Posts Tagged chronic pain
Anxiety from Chronic Pain
Posted by Dr. Epstein in News/Press Releases, Pain Management on December 9th, 2009
Approximately 7 million Americans suffer with generalized anxiety disorder or GAD. This condition often accompanies chronic pain since the pain patient understandably gets anxious over the lack of treatment of their pain or the difficulty they have finding a pain management physician to treat their pain, especially if they are tired of tried and failed invasive techniques and the consequences that may follow them.
The Food and Drug Administration has recently taken a major step forward in the treatment of generalized anxiety disorder by the approval of Cymbalta for that condition. From the pain physicians aspect this will help us achieve a lessened anxiety state in many of our patients and that will lead to lessened pain since they do go hand in hand. Previous to Cymbalta’s approval for GAD most of the anti anxiety agents available to use were benzodiazepines class medications. These medications, benzodiazepines, are effective in appropriate doses but the higher the dose of these medications the greater the chance of respiratory depression. The opioid class of medication often utilized to effectively treat our patient’s pain is also a respiratory depressant in many doses. Those two medications combined had additive effects and in rare instances death could, and would, occur. With that in mind the patient often had to make a chance of what was worse their pain or their anxiety since it was difficult to safely treat both concomitantly.
With this new treatment option it will be safer for the pain management physicians to treat both a patient’s pain and their anxiety over their pain and its effect on their quality of life. Quality of life improvement is the major goal of the treatment of pain today. Since this new approval of Cymbalta I stress that those of you suffering from anxiety over your pain and its adverse effects on your quality of life tell your treating physician of your concerns and allow him to decide if you are a candidate for additional therapy safely.
Thank you for reading our website. Remember “Pain is inevitable but suffering is not!”
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!”
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!