We see a good number…perhaps most patients in chronic pain on these incredible medication regimens…literally a dozen different drugs, taken at different times, and this is a frequently expressed concern.
You have someone who:
[*]Has minimal understanding of what their medications do
[*]May have limited intellectual ability to even understand the function (and interactions) of the medication
[*]Are desperate in their quest for pain relief and will dependently take anything prescribed
[*]Are sleep deprived
[*]Are medicated to the point of sedation throughout the day, every day
Have to remember which medications to take with meals, take on empty stomach, take twice daily, three times daily, four times daily and/or at bed time
Will spend more time tracking their medication schedule than they will getting encouraged exercise
Now, at the same time, the individual is to make realistic decisions regarding surgery, second and third opinions, future occupational choices, complex problems in the home and deal with sometimes overwhelming financial concerns.
What I find most often is that patients do not take medications as prescribed although if asked in the incorrect fashion, they will claim that they do. If, however, you ask them “I know you are prescribed many medications, and I understand it is difficult to remember to take them all at the right time…tell me how you handle all of this.” They will then tell you that they take many of the medications as they need them, will skip some because the drugs “upset my stomach…make me dizzy…make me sleepy…do not do anything at all..
A common finding is that they are prescribed Medication A at (for example) 100mg three times a day. They do not like how it makes them feel. When asked if it helped with their pain, they will say that “it really did not help.” The medication is then increased, prescribed more often, and this goes on and on.
In reality, the patient is either not filling the prescriptions or just lets the pills sit in a drawer.
The more realistic question should be: “Do you feel that the medications are helpful? Are there any that you feel you cannot or should not be taking? Have you had to change the schedule that I recommended? Have you stopped taking any of the medication? Do you feel that it is taking much of your time trying to remember when to take which medication and how much to take?”
There is a psychology of matching the individual patient to the schedule of medications prescribed. If you do not understand how the patient responds to the complexity of the regimen or how he/she is self-modifying the regimen, then you will not succeed in helping the patient reach their goal.”