Addiction Is Painful, Too; Drugs Must Be Last Option

The picture of drug abuse in America is changing. No longer limited to experimental teenagers or excessive drinkers, drug abusers come in all ages, ethnicities and socioeconomic backgrounds. Sadly, one of the major sources of drug addiction begins in the doctor's office with patients turning to narcotics for relief from chronic pain.

Published in the Journal of Pain, a research study indicates that between 3 percent and 16 percent of the population abuse narcotics. Many clinics specializing in the management of chronic pain are overwhelmed with patients who exhibit drug-seeking behavior. In this setting, it is difficult to distinguish drug addicts from those who truly need these medications.

The problem is made worse by the fact that every patient will ultimately build a tolerance to narcotics — over time higher and higher doses are required for relief from pain. Without appropriate supervision, virtually anyone can become addicted to these powerful medications.

Because the risk of addiction is so great, some doctors are fearful to prescribe narcotics, and many patients choose to suffer with pain rather than taking medications because of dependency concerns. This fear is an unfortunate side effect of the potent pain relievers because the medications can be lifesaving for individuals with intractable chronic pain, either from cancer, arthritis, back pain or other injuries.

It is important to understand that treating pain involves much more than taking pain pills. An accurate assessment and diagnosis are critical. Comprehensive plans for care must incorporate many different modalities depending on the nature of the pain, including exercise, physical therapy, chiropractic care, acupuncture, massage and physical aids.

When dealing with pain management, the principles are simple. Use the lowest dose needed to relieve pain. Because it is far easier to prevent than relieve pain, patients should take pain pills on a regular schedule rather than waiting until the pain becomes severe. If possible, do not take pain-relieving medications indefinitely. When the problem resolves, stop the pills. It is also important to remember the power of your mind-body connection. If you believe that a mild analgesic will not help you, it won't. Be aware of potential side effects for any medication and how to identify them.

The first choice for mild-to-moderate pain is acetaminophen, the generic form of Tylenol. The usual dose is two 500-milligram (extra strength) tablets three times daily. If this is insufficient, you may increase to a maximum of two tablets four times daily.

If that is inadequate, it may be time to consider an over-the-counter nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen (Motrin) and naproxen (Aleve). These drugs can cause gastrointestinal upset, fluid retention and high blood pressure. The recommended daily dose is 400 milligrams of ibuprofen or 500 milligrams of naproxen tablets twice daily.

If over-the-counter medications are inadequate to control pain, an evaluation by a physician is needed. More powerful medications include tramadol (ultram) and hydrocodone, which generally come in tablet form combined with acetaminophen. For those with intractable severe pain, narcotics may be appropriate. However, drug-seeking behavior is much more likely when taking hydrocodone or morphine. Various brand names include Lortab, Percocet, Oxycodone and OxyContin.

Despite the risks of narcotics, these drugs have an important and valuable role in patient care. Narcotics can greatly improve quality of life for patients with chronic, long-standing and crippling pain. With medical supervision to assure the lowest possible dose is prescribed, patients can take these medications responsibly.

Drug-seeking behavior should be suspected if the patient begins using greater doses of these medications, sees multiple physicians asking for the drug, or uses a month's prescription in a short period of time. In this case, it is the doctor's responsibility to recognize the problem and assure that the patient seeks help.

There are many wonderful resources to help patients cope with addiction. Talk to your physician immediately if you or a loved one is having difficulty managing the risks of powerful medications. Remember, drug addiction does not discriminate. Anyone can fall prey to the dangers of prescription medications.

Dr. David Lipschitz is the author of the books, "Breaking the Rules of Aging" and "Dr. David's First Health Book of More Not Less." To find out more about Dr. David Lipschitz and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com. More information is available at www.DrDavidHealth.com.

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