Medication for Pain:
Almost all patients complain that their doctor does not understand their pain, and fear that their access to prescription narcotics will be cut off. They know little about the action or side effect of the drugs (constipation, agitation, sleep disruption and mood changes are common complaints). While they know that “these drugs can be addictive”, they cannot measure the degree of their own addiction. They simply know that they are suffering, want relief and often feel they must bargain for medication refills. Many patients are maintained on opiates without having a long term plan for their use of the drug or for weaning.
You may find the following helpful:
“The number of Americans who regularly use prescription pain relievers such as oxycodone for nonmedical reasons has shot up since 2002, in parallel with fatal overdoses of these drugsÉpopulations at greatest risk for chronic nonmedical use: men and persons aged 18 to 49 years (Arch Intern Med. June 25, 2012).
The rate of chronic nonmedical use of prescription pain relievers 200 days or more in the past year increased from 2.2 to 3.8 per 1000 people. A November 2011 report from the CDC found that the number of overdose deaths from opioid prescription pain relievers in the United States has reached epidemic proportions and is now greater than fatalities from heroin and cocaine combined.
One of the most alarming trends is seen in a 2010 study by the Substance Abuse and Mental Health Services Administration (SAMHSA). This study found that hospital admissions due to substance abuse increased by 400% during a 10-year period (1998Ð2008) among people older than 12 years as a result of misuse of prescription pain relievers. Nearly one million teenagers (12-17) reported using pain relievers for nonmedical reasons for 200 days or more in 2009-2010.
Although the data on the self-treatment of pain in teens are inconsistent, there is consensus about the following facts:
¥ Self-medication is common in children and adolescents;
¥ Nonprescription analgesics are the most commonly used products;
¥ Use of pain-relief products increases with age; and
¥ Girls are more likely than boys to report self-treatment of pain.
Numerous studies have documented that teens lack knowledge about the appropriate use of pain medications, different names for the same products, and adverse effects. Teens may share medications, both prescription and nonprescription, and may not be aware of contraindications to the use of these productsÉprescription medication use was reported by slightly more than one half ( 52%) of all teens. These pain pills included:
¥ Prescription-strength ibuprofen: 36%;
¥ Acetaminophen with codeine: 30%;
¥ Acetaminophen and hydrocodone: 12%;
¥ Propoxyphene and acetaminophen (a combination that was withdrawn from the market in 2010): 8%; and
¥ Long-acting opioids (such as controlled-release morphine): 4%.
Quite often, the health care provider has lived, and will live, an existence that bears little resemblance to that of the injured worker in chronic pain. The use of the drugs to meet unspoken psychological needs must be explored.