The news that painkillers may have contributed to Prince’s unexpected death has once again thrust painkiller use into the media spotlight. According to the most recent data from the Centers for Disease Control and Prevention (CDC), over 14,000 people died of opioid overdose in 2014. This may seem like a small fraction of the nearly two million people in the U.S. who are either dependent on or abusing opiates, but any death from painkiller use is preventable.
Recent media coverage on painkiller use
Much of the recent media coverage has focused on the more sensational aspects of painkiller use and dependence. The fact is that many people in their lifetime will be faced with the prospect of utilizing an opioid for pain management. Those who need painkillers for pain management may hesitate because they are worried about dependence or the stigma that comes with painkiller use. A recent CNN article highlighted this dilemma and focused on many of the same ideas and questions that inform Pain Doctor’s approach to painkiller use.
Any discussion of painkiller use must first differentiate between physical dependence and addiction. Susan Weiss, PhD, chief of the science policy branch at the National Institute on Drug Abuse, points out that even though addiction and dependence share some characteristics, they are fundamentally different, saying:
“Physical dependence, which can include tolerance and withdrawal, is different. It’s a part of addiction but it can happen without someone being addicted.”
Scott Fishman, MD, professor of anesthesiology and chief of the division of pain medicine at the University of California, Davis School of Medicine, agrees and defines addiction as a “chronic disease … that’s typically defined by causing the compulsive use of a drug that produces harm or dysfunction, and the continued use despite that dysfunction.”
A good example of this is type 1 diabetics who are physically dependent on insulin but are not addicted.
The CNN article makes this distinction between dependence and addiction and then focuses on what opiates are useful for. The most effective types of painkiller use focus on temporary situations, such as acute pain that is a result of an accident or injury. Other effective types of painkiller use are for cancer pain and post-operative pain.
Beyond that, opiates can be remarkably ineffective at managing long-term pain and come with a high risk of dependence.
Dr. Gary Franklin, a research professor at the University of Washington and medical director of the Washington Department of Labor and Industries pointed this out, noting that long-term painkiller use could exacerbate the problem:
“After 12 weeks, you will have severe withdrawal attacks if you stop taking these drugs. There’s no evidence that these drugs actually help for these kinds of conditions, and it may actually make the pain even worse.”
CNN goes on to point out that beyond prescribing opiates unnecessarily, the length of the prescription matters. As Dr. Franklin pointed out, signs of physical dependence can appear at 12 weeks, and some experts believe that occurs even earlier. CDC guidelines for prescribing opiates advocate the strategy to “start low and go slow.” This means that patients who would benefit from a short-term opiate should be prescribed the lowest effective dose for the shortest period of time.
If a doctor determines that short-term painkiller use is an appropriate pain management strategy, the next step is to think about the end: tapering off. Even with appropriate short-term use, the body quickly adapts to the opiate and can experience withdrawal symptoms such as nausea, anxiety, cramping, irritability, insomnia, and other physical and psychological symptoms. These symptoms can be managed with a well-designed plan to taper off instead of an abrupt cessation of use.
Pain Doctor’s guidelines on painkiller use
At Pain Doctor, we believe firmly in developing a holistic pain management strategy that addresses all aspects of pain, from physical to emotional. In some cases, this does include painkiller use. We work with an opioid therapy statement that incorporates the prescribing guidelines set forth by the CDC.
Our process for painkiller use and prescription is based on the following guiding principles.
We believe in holistic pain management.
This incorporates lifestyle changes in diet and exercise as well as complementary therapies and counseling when appropriate.
We look at family history when considering opioid therapy.
A family history of addiction of any substance may indicate a predisposition for early dependence or addiction. This does not necessarily eliminate opioids as a possible part of treatment, but it changes the conversation we might have with a patient.
We participate in prescription drug monitoring programs.
When we begin opioid therapy with a patient, we believe it is the best course of action at that time for that patient. In order to help the patient manage their prescriptions, we participate in prescription drug monitoring programs to ensure that the prescription is being filled and utilized in the manner in which it was prescribed.
We believe in communication.
We recognize that for some patients, opioid therapy may be the best option for a longer-term treatment plan. In these cases, we re-visit with each patient on a regular basis. This helps us to understand how the opioid therapy is progressing and if we need to make adjustments or begin to help the patient taper off. If we believe there is a cause for concern, we follow CDC guidelines and reserve the right to ask for a urine sample or pill count. At any time between these visits, we encourage patients to call or come by with any questions or concerns they have.
We believe in treating patients with dignity and respect.
Our goal as pain management specialists is to help our patients get back to their lives. We take this mission seriously and are dedicated to treating you and your loved ones with dignity and respect. Many patients in pain feel stigmatized or ignored. We are here to treat you with the care and consideration you deserve.
Pain Doctor is committed to responsible prescribing and painkiller use. If you or a loved one are in pain, give us a call to talk about your options.