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Fri, Dec. 06

Let's Talk About Pain Treatment

If we're going to discuss pain, we need to talk about a few problems pain patients have and educate everyone on three current medical terms related to pain medications - Addiction, Tolerance and Physical Dependence.

It's important to understand the meaning of addiction, and not confuse it with tolerance and physical dependence, something that affects all patients.

Addiction is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving. Addiction creates problems with relationships, money, law enforcement and more.

Physical dependence is a state of adaptation to a class of drugs. Withdrawal syndrome will be produced by abrupt cessation for all patients.

Tolerance is a state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the drug's effects over time.

All drugs must be judged by their risk vs benefits to the patient.

If the benefits outweigh the risks for the patient, and the medication improves their condition, improves their quality of life, and allows them to get out and do things, then it's a good medication.

Pain Patient Problems

Pseudoaddiction

If the patient is always out of medication, or comes in early, the pharmacist might try contacting the physician, and asking them rule out pseudoaddiction, rather than assume every patient is a drug abuser. Then, if a patient continues to run out of medications, the physician should look at ending the relationship.

Many physicians who treat pain don't treat the side effects of opioids.

Constipation is a side effect of opioids, and physicians I've seen never ask if it's a problem. Chronic constipation can cause colon cancer.

Excessive Sweating

A problem for patients who take opioids, especially here in the desert, is excessive sweating. It can be 80 degrees and I'm sweating, and when it gets hot, I'm soaked.

A couple years ago, my wife had a bigeminal heart rhythm. That's a PVC every other beat, a life-threatening rhythm, because her potassium was low from excessive sweating. This can cause serious problems for pain patients, especially along the Colorado River where temperatures can be above 115.

Testosterone

Opioids delete testosterone with every dose, lowering the testosterone of the many male patients to prepubescent levels. Low testosterone can cause many problems for male patients, including loss of muscle mass, increased fat, irritability, fatigue, mood swings, and diminished sex drive.

Its hard for the patient and their wife to understand, because for the guy, its like when they were 9 years old. You don't think girls are ickey, you just have no interest and don't realize it.

The wife thinks if her husband doesn't want to make love to her, he either doesn't love her, or he's cheating.

So I urge physicians to test their patients testosterone, and pharmacists to ask patients on opioids if they have any of the above side effects.

Till next time

Jay Fleming

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