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The following roadblocks may prevent patients from receiving the proper pain management. If you understand the blocks that prevent people from obtaining adequate pain treatment, you can avoid them. Click on each subject of interest to you for information.

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Drugs 101 Pain 101

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How To Choose A Treatment

The Addiction Myth

Many patients, and even some doctors, fear that taking narcotic drugs to control pain will lead to addiction. This fear prevents many pain sufferers from receiving the proper care. However, studies indicate that addiction to narcotic pain medication that is used for medical reasons is rare for people with no prior history of substance abuse. Most pain medications don’t produce a “high.” They merely relieve pain.

In one study of over 12,000 medical records, only four cases of narcotic dependency produced by medical treatment were found.

According to the National Cancer Institute, addiction is defined as “dependence on the regular use of narcotics to satisfy physical, emotional, and psychological needs rather than for medical reasons.” It is also a chronic relapsing condition which is generally characterized by compulsive drug-seeking and abuse.

Even a predisposition to addiction doesn’t mean you will necessarily become addicted to pain medicine.

Pain relief is a medical reason for taking narcotics. Therefore, if you take narcotics to relieve your pain, you are not an “addict” no matter how much or how often you take narcotic medicines.

If you and your doctor decide that narcotics are a proper choice for your pain relief, use them as directed. The fear of addiction should not prevent you from using narcotics to effectively relieve your pain.

Pain Is Subjective.

Pain is frequently referred to as the fifth vital sign. Unlike the other signs such as temperature, pain cannot be measured objectively. Instead, doctors have to rely on you to describe your pain. This involves: 
  • Where is it located?
  • Is the pain a throb, ache, sharp, stabbing etc?
  • Pain level on a scale of 1 - 10 (see below)
  • How frequent is the pain?
  • Does the pain spread or move?
  • Does lying down or resting or medication relieve the pain? If so, how successfully and for how long?
  • How does the pain impact on your daily activities and your ability to concentrate and think clearly? (For a list of daily activities to help jog your memory, see Daily Activities.)
  • Do you wear or use any device to relieve the pain or its effects? Be specific and describe everything you do to relieve pain, whether it's cool baths, warm baths, staying in a dark room, listening to music, loose clothing, sunglasses to cut down on glare or whatever.

We provide a Symptoms Diary to help you keep track of pain and its severity.

Tolerance To A Drug Over Time And The Need For Higher Doses

Many people confuse drug tolerance with addiction.

With drug tolerance, the body becomes used to a given dosage of a particular drug.

Tolerance to a medication can develop after prolonged use. A change in medication, or increased dosage level may be needed to provide the same amount of pain relief benefits. This is not unlike a diabetic’s need to increase dosage of insulin medication to control blood sugar.

High doses can cause respiratory failure, but not generally for someone whose drug levels have been increased gradually over time. As pointed out by Tina Rosenberg in the New York Times: “For individuals who are properly titrated (drug levels are increased gradually over time) and monitored, there is no ceiling on opioid dosage. In this sense, high-dose prescription opioids can be safer than taking high doses of aspirin, Tylenol or Advil, which cause organ damage in high doses, regardless of how those doses are administered.”

In general, the standard practice is to increase dosage until pain is controlled or the side effects outweigh the benefits.

Do not assume that because a small dose doesn’t work, a higher dosage will. Opioids do not help everyone. Sometimes a drug holiday is recommended, or a change to another pain medication.

Changes or increases in dosage should only be made under the supervision of your doctor or other health care provider.

Physical Dependence

Physical dependence is frequently confused with drug addiction.

Physical dependence is dependence of the body on the presence of a particular drug. Physical dependence can be experienced in the form of withdrawal symptoms. For example, you are likely to feel withdrawal symptoms if you have been taking a narcotic or some steroids over a long period of time and then suddenly stop taking the medicine.

Withdrawal symptoms can usually be prevented or greatly minimized by gradually decreasing the dosage of the medication. This should only be done under the supervision of your doctor or other health care provider.

Side Effects

Many patients fear the side effects of pain medication which may lead to under treatment.

It is true that all medications have the potential to cause side effects.

Many side effects lessen or resolve as your body adjusts to the medication. For example, drowsiness usually wears off in a few days.

By working closely with your doctor you can usually develop a plan that will eliminate or adequately control many medication side effects.

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Side Effects

The Myth That Chronic Pain Is Harmless

Chronic pain can be very harmful. For example:

  • Pain can harm both physically and emotionally. It can also cause clinical depression and anxiety (which are both treatable).
  • Pain absorbs energy and attention
  • A person in pain is often irritable and self-involved.
  • Relationships can suffer as a result of pain. 

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The Need To Keep A Stiff Upper Lip

Americans like to think of themselves as tough and to keep a stiff upper lip. Some people even think that pain will hurt their doctor’s feelings by admitting that the doctor’s treatment isn’t working.

These are not reasons to avoid or unduly minimize pain medications.

Many Doctors Are Not As Knowledgeable About Pain Management As They Could Be

This may be the result of not having received adequate training or experience in pain management. Like some of their patients, they may have unfounded fears of narcotic addiction, or may be concerned of the legal ramifications of drug enforcement agencies for writing too many narcotic prescriptions.

According to the American Cancer Society, actions by drug enforcement agencies may be exaggerated by medical professionals, and should not be an obstacle to pain relief.

If you suffer from chronic pain, your doctor should provide the same time and attention to pain management as he does for the other medical aspects of your condition. If you’re not getting the pain relief you need, seek a doctor who specializes in pain relief. See the next section.

Government Crackdown On Prescription - Drug Abuse

The federal and many state governments are on a campaign to reduce prescription drug abuse. According to the Wall Street Journal, the crackdown is making doctors more reluctant to prescribe some drugs out of fear they will attract attention from regulators. Doctors may even be liable if a patient turns around and sells the drugs.

In addition to pointing out to your doctor the facts in this article, you can offer to take regular urine tests to confirm that you are actually taking the prescribed drugs.