Drug abuse co-occurring with chronic pain, comment


This is an interesting post about physician’s obligation to “relieve chronic pain.” As the patient(s) may be coming in for treatment of pain with a concurrent drug abuse situation, the patient is the one who does the healing and the nature of the pain needs to be fully examined. Drug addiction can be recreational, prescribed meds, and common “foods” like sugar, alcohol, caffeine, nicotine, nutritional stimulants, etc. If a patient does not respond to pain meds, there could be many causes that warrant further investigation. If substance abuse is suspected, then blood testing and urinalysis may detect overuse, but how about in people that have been long-term users/abusers?

I don’s believe that the solution is to simply use an “alternate drug.” A professionally supervised detox program will usually free up the liver detox pathways to allow the meds to work better – in the even of an emergency situation with debilitating pain. If the pain is chronic in nature than the origin must be detected and dealt with in order for the patient to regain health.

In my experience most patients want help with their addictions usually come clean if they trust the practitioner. Our job as health care practitioners is to promote health – neglecting the patient’s habitual abuse and underlying causes for his/her chronic pain is just pain lazy and irresponsible.

There is a person sitting in front of us who needs our immediate help and we must understand the situation in to the best of our ability. Giving the patient more meds is no solution, and you can’t promote health by loading people up on drugs -in fact you may kill him/her. They will need education and integrative therapies that will help them piece together their lives. The “chronic pain” is the body’s way of communicating a person that there is a problem or imbalance and using meds to shut off this alarm is not an effective long-term solution.

Original Post:
October 16, 2008
Physicians are obligated to relieve chronic pain. What should the professional do when chronic pain is present, but substance abuse is a concealed co-occurring disorder? When addicted patients experience any type of pain, the goal is to treat the pain; the addiction treatment in not the priority while patient is in pain. If drug abuse is unknown in the patient it’s the nurse’s job to suspect abuse when normal doses of analgesics do not relive the patient’s pain. If the nurse can determine the drug that is being abused and the amount being used, it is best to avoid exposing that drug to the patient and have an alternative drug.

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