Friday, July 20th, 2012 at
“Thank you for treating me as someone struggling with pain and not as a former drug addict who could not be trusted with strong pain medication” – a note I recently received from one of my patients.
A patient with a history of drug abuse may be fearful that their past will prevent adequate treatment for a serious painful condition. My patient imagined that I would not be respectful of his suffering and his commitment to sober living. He received the pain medication that allowed him to go through a series of medical and dental procedures without suffering. He was grateful.
Concerns about opioid misuse have made physicians wary of prescribing potentially habit-forming pain medication. Illicit prescription drug use is a growing problem in the USA and is actually the preferred street drug aside from marijuana. However in treating patients in pain, two basic American traditions should be the guiding principles with patients who have a history, or who test positive on a written test to determine the risk, of drug abuse:
1. Innocent until proven guilty; and
2. in the words of Ronald Reagan, Trust but verify. Those patients who have problems properly using pain medication need extra attention, not condemnation. They may be more difficult to treat, but that is why there are specialists to deal with complex pain problems.
Tuesday, April 10th, 2012 at
The NY Times on 4/9/2012 ran a story about the overuse and unintended negative consequences of strong (opioid) pain medication. They mentioned opposing views concerning the liberal use of opioids. I participated in a debate in 1995 about the inappropriate use of the diagnosis “Chronic Pain Syndrome”(CPS) in patients whose muscles had not been assessed as a cause of their persistent pain, which resulted in the justification to put some of these patients on opioids for the rest of their lives.
Since then one of the largest growth industries in medicine is the evaluation and treatment of back and neck pain, currently accounting for ~$100 billion in direct medical costs. The pain juggernaut is fueled in part by ignoring muscles which are the most common reason for pain complaints. Addressing the incorrect causes of pain leads to inappropriate, expensive and potentially harmful treatments with poor outcomes, persisitent pain, and overuse of opioids. CPS is a license to prescribe life-long medication. Chronic use of opioids has not been studied for its overall impact on patients with CPS but neither have any of the other medications that we are now using. Does the marginal reduction in pain in many of the patients taking these medications justify their costs and side effects? As the Times reports, for some patients the treatment is actually making them worse.
Imagine if some of these patients had pain that could be eliminated. Many do; it’s from muscles that are not evaluated or treated in a systematic way. My new book, End Back Pain Forever, to be released by Atria on June 5, 2012 is a wakeup call to change the way we are treating common pain problems.
Wednesday, July 8th, 2009 at
Back pain that never goes away completely can undermine your quality of life. It can prevent you from participating in activities that bring you pleasure and security. The medications that we use to deal with the pain, while being life-savers in terms of providing relief from the suffering, expose us to potential harm.
Tylenol (acetaminophen) has been found to result in more than 40,000 cases of liver damge each year in the US. Some of these patients have died. Because of the misuse of this generally well tolerated drug, the FDA will limit its availability in combination drug products such as Percocet and Vicodin. The recommended upper limit has been 4000 mgms but will probably be reduced in the near future . A regular dose Tylenol tablet is 325 mgms, making twelve the maximum number of tablets/day. When you take the combinaton drug you may not be aware that you are ingesting the same drug as in Tylenol and inadvertently take a harmful overdose.
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