Dr. David B. Adams – Psychological Blog

Psychology of Injury, Pain, Anxiety and Depression

Predicting PTSD

All drugs have side effects. Take many drugs, and you have many side effects. Take a whole lot of drugs and…well, you get the picture.

Post-injury patients may have a myriad of physical complaints. They may be prescribed anti-inflammatory drugs, muscle relaxers and narcotic pain killers by multiple physicians as their care moves from occupational medicine to a series of specialists. There is no policy or program whereby they “turn-in” their old drugs before receiving the new medications. Similarly, there is often no screening for patients who continue to take the old drugs in combination or in lieu of the new drugs largely due to personal preference for one drug over another.

Side effect profiles become quite complex and range from dry mouth to day time sedation to dizziness, stomach pain, constipation and nausea. Many of these patients are on so many drugs that the better part of their day is spent watching their drug schedule or anticipating when it is acceptable for them to take more narcotics.

This becomes all the more complex because a large number of these patients are understandably depressed. Their careers may have ended, their income is severely curtailed and they are in pain. Someone may put them on multiple antidepressants, highly sedating anti-anxiety agents, various (hypnotics) sleep agents and these may be prescribed at maximum dosage level or at insufficient levels.

Patients most often blindly comply with prescribed medication, but they rapidly learn to prefer one drug over another, to avoid some because of GI complaints, and will often take one medication to counteract the adverse side effects of another drug.

Importantly, it is rare that someone sits down with the patient and asks what they have experienced while on each drug and whether any individually, or in combination, are a cause for discomfort or concern.

The best source of information as to whether a medication is appropriate is the patient taking that medication. But it is a source that is rarely utilized.

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