Narcotics, back pain, and preventing addiction Posted: 12-09-06 17:30pm
Hello,
My husband and I live in Brooklyn, NY.
He has been seeing a pain management
specialist because of his back for about 4
years. And is on alot of heavy prescribed
narcotics. He is still taking the
prescriptions.
The question: What are some required
steps or guidelines, a physician could
perform to monitor their patient for
adversely affected signs of addiction?
Meaning, is a physician required to
prevent addiction by means of routinely
monitor medication levels, either by blood
or urine? Or run a diagnostic test and
drug screening, if prescribing a
controlled substance?
I understand we are all adults and are
fully responsible for our own actions and
I'm honestly not blaming the doctor for my
husbands addiction at all. Its becoming
extremely frustrating to not be able to
find the answer. We plan on asking his
pain physician the same question, but want
to be prepared first.
I find it hard to believe that there
are no set rules or guidelines for
preventing addiction caused by prescribing
narcotics, otherwise a physician could
prescribe narcotics for a long time to
their patient and not worry if they have
liver damage, toxic levels, or abusing the
meds.
We leads me to believe there is some
sort of process to preventing this, is
based on this info I found on the DEA's
site:
'As noted in Supreme Court (Gonzales v.
Oregon) patients use controlled substances
under the supervision of a doctor so as to
prevent addiction and recreational abuse'
I apologies for taking up your time
and tried to find the correct words to
express my concern, with the fewest words
possible. Please find it in your heart to
try and help me. I'm sure the answer is
there, I've searched endlessly online and
nothing. I will be extremely grateful for
any help.
Thank you so much,
Lisa S
|
DoctorAnswer
Doctor Answer
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Back Pain Answer A1958 Posted: 12-15-06 06:13am
In many cases of chronic pain treatment,
addiction to narcotics could be a possible
result. It depends a lot upon the cause of
pain. If the pain is due to a chronic,
progressive and degenerative disease (such
spondylosis of the spine), you should be
aware that painkillers are prescribed for
a longer amount of time than for other
conditions. Painkillers do not heal a
condition but only relieve the pain
temporarily (symptomatic therapy). The
medical conundrum exists when painkillers
are not only necessary for the treatment
of the condition, but may even bethe only
therapy available.
There are 2 types of painkillers: opiates
(narcotics) and non-opiates. Non-opiate
painkillers (paracetamol, acetaminophen,
aspirin, ketoprofen, ibuprofen,
diclofenak, indometacine, remoxicam…) do
not cause addiction but they can damage
the stomach (peptic ulcer) and have a
weaker effect than narcotics. Opiate
(narcotic) painkillers (codeine, tramadol,
morphine, methadone, fentanil,
pentazocine…) have a stronger effect
than non-opiates and don’t damage to the
stomach but they ALWAYS cause addiction IF
USED OVER A LONG PERIOD.
The best way to prevent addiction from
narcotics is TO AVOID NARCOTICS AS MUCH AS
POSSIBLE. This means that in the case of a
long lasting, painful disease (like the
one experienced by your husband) you and
your doctors should first consider all
possible causal therapies. Causal
therapies may includes surgery (if
possible) and physical therapy.
Unfortunately, many chronic degenerative
diseases (like spondylosis) have no
efficient causal therapy because their
cause is unknown and a symptomatic therapy
(pain relief) is the only therapy.
Pain relief (symptomatic) therapy for
chronic diseases usually starts with
non-narcotic painkillers followed by
stomach protection. Non-narcotic
painkillers for chronic pain should be
used as long as the pain is calm enough to
bear and as long as the side effects from
the painkillers are tolerable.
Non-narcotic painkillers are also used for
mild and moderate acute pain.
Narcotic painkillers are usually used for
short treatment of SEVERE ACUTE pain
during conditions that can be efficiently
treated with causal therapy (renal colic
or heart attacks, for example) and for
longer treatment of SEVERE CHRONIC pain in
progressive diseases with a bad prognosis
(terminal stadium of malignant diseases).
The problem is what to do when the pain
becomes worse and non-narcotic medicines
do not help anymore... or their side
effects can’t be tolerated (peptic
ulcers). There are some alternatives
available such as injecting a local
anesthetic (lidokain) to the affected area
or surgical analgesia, but in many cases
usie of narcotic drugs is inescapable.
Using narcotics for more than 2-3 months
leads to addiction. Addiction manifests
with tolerance (in time bigger doses are
needed to achieve the same effect) and
abstinent syndrome (when coming the
narcotic, the pain become even worse and
additional mental and physical symptoms
are present). Addiction can be prevented
by using the drug suckers as possible, in
doses as minimal as possible. Every case
is specific unto itself and it is not
possible to discuss an absolute best
combination of medicine, usage duration
and doses.
You can consult a neurosurgeon, a
neurologist, an orthopedist and a
rheumatologist for expert opinions on the
matter.
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