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Narcotics, back pain, and preventing addiction

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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

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replied December 15th, 2006
Back Pain Answer A1958
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 be the 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 posibble. 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 as shortest 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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