Little Mini-rant on prescription painkillers...

[drmeow]

27. I agree on the first point, have some mixed response on the second

For clarification - for 6 years I managed a pain research lab which studied, among other things, non-drug treatments for chronic pain and I'm currently volunteering with the pain management group at the local VA. I also did my dissertation on adult children of alcoholics so I know a little about the addition literature.

For terminal patient - yes, give them what they need. In the UK hospice gives a pain killer cocktail which includes heroin - because heroin allows you be alert while also alleviating pain. But in the US they can't give that cocktail (at least, they didn't used to be able to) because of heroin's status as a controlled substance. STUPID, STUPID, STUPID.

For chronic pain patients - it is not so much the addiction aspect which is the biggest problem but the accidental overdose problem. In addition, habituation is a problem with long-term opiate use which, in turn, increases the accidental overdose risk. There are also side effects of opioids other than addiction which can be problematic.

Pain is not just biological in nature. It is a complex psychosocial phenomenon. Many people who suffer from chronic pain believe that opioids are the only why to manage their pain and will often demand opioids and resist tapering off opioid use. However, research is increasingly showing that non-drug treatments for pain can really help with level of pain, functionality, and coping with pain and can even be more effective than opioids. The solution, of course, is to allow pain treatment experts to tailor the treatment program to the patient keeping all options (including opioids) on the table. But we also have to be careful about our cultural belief structure which leads us to believe that opiates are always the best and usually the only option when they really aren't.

Many (most) people come to chronic pain through acute pain, and by the time they get into treatment for chronic pain they are already addicted. Because the most effective treatment may not be opiate use, coming into treatment already reliant on and potentially addicted to opioids can be a significant problem, especially if that opioid use ends up actually interfering with a more effective treatment program.