply say (they boast when they say this) 'I don't give pain pills to ANYONE'-- as if they are doing society a favor by saying no!   My point is that there is not one type of doctor, and there are more 'types' than the stereotypes that I just described.

Second, the vast majority of opiate addicts do not use opiates 'recreationally'.  That implies that the addict is somehow enjoying his/her use.  That stage of use is very short;  within a couple months most addicts have developed a situation where they are using to avoid being sick, and they are wishing that they had never started using.  I realize that the term 'recreation' is intended to separate the 'legitimate' from the 'non-legitimate' users, but that difference is not as great as you think.  The people who present to me for treatment of opiate dependence most often started their opiates by filling a prescription for a painful injury, and then found that they couldn't stop taking them.  Instead they used the pain pills that were laying around the house from prior surgeries, then they raided the medicine cabinet of mom and dad's place, then they started doc shopping or ordering off the internet.  

Third, and finally... even the line between 'real' pain and 'fake' pain is often difficult to find.  Many patients who are addicted to opiates, when asked if they 'really' have back pain, say 'I don't really know anymoe... I THINK so'.  The pain becomes something that seems to come from inside their heads in a way, and they start to question whether they are really hurting or whether instead they are afraid of withdrawal, and so they are taking pain pills for that.

Of course, there ARE patients with true, severe pain... for whom opiates are a clear necessity.  But there are fewer of THOSE patients than there are patients who fall into the 'confused' category... at least in my experience.