Dealing with pain...

I have been reading (again) a book called The War On Pain, which is written by Dr. Scott Fishman and it is an excellent look at how an anesthesiologist views the treatment of pain. In the book he discusses the many aspects of pain management and how he approaches them with his patients so that we might better understand how they work.

He has an excellent section on Chronic Regional Pain Syndrome which in my humble opinion one of the more important issues in the discussion of pain management. Back injuries are easy to claim but very difficult to prove or diagnose in many cases leaving both the patient and the doctor frustrated. Having been in this position at one time I can sympathize with those that have to go through it. While I did not have CRPS the doctors believed that I was telling them I was in more pain then my injuries should be causing. It was not until they actually did surgery and found that the damage was indeed as bad, if not worse then I was telling them and for some reason standard tests were not revealing the cause.

Another issue in dealing with pain is the problem called "pseudo addiction" (which Dr. Fishman also covers) and it is found in chronic pain patients. Pseudo addiction is a case where the patient might exhibit all the symptoms of addiction yet if you actually increase the medication and stop the pain the symptoms go away. This is generally found in the case where a patient is being treated with the wrong medications for the symptoms being exhibited.

In the case of someone suffering from acute pain a doctor might use something like Percocet or Lortab in varying doses according to the pain. These types of meds are designed for short term relief, say several weeks or a few months in duration as opposed to Kadian which is designed for use in chronic pain patients and to be time released and used for long term, in many cases for years.

So why can't they prescribe drugs like lortab long term? It is interesting really and is one of the reasons someone on Lortab may exhibit the signs of "pseudo addiction". The patient starts to become tolerant, as we all know, and over time they will need more to achieve the same results as well the body will also start to metabolize the drugs faster. This might mean taking the medications every 4 hours rather then 6 (as they are not time released) or perhaps even more dangerous self medicating by taking more then the prescribed daily dose. It is a double edged sword for the patient, they need relief but a doctor is going to be reluctant to prescribe any more due to the signs of Pseudo Addiction.

So how do you treat this problem? Simple, you increase the meds or find the meds that will work effectively to treat the pain. When the pain goes away so do the pseudo addiction problems. I know this was the case for me when I was still on Lortab. After several months the medication just did not work for me and to top it off the doctor thought I should be weaned off of it and actually started to decrease my doses.

I know I have covered this before but it is always something I will bring up several times a year, people need to be informed so that they can learn to deal with their doctors and their pain effectively. Yes, doctors went through a lot of schooling to do what they do but in the end only you can tell them the kind of pain, where it is and what seems to be working to make it better. It is all about quality of life in my opinion and too many doctors are worried about other issues making the return to a decent quality of life difficult if not impossible. Getting the doctor past their fears is a major stepping stone and in the end if it proves a more daunting task then it should be then it is time to find another doctor who understands. Of course this is something that should be carefully contemplated, the last thing you would want to look like is someone shopping for a doctor and medications. Then the pseudo-addiction tends to look more like a very real addiction problem.

Getting a doctor to see past the addiction issues, both real and pseudo is an important part in having your pain or even your loved ones treated properly. If you are uncomfortable dealing with this topic with your doctor then I HIGHLY suggest that you buy this book and read the parts pertinent to your issues. They should really help you understand what is going on with you and how to broach those issue so that your doctor can understand what you need. I have listed below a few online resources for purchasing a copy and I make nothing from any of the companies if you purchase from them. I did include a company out of Ireland I believe for those in the UK as I am not sure how shipping from the States might work for you.

Amazon

Books A Million

Gill MacMillan For those in the UK.