Helping Patients Understand the
Pain management is, by its nature, a multidisciplinary profession and so the over-emphasis on the medical model—while a central part of paint management—oftentimes misses the point. And so this article will frequently refer to “heath care provider” while at other times referring to physician or medical provider. This was done on purpose. The questions patients bring up are often not directed at the physician or other prescriber but, instead, at the psychologist, clinical social worker and sometimes the physical therapists. The reason is that the latter professions spend much more time with the patient and are the ones who have to interpret what is happening and then work with the rest of the team, as well as the patient, to clarify issues. As one who has owned and operated two different pain centers with a large multidisciplinary team—along with working in a clinic with 44 physicians and with the U.S. Public Health Service—the lead author is keenly aware of the wider role played by all health care providers.
The purpose of this article is to be used as a handout to patients and is based on clinical experience interacting with pain patients and documenting patient behaviors over the years.1-4 In fact, after the authors had written this article, it was tested by having current patients read it. The result was a dramatic reduction in complaints and misunderstandings. The authors believe that it would be helpful to all pain patients to understand and clarify issues that typically arise in pain management and, ultimately, improve patient-physician communication.
What Pain Patients Need to Know
Do you every wonder what your pain medicine provider is thinking about you?
- Have you ever felt your pain medication provider treats you as a ‘drug addict?’
- Do you wonder why your health care provider is concerned about how you have used, or are using, chemicals such as alcohol, drugs and/or pain medications?
- Do you think that your provider is overly concerned about these issues and your past and present use of such chemicals?
So that you won’t feel that you are being treated as a criminal or a ‘drug addict,’ it might be helpful to know what your provider is thinking and concerned about. The following discussion is designed to help you work with him/her as a partner in your care.
Please take time to read this so we can learn to speak the same language. This information will:
- help to reduce misunderstandings and problems later on that will cause both you, the patient, and your provider to be upset and on the defensive in some fashion;
- help to make your life more comfortable as you are taking your pain medication;
- help your provider feel more comfortable with you;
- help your family members, and others, to understand the importance of your pain medication as part of an overall pain management approach to chronic pain problems;
- help you understand that, sometimes, providers assume that patients understand all the issues that seem like ‘common sense’ to them since they deal with chronic pain issues on a regular basis; and
- help answer some questions you may have which are not fully answered during your appointment with your provider since time seems to go quickly in appointments.
Addiction and Dependence Issues
Many health care providers are overly worried about the use of pain medications. As a result, there is a tendency to ‘under-medicate’ patients who have chronic pain conditions. There are also times when patients are ‘overly-medicated’ for their pain problems. So the question for everyone involved in the process is how to find the proper dosage of medications that:
- allows for the best pain relief;
- is at a dose that will not cause as many side-effects; and
- avoids the patient feeling overly-sedated and tired all the time.
In 2009, the Food and Drug Administration (FDA) and the Center for Disease Control and Prevention (CDC) expressed concern about a surge in accidental overdose of opioid medications. They are now working together to study this problem while, at the same time, wanting to promote an environment in which health care professionals make appropriate use of pain medications while minimizing inappropriate use and diversion of medications that may cause serious problems.5
Research suggests that 90 percent of the patients who are receiving pain management treatment were prescribed opiate medication. The concern is that 9 to 41 percent of these patients end up with abuse and addiction issues. Further, 16 percent also used illicit drugs while on pain medications. There are some indications that those who are recovered alcoholics or drug addicts may also have more abuse problems with their use of pain medications. For this reason, it is important that all concerned be open and honest in working together so that you obtain the best results from your pain medication treatment.6
Our goal is to have the best results in being able to manage your pain problems and this means that we all know as much as possible about these issues. We know the majority of patients will use their medications appropriately. For this to happen, however, we all have to be working together on the same team to be sure everything is being accurately monitored for your well-being.
The use of pain medication requires an understanding that the medication can slow down the transmission of pain messages to the brain centers that control the awareness of pain in the body. This center in the brain that controls pain is also the same one that controls our moods: anxiety, tension, depression, and so on. The medication ‘binds’ to certain opioid sites throughout the body. This results in the body becoming ‘dependent’ on the medications. Stopping the medications abruptly will result in withdrawal symptoms. This is normal with many medications. However, if you ever stop your medication, it is important to first talk with your medical provider. It is always better to work out a plan that will allow you to slowly decrease the dosage and the usage of the medication over several days, or longer, depending on what your medical provider knows about the particular medication you are taking.
Difference Between Addiction and Dependence Issues as it Relates to Pain Medications
What was just described above explains how the body can become dependent on the medications.