Archive for category Opioid Dependence
Not only a provider of pain relief but I am a pain patient
Posted by Dr. Epstein in News/Press Releases, Opioid Dependence, Pain Management on July 7th, 2010
I am now not only a provider of pain relief but I am a pain patient. On the 16th of June 2010 I underwent a partial knee arthroplasty, or a knee replacement that was done to two out of the three compartment of the knee joint, therefore partial, or unicompartmental, knee replacement. I will not go into the difference between a total versus a partial knee replacement as that is the responsibility of an orthopedic surgeon. But I will go into some of the thoughts of a pain patient as I now have a better empathy for the need to relief pain, the thoughts that go through the minds of someone in constant pain, and the understanding that you are not alone.
As a pain patient we constantly wonder if we will have enough medication to relief our pain since the doses we as physicians only have your response to our questions to guide our dosing habits and medications used. What happens if the dose utilized is not high enough? What happens if the dose utilized is too high? What happens if the medication does not work? What happens to us as pain patients when we run out of pain medication since our provider usually will only prescribe and see us once a month? All these questions run through our minds from the time we arise until the time the bed calls our name? I wonder some times because my pain gets so high if a take an extra “dose” of medication? In that scenario in order to reach the months end I will have to forgo a dose or two and our physician may from us from the program since we did not follow his/her directions for taking, for example, one tablet every 4 to 6 hours. But what do those directions mean anyway? We have a medication prescribed 1 tablet every 4-6 hours, that can be 4, or 5 or 6 pills in a 24 time period but our prescription for the month is a 112 tablet, therefore if I take 5 pills some days, some days 6 pills because therapy was extra hard that day, and some days 4 tablets? My pain remains uncontrolled since I do not have enough medication and cannot get additional medication before my next scheduled visit. I am sure in a messy situation calling for one of two responses only; take more medication to control my pain and hope the pain is controlled adequately the last week of the month or take the prescribed 4, of 4-6 hours, and me in pain the rest of the time that is throbbing constantly, sharp at times and radiating at other times. All these situations do exist for the patient in pain. Why does a physician feel that surgery is necessary to relieve a medical condition and than as a patient who has just “knifed” as in an alleyway robbery dosed not feel it is necessary to prescribe adequate pain control medication after the surgery? I cannot answer those questions at this time I can hope that the Lord above places pain patients in my path that I will be able to understand and control their pain. And as a final though; I DO feel your pain, 24 hours a day and 7 days a week.
Trust is the foundation between physician and patient
Posted by Dr. Epstein in News/Press Releases, Opioid Dependence, Pain Management on December 9th, 2009
Trust a key word and a staple in the relationship between doctors and
patients, especially when treating pain management. When a patient
first comes to see a physician for pain management, they must realize
that the history they express to the physician, usually, at that visit
anyway, is totally invalidated and a scheduled medicine is more often
than not being requested or being thought of as appropriate by the
prescribing physician, physician’s assistant, or nurse practitioner.
Often at a first office visit a patient will have very little
information other than names, very occasionally addresses and phone
numbers of other practitioners, and some recent x ray or MRI results.
The patient does not realize importance, legally in today’s society,
of the present provider contacting: past physicians, past pharmacies,
past hospitals, and past diagnostic testing facilities for faxes of a
patient’s previous visits. Often also ignored is the fact a computer
wise patient can go on a computer, do a little research on a medical
condition and create false imaging reports. Do not laugh because it is
frequently done. It is done as often as a patient bringing in
duplicate urine from a ‘clean’ person and substituting it for their
own. That also frequently happens. The funnier part is when patients
think that their charades are original; I can tell you in doing
medicine for 36+ years, very little of the fantasy tales have not been
tried on my practice.
Then the patient must trust me as a physician. All medications taken
in a way other than as directed can result in serious injury, an
emergency room visit, or in some cases resulting in death. It may be
a consequence of the self prescribing dosage, a dangerous combination
of medication taken, or an allergy reaction based on the prescription
being taken or used in the wrong manner. The medicines utilized in
pain management not only can injure or kill a patient but it can do so
when the abuse is even minimal. A minimal prescribed dose of
alprazolam (Xanax) combined a “little” illegally obtained Oxycontin or
methadone can put someone to sleep, and they may never wake up. This
is your accidental overdose. This is the question that surrounds the
deaths of Elvis Presley, Michael Jackson, Anna Nicole Smith along with
a multitude of others. The amounts of these legally prescribed
medication necessary to kill someone is minimal in the right
combinations and doses. Example is Xanax and Oxycontin, both abused in
the world by people who cannot face their own problems, are both
respiratory depressants, taken together in an abusive manner without
following your physician directions can cause a person to stop
breathing. That is why most, but by no means all, overdose deaths
involve multiple drugs. Now do not feel: “well I can utilize one drug
and get high and live,” because utilizing an Oxycontin 40mg, one of
the most abused medications in America today, for one person will have
minimal adverse effects, and then for metabolic reasons the next
person who does the same medication, in the same dose winds up
stopping breathing and sleeping into eternity. You never know when
that will happen or to whom it will happen.
The above all being said the key message is: number one do not take
medication purchased or obtained illegally and that can be pills
prescribed for someone in your family and in your own medicine
cabinet, number two is that if you utilize a practitioner who limits
their medical practice to pain management take the medication only as
prescribed and give it to no one else unless you can live with the
thought you may have killed someone. Besides the fact your giving one
controlled substance pill to another person can bring a felony charge
of trafficking in narcotics against you, whether the person lives or
dies and the person may well be an undercover policeman/woman. And you
never know when the pain management practice you obtain your
medication from works closely with local and/or federal law
enforcement.
Therefore be truthful and take all medication prescribed for you by
you in the manner prescribed and help save you or your friends life!
Understanding your bodies response to opioid medication
Posted by Dr. Epstein in News/Press Releases, Opioid Dependence, Pain Management on June 3rd, 2009
A correct defining of terms is essential to understanding the use of opioid type medications. Prolonged or chronic use of opioid medication will cause one of four types of responses by your body. These 4 responses are dependence; tolerance; addiction or pseudo addiction.
Dependence is a physiological response of the body to medication. This means the physiology of the body gets used to seeing this particular, whatever it maybe, drug in the blood stream and adjusts to it. Therefore, the sudden cessation of the medication will cause the beginning of a withdrawal syndrome as the levels of the drug decrease.
Tolerance is similar to dependence in that both are physiologic body responses. Tolerance just means that the body once again gets used to, and adjusts to, a certain consistent blood level of a medication in the bloodstream. Since this level of medication is consistent the body adjusts to it and then more medication is needed to achieve the same effect as a smaller dose once did. This not only happens with opioid medication but can happen with insulin or blood pressure medication.
Addiction is a drug craving and its continued use even though the person realizes the continuing use of the drug may, or many times, has already hurt them. The drug controls their life and they will do anything to obtain it no matter the consequences. This is a biological physiological and genetic response to the drug. The important thing to remember is that a drug maybe addicting yet may cause dependence. Remember dependence will cause a withdrawal syndrome as it is suddenly removed. Well cocaine is one of the most addictive drugs available, yet it does not cause dependence. I find that very interesting.
The last thing that may happen is called pseudo-addiction? The person will demonstrate all the characteristics of an addict, control; craving; consequences; and continued use in spite of harm, but is not addicted to the medication. What happens here is that the patient starts on a dose of medication that is too low or tolerance develops quickly and the pain is not adequately controlled. So in an attempt to control his or her pain the patient displays addictive behavior. The interesting and satisfying aspect of pseudo addiction is that once the pain medication level, usually an opioid, is raised to adequate blood levels all the addictive characteristics leave the patient and they maintain productive lives at that point.
Are you fitting into any of these categories? If you feel you maybe, or just have uncontrolled pain or an already developed opioid dependency problem please contact Health and Pain Management of Florida at your earliest time. Remember that “Pain is inevitable; suffering is optional!”
Truthfulness is supreme!
Posted by Dr. Epstein in News/Press Releases, Opioid Dependence, Pain Management on April 15th, 2009
Truthfulness is supreme!
In a pain management medical practice mutual trust must be established between patient and the physician. On occasion patients feel that their answering questions about past behavior honestly will exclude them from a physician’s care. In our practice it works just the opposite.
We at Health and Pain Management of Florida live by two mottos: the first is “pain is inevitable, but suffering is optional”; the second is “today is the first day of the rest of your life”. I need to feel that I can trust the patient with medications that may potentially cause the loss of life. Of course any medication, including aspirin, can cause the loss of life, it is just the prescribed opioid medications that may do that quicker. And the patient must have complete trust in me because I am prescribing potent and potentially lethal forms of medications. So you can understand that this trust and confidence issue is one that runs from patient to physician and the physician to patient.
So please remember whatever the past, whatever the problems, tell your physician. A patient may have something in their past such as misdemeanor; a felony drug charge; a short or long prison confinement; etcetera tell the physician. Those problems may require the physician the monitor you more closely when you start medication but they should not keep the physician from treating your pain. Honesty is always the best policy! That is because when we as physicians find questionable activities in your past, via computer searches or previous medical records, instead of directly from you as our patient, we are less likely to be understanding and more likely to discharge you from our practice since the bond of trust has now been violated.
Thank you and remember “pain is inevitable; suffering is optional!”
Is Pain Medication the Answer?
Posted by Dr. Epstein in Opioid Dependence, Pain Management on March 18th, 2009
Is Pain Medication the Answer?
Daily, people come into our office and say they “do not want to start taking narcotics” out of a fear of addiction. We explain that there is a possibly of addiction, dependency, or tolerance to the medication. That is not our goal and that is why we monitor so closely for such behavior. Pseudo addiction is when a patient displays all the criteria of someone being addicted to opioid medication, but their behavior is not an addiction problem. Their problems exist due their physician under prescribing the medication necessary to control their pain, which in turn makes them portray behavior of an addict seeking pain medication. As soon as the medication is raised to the necessary level to control their pain, the patient’s addiction characteristics disappear. These aberrant behavioral characteristics will not disappear with increased doses in a truly addicted person.
After I explain the different possible conditions and the inherent dangers of the medications, I then explain to the patient that our goal is to achieve the highest quality of life that their condition allows. Yes, a patient in their 20’s, 30’s or 40’s who starts on scheduled medication to control their pain may become dependent, tolerant, addicted or pseudo-addicted. However, if they do not utilize some available service or medication to control their pain they then become dependent, or addicted to their pain.
The question to be answered is;
-Are you better off taking medication to control your pain which improves your quality of life and enables you to live as normal as possible?
Or
-Are you better off not taking medication to ease your pain? Are you able to bear with the pain and enjoy family, friends, work, and recreation? One way or another people who suffer from chronic pain will be dependent on either pain medication or unfortunately pain itself.
At the least, your quality of life may improve and be more enjoyable with pain controlling medication. That is not to say all patients in pain are candidates for pain medication. Call your primary physician and discuss this matter or call our toll free number 866-723-9002 to set up a phone consultation appointment.
Remember: Pain is inevitable, but suffering is optional!