Quote:
Originally Posted by LoALAnna  My question is: How is it YOU (generally speaking) know when a pain med is not needed, especially when the person in question has chronic ongoing pain, and even surgery (back, for example) has not helped? There has been documented cases that in the U.S., especially,where doctors are afraid to prescribe the strength needed by the individual patient(due to regulations, etc.) to relieve the pain, and so the patient sometimes has no choice but to supplement just to get some sort of relief and semblance of a "normal" life. |
Let's first decipher what you mean by "supplementing". Is this a person who is taking more than one drug prescribed by a single doctor? That can be a normal course of treatment because some medications work better in combination than they do separately. Are they supplementing by taking more of a prescription drug than is prescribed? More usually isn't better in terms of pain relief, and in most cases it's more dangerous. Are they taking it in a way inconsistent with the intended method of delivery (snorting crushed tablets, for example)? That's addiction and not pain relief. Addiction increases the perception of pain that is out of proportion with the stimulus.
What you are describing (in the example you gave) is someone who's pain may be uncontrolled. That's not the same as someone who is addicted, though many of the same behaviors may present in both. It's also important to differentiate between someone who is
drug addicted (which means they are taking the drugs because they have an overwhelming, compulsive, uncontrollable need to take a drug for a reason other than they were prescribed or in a manner inconsistent with the labeling) versus
drug dependent (which is someone who is using the medication as intended, but has a physical dependency on the medication to function normally). While addicts may also have a physical dependency, not all people who are physically dependent are addicts. The treatments and prognosis for the two are very, very different.
While every patient responds and perceives pain differently, we (generically speaking) have some good physiologic measures for differentiating pain. Pain relief is an art, and this is where having one consistent care provider becomes essential. Too often, patients "doctor shop", getting a few meds here and a few there. When they do that, the primary doctor does not have a good over view of how severe a patient perceives their pain to be or how they perceive it affects their life. This has led to many doctors to severely limit the way they treat pain because of the potential for the abuse of the medications they prescribe. Yes, some doctors are loathe to increase the amount of a drug to the level the patient feels is necessary, some due to regulations, but most due to the risk of side effects that come in to play with the higher doses.
All pain is not the same, consequently there is no generic pain medication or dosage for a certain condition. A good provider does in-depth interviews and exams to determine things like the location, duration, aggravating and mitigating factors and the quality of the pain (does it burn,cramp, tingle... does it radiate,etc) Surprisingly,while narcotics are often found to be better for acute (right around the time of the injury/surgery), pain while medications like Lyrica (which is an anti-epileptic drug) and Cymbalta (which is an MAOI) are being used successfully in chronic pain because they seem to do a better job of interrupting the pain signals. There are also a lot of non-pharmacological interventions that have great affect on chronic pain (like spinal cord stimulators and nerve ablations). Often times, all it takes is a change in medication to one that treats the underlying condition to attain adequate pain relief.
It's a fine line to determine whether someone is self-medicating due to improper pain management versus someone who is self-medicating because they are exhibiting addictive behaviors. It's not fair nor accurate to state that it's the pain medication that made the person addicted (remember, dependency is not the same as addiction) Rather, it's the behaviors around the treatment of pain that are more likely to cause the addiction. I would go so far as to say that a person ALWAYS has a choice in whether they choose to "supplement" in a way that's unhealthy.