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Road Blocks To Adequate Pain Management

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

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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.

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