 | Rachel Stevens MD, is a family physician at the Girard Medical Center clinic in Frontenac, KS., Dr. Stevens graduated from Pittsburg State University and completed her medical training at the University of Kansas School of Medicine. She completed her family medicine residency at Research hospital in Kansas City, MO and is board certified in family medicine. She is currently accepting new patients of all ages and offers extended and weekend hours at her clinic for the convenience of her patients. |
Health & Wellness
2011-01-01 11:24:00
Opioid pain medications for chronic pain
: How can my physician assess my risk of addiction vs. tolerance?
Answer: It is very difficult to predict this as physicians, because any patient can become addicted to narcotic medications despite real pain. However, some risk factors
Answer: Chronic untreated pain is an epidemic affecting an estimated 50 million Americans with an annual cost of up to $100 billion. With limited options in pain management, physicians and patients alike struggle with the ramifications of the addition of opioid pain medications to a patient’s daily medication regimen.
Narcotic pain medications are not for everyone --in some patients they can actually worsen the pain effect. Using opioid medications for longer than 6 days doubles a person’s risk for disability, and there is a significant risk in EVERY patient for addiction and abuse.
The word addiction simply means the compulsive use of a drug that causes dysfunction and continued use of the offending agent despite that dysfunction. This is in contrast to tolerance. Tolerance is the need for increasing amounts of an agent to receive the same benefit. Tolerance also implies that abrupt cessation of an agent will result in withdrawal symptoms. Every patient becomes tolerant to the effects of narcotics, but not all patients become addicted.
Physicians are correct to be concerned for their patients. Unintentional overdose is the leading cause of death in ages 25 to 55 and the second leading cause of death in teens. A staggering number of these deaths are from prescription narcotic medication abuse, surpassing both heroin and cocaine combined. A recent study of high school teens has shown that 19% of teens report abusing prescription medications to get high. Forty percent of teens believe they are “safer” than other drugs and 29% believe they are not addictive.
Question: How can my physician assess my risk of addiction vs. tolerance?
Answer: It is very difficult to predict this as physicians, because any patient can become addicted to narcotic medications despite real pain. However, some risk factors assist us in choosing appropriate candidates for narcotic therapy. Patients with psychiatric disorders, lower socioeconomic status, history of substance abuse, concomitant use with sedative/hypnotic agents (benzodiazepines and barbiturates), and certain medical conditions including COPD, congestive heart failure, obstructive sleep apnea, chronic renal failure, liver failure, and elderly patients are all at higher risk for negative effects.
Patients with favorable outcomes will be able to modulate their usage without difficulty to balance least pain with most function as opposed to patients requiring increasing amounts with no clinical signs of improvement in function.
Question: What measures can my physician take to monitor my response to narcotic medications?
Answer: A responsible physician will exhaust all other means for pain control before turning to chronic narcotic therapy. The lowest dosage should be used and a patient’s response should be modulated based on return of function. As with any other medication, if a patient fails to show response, these medications should be withdrawn. Longer acting agents should not be used in acute pain. Your physician may ask you to sign a narcotics contract outlining their specific recommendations for monitoring your progress including random urine drug testing and guidelines for termination if a violation occurs. Your physician may also require you to consult with a pain management specialist at any point in your care plan.
