In a study reported in the American Journal of Psychiatry, 61 % of participants who died as a result of opioid abuse were diagnosed with chronic pain.
But as a doctor, providing care to patients is your priority, and sometimes that requires prescribing pain medication. You have been sworn under oath to care for those in need of help. Sometimes this means relieving the pain of a patient with the use of a drug that has potential for abuse.
You are faced with the dilemma of helping your patient, but also potentially creating a scenario where the patient could abuse or become addicted to the medication. This is especially true when the pain you are treating in a patient is considered long-term or chronic.
Chronic Pain
Chronic pain is pain that lasts more than three months, or 12 weeks. When you are injured, messages are sent from the point of injury to the brain, signaling a feeling of pain. In an acute injury, this pain will discontinue after a few days or weeks.
With a severe injury, the pain lasts months and sometimes even years past the initial incident. Chronic pain is the nervous systems way of signaling a problem, even if the injury has healed. The nerves keep firing but for an unknown reason.
Because it can be difficult to make the nerves stop signaling pain, treating the pain with medication becomes a more viable option. Each medication used to treat pain has a potential for abuse, some more than others.
Muscle Relaxants
Some common muscle relaxant medications include Soma and Valium. These are used to treat patients who experience both short term and long-term issues with muscle spasms. Normally, these medicines are used for a brief period, usually one or two weeks when prescribed for pain.
However, medications created for one problem can be found to ease other problems. For example, Valium was created to help with pain felt when muscles spasm. But it has since been found to be a great treatment of anxiety.
Anti-Depressants
Musculoskeletal pain has found treatment success with the use of anti-depressant medications like Cymbalta. Anti-depressants have been studied and findings show that these are a great way to treat chronic pain, especially neuropathy.
There is not a clear explanation of how anti-depressants work to alleviate pain, but theories suggest they work with the serotonin and norepinephrine chemicals, boosting feelings of happiness and reward.
Both tricyclic antidepressants and serotonin reuptake inhibitors are used to treat neuropathic pain.
Painkillers
Cells that are damaged or injured release chemicals called prostaglandins, which can easily irritate the nerve endings that sense pain. Taking a pain reliever can prevent the damaged cells from producing prostaglandins.
Painkillers can be mild or strong. Mild pain reliever examples include non-steroidal anti-inflammatories such as naproxen and ibuprofen. These are typically used for short-term pain and to reduce inflammation. They are not effective for long-term use like with chronic pain.
Moderate pain relievers address more serious causes of pain. Most often, mild opioids are prescribed, including codeine and tramadol. The dose of the opioid should be reduced as healing takes place.
For more serious pain that seems to be chronic rather than acute, stronger opioids may be required. These include medicine such as morphine or oxycodone, and variations of those two.
Stronger opioids can help relieve pain but come with negative side effects.
All opioids should come with a treatment plan for the patient that includes starting dose and instructions on how to gradually ween off the medicine when it is time.
Can Be Monitored and Easily Dispensed
Governments have established programs called the prescription drug monitoring program to help physicians verify whether or not a patient has been listed as an abuser of certain drugs. This monitoring system has been a terrific way to prevent patients from doctor shopping.
You can dispense schedule II through V class of drugs only and you must follow all Drug Enforcement Administration rules strictly. Doing so gives you the most insight about whether your patients are using their medicine appropriately.
You are the only one in your office who can prescribe a controlled substance to a patient. Plus, the prescriptions you write must be detailed and include the patient’s full name and address.
They must include the date issued, your name and DEA number. It also must detail name of medicine, dosage, strength, quantity and if refills are allowed. Including cautionary warnings, and clear instructions for use are necessary.
Benefits of Drugs with Potential for Abuse
The drugs themselves can provide benefits for patients who are suffering. People should not have to suffer in pain when there is a way to ease their pain. All drugs with potential for abuse come with risks, but these risks can be reduced by you, the physician.
Following best practices when prescribing opiates or other pain relievers is a start. Unless the patient has cancer, do not prescribe opiates as the first line of treatment. Try other avenues first, even holistic treatments like acupuncture or massage.
Develop a treatment plan with your patient that includes starting doses, dates and times, as well as ending doses, dates and times. Help your patient ween off the medicine by replacing the opiate with other pain-relieving options.
Utilize the services of a dispensing company, giving you complete control over your patient’s prescriptions and refills. Controlled substances can be ordered through the dispensing software program, making it much easier than using a pharmacy.
Furthermore, controlled substances are prepackaged in the safest forms, labeled for easy use and you can determine how many pills your patient gets at one time. The packaging used in dispensing has undergone rigorous testing and passes all inspections required by governmental and state authorities.
Yes, drugs with potential for abuse come with risks. And yes, the number of those addicted to or abusing opioids is high. But there are many patients who are suffering with acute and chronic conditions that can benefit from pain medication who truly need the relief.