Chronic Pain, Part 2

The treatment of chronic pain has been in the news a lot lately because of the increase in overdoses from opiate pain medications. There have also been reports of individuals who become addicted to prescription opiates such as hydrocodone or oxycodone; then, when they can’t get these anymore, they transition to using heroin.

There are many opiate medications that are used to treat pain. Even with short term use, it is easy to become dependent and/or addicted to these medications. It can start as early as adolescence and can even happen in the elderly. If you are prescribed an opiate pain medication after an acute injury or after a surgery, it’s best to take it as infrequently and for as few days as possible. If you have some pills left, don’t keep them. You can take them to the Harrisonburg Public Safety Department where they will dispose of them.

My approach to chronic pain is pretty straight-forward. Since I am not a specialist, I tend to treat with non-narcotics until these don’t seem to be working anymore. I think physical therapy is invaluable in helping to build up strength and mobility, which helps improve your quality of life and also helps your pain. If you reach the point where these more conservative measures aren’t helping, then the next step is a referral to a pain specialist or whatever specialist you may need to see. I do the same thing with every patient I see who has a chronic disease. Once I see that their disease is progressing to the point that I am no longer comfortable treating it, I send them to a specialist. Based on the recommendations of the specialist, I will treat accordingly.

Opiate side effects include: drowsiness, confusion, constipation, itching, dizziness, nausea, vomiting, and decreased testosterone levels. They also increase your risk for developing respiratory depression (which means that you can stop breathing), liver disease, decreased blood cells, kidney disease, and addiction. Seriously, would you take an antibiotic or high blood pressure medication if it had that list?

One other thing about opiates to remember is that medical providers are not stupid. When someone comes in to our office with pain, who has “tried everything” but it still hasn’t gone away or who has an “allergy” to every non-narcotic pain medication possible, we don’t just write a prescription for a narcotic. There are a lot of other interventions to try first: muscle cream, physical therapy, medications that target specific types of pain, or referral to a pain specialist (or another specialist if indicated).   Also, there are certain rules that we have to follow if we start patients on an opiate that we anticipate they will be taking for a long time.