Step 9: Working with your doctor
Suffering from pain can leave you irritable and frustrated. If you want to develop a good relationship with your doctor and his office, remember not to take out your frustration on your physician or his staff. Your doctor’s office is more likely to be responsive if you act respectfully rather than combative with demands.
Your doctor has a limited time to evaluate your problem and discuss treatment options. Therefore, come on time to your appointments and make sure to fill out all paperwork as requested by the office. Try to organize your thoughts prior to your visit so that you can communicate your problem in a concise manner.
When you talk to your doctor about treatments, don’t expect him to have a quick fix for you. Chronic pain is a complex problem in which many require several treatment forms. Chronic pain may need to be treated just like other chronic medical conditions. Just like a diabetic needs to receive ongoing treatment, a chronic pain patient may require long-term treatment.
Several medications are used to treat chronic pain. The main categories of medication used to treat chronic pain include:
- Simple Analgesics. These mild pain relievers can control pain without causing drowsiness. Several of these medications are available without a prescription– they include acetaminophen, aspirin, and nonsteroidal anti-inflammatory medications such as ibuprofen.
- Adjuvant Analgesics. Adjuvant analgesics are medications that are used to treat conditions other than pain. However, because of the way these medications work, they can also reduce pain.
- Multipurpose analgesics such as anti-depressants or corticosteroids.
- Analgesics for neuropathic pain (nerve pain) such as local anesthetics or anticonvulsants (Neurontin, Gabapentin).
- Analgesics for musculoskeletal pain such as muscle relaxants (Robaxin, Soma, Flexeril)
- Opioid Analgesics. These narcotic drugs, either derived from opium or synthetic opiate can alter a person’s mood and behavior. Opioid analgesics have the potential for addiction in some individuals. These medications include Hydrocodone, Morphine, Oxycodone, and Methadone.
Opioid Analgesics and chronic pain.
Opioid medications work by reducing pain by affecting receptors in the brain and spinal cord. Adjuvant non-opioid medications, in contrast, tend to work more specifically on injured body tissues. Opioids decrease the brain awareness of pain, whereas non-opioids alter tissue chemicals at the injured body site by reducing inflammation or decreasing the pain threshold.
Although opioids are stronger pain relievers than adjuvant analgesics, they may have several pitfalls. An individual taking opioid pain relievers may develop tolerance, physical dependence, and more rarely addiction. Tolerance is characterized by an individuals need to increase the dosage of opioid over time to produce the same pain relieving affects. Dependence means that over a period of time your body has become dependant on the medication-if you stop it abruptly, you will go through withdrawal. Addiction on the other hand refers to a person taking pain medication for the “high” effect. Addiction is characterized by loss of control, compulsive drug use, and continued use of drug despite its harm. Individuals who develop tolerance and dependence to opioids do not necessarily become addicted to pain medication. In fact, the vast majority of individuals taking pain medication for a chronic pain condition do not develop an addiction.
Opioids are commonly used for pain control for conditions causing pain for a limited period of time such as after surgery or breaking a bone. As the body heals, the pain medication is tapered until the person if off pain medication. In some cases opioids are used to treat cancer pain or pain related to other terminal illnesses. In these situations issues of dependency or addition are not a concern.
Opioids and non-malignant pain: the double edged sword
Although several individuals in the field of medicine feel that pain is under-treated in many individuals, there remains a controversy over the use of opioid medication in chronic non-malignant pain. Non-malignant pain is defined as pain that is not caused by cancer or a terminal illness.
Some doctors feel that opioid medications, which produce an automatic physical and psychological dependence, should not be used for chronic pain treatment because they have a potential for addiction. They also argue that opioids should not be used to treat non-malignant pain because they can change an individual’s mood or behavior. Another concern is that individuals that take opioids regularly may develop a strong belief that if they don’t take pain medications they will be overwhelmed by pain. Fear creates a psychological need to continue to take pain medication.
On the other hand, other doctors contend that many individuals with chronic debilitating pain can take opioid safely without problems. People can take pain medications on a regular basis, just as a diabetic patient takes insulin to treat their disease process. They become more functional, re-enter the work force, join in activities with their families, and report better control of their pain while taking opioid medications. Many of these individuals do not need to increase their dosages of medication. They lead relatively normal lives.
So where does that leave us? Is it reasonable to take opioids for non-malignant pain? It is this author’s feeling that opioid can be used safely to treat chronic non-malignant pain. The ultimate decision is up to the individual with the chronic pain condition and his or her physician. Needless to say, there are many other issues to consider when taking pain medications for a chronic pain condition. One of the strongest concerns is addiction. The following are red flags raising the concern over psychological dependence and addition. Please consult your physician with any of the signs below.
Signs of psychological dependence and addictive behavior
- Do you use pain as an excuse to take opioids when you want to forget your troubles?
- Do you think you are taking more pain pills than you should?
- Are you taking more medication than your doctor has prescribed?
- Do you use excuses to get prescriptions early such as “I lost my medication”, “My medication was stolen”, and “I dropped my medication into the drain”?
- Do you get pain medication from more than one doctor? (Do you doctor shop?)
- Have family members expressed concern over your behavior or the amount of opioid you are taking?
- Have you become physically or psychologically abusive to a spouse or other family member?
- Do you try to obtain opioids illegally or take pain medications prescribed for someone else?
- Have you become forgetful or lose track of hours or days because of taking opioid pain medications?