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01/18/2008 02:44 PM

Chronic Intractable Pain

psydchick

Topic: Chronic Intractable Pain

The patient who suffers with Chronic intractable pain, it is the type of patient who needs a special consideration. This is usually a patient who has suffered with pain longer than three months, and who is truly in need of pain relief and help. This is a patient who usually exhibits all the signs of narcotics seeking behavior. The term narcotic seeking behavior is usually given to a patient who exhibits signs and symptoms of the want to or need for pain medication, and becomes extremely agitated when the medication is not given. But the patient with Chronic intractable pain, is one who is truly in pain. A drug seeking behavior is not uncommon. The patient is in pain, and is seeking relief. The majority of doctors who see this type of behavior, automatically label them as a patient who is a hypochondriac, or who has a bad drug habit. On the contrary, this is a patient who is truly in need of medication, and with today's society, it is very hard to find relief for Chronic intractable pain. Like most patients early on, the patient is missed diagnosed or diagnosed and miss treated. The reason I say miss treated , is because some doctors, like you to have what they call a pain contract. This is a contract between a patient and doctor which stipulates how much pain medication the patient is to receive over a period of time. This however it is not true pain management. For a patient with Chronic intractable pain. The only way to treat this patient is, too titrate the patients narcotics via long acting narcotics such as Oxycontin or MSIR (Morphine sulfate continuous releases), to place where the patient is no longer in pain. The patient will also require a short acting narcotic for the intermediate state of when the long acting narcotics is at its low and before it begins to release its second dosage.

the problem with many doctors is that they are not adequately trained in how to treat patients with chronic intractable pain. This is a huge problem in today's medical society. The American Medical Association is presently undergoing changes in the teaching of new doctors on just how to treat chronic intractable pain. The breed of medical doctors who now occupy our society are, what we call pain illiterate. This means they are either to scared of treating a patient pain and possibly creating a condition in which the patient becomes addicted, or the foremost reasons why doctors today in California, do not treat patients appropriately is because they are afraid of losing their license. In the state of California, this is no longer an issue with patients who have been diagnosed with chronic intractable pain. The state has mandated the use of narcotic pain killers, through Senate bill 402 or (SB402) which protects doctors from prescribing strong narcotic pain killers to patients with chronic intractable pain. They no longer have to fear reprisals or disciplinary actions for treating such patients. The law now states that doctors are free to prescribe narcotics to patients who have chronic intractable pain ,with what ever, and how much is needed of the their standard or triplicate pain medications for the relief of their pain. Also the patient has the right to reject surgery over taking pain medications for relief. Per say, a patient in which surgery would be required to relieve pain, does have the option either to have the surgery or continue taking pain medications without any reprisals on the doctor.

This Law is currently active in California & only a few other states @ this time.

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06/14/2012 07:37 PM
Pmarie
 
Posts: 182
Member

Thank you for this informative article! I am one of those with chronic, intractactable pain. I manage my life around it, and I use a boatload of mess, including Vicodin. My doctor has been treating me over a decade and he knows, obviously, I am not seeking narcotics. I live in Southern California, and have ruled out moving to another state because of my concerns over this matter. I hope other states pass laws so that people who need it can get relief.

06/18/2012 06:20 AM
SSLMD
Posts: 1023
Member

A few minor corrections:

1. We generally cannot reach a point of no pain with narcotics. We hope to make the pain tolerable enough that a patient may have a decent life in spite of the pain.

2. You are quite right in emphasizing the need for sustained action pain relievers. For those getting something like four hydrocodone/tylenol or four oxycodone a day, results are usually much better if one takes half a tablet every three hours rather than one tablet every six hours. (But you must take a whole tablet the first time or if it has been five hours or more since the last dose.)

3. MSIR is a brand name and short for morphine sulfate, immediate release. The sustained release form is MSContin or any of a handful of other brands. (Avinza, Oramorph SR, Kadian come to mind, but there are others.)

4. I am not familiar with California law, but agree with your observations in the second paragraph.

(The large type with colored letters actually make the item harder to read. I copied it into a word processor to read it.)

Post edited by: SSLMD, at: 06/18/2012 06:21 AM


07/07/2012 12:45 AM
anji
Posts: 18
New Member

I'm also one of those folk that fit into this category and agree with SSLMD that the "no pain" thing really should be "tolerable". I was finally able to start extended release meds that have finally made this pain thing "tolerable" after two years of completely unmanaged pain. It's amazing how the exact strength of meds can be so different from one another with regards to, depending on delivery (extended relief vs. quick acting).

I also agree with the doc in the breaking a perc in half bit, and how it can bring more relief in three hour periods, as opposed to taking a full one for a longer period...

Sometimes it really does take some experimenting with our meds, to find the right timing and the such. I mean, don't be an idiot and do something dangerous but if taking a pill at 5 pm is better than say, 9 pm depending on your needs, then I think by-all means!

Thanks everyone for your advice!

anji


07/08/2012 10:15 PM
slada
slada  
Posts: 2417
Senior Member

I agree with you guys and now in Canada/Ontario is different for pain pills like Oxicodone because people get addicted and many of them use them for getting high,you all know about.

My doctor didn't want to give my son 21 those pills because he have headache but he give me,because he realize how much pain I have.I am trying not to take lot,and not every day,and this is maybe my mistake because I am very irritable all day because of my pain and not be able to show somebody how much hurt.I don't care about addiction I just don't want to damage my liver because I am already on different pills for 3 years.

Many hugs from Canada


07/09/2012 05:37 AM
SSLMD
Posts: 1023
Member

1. Addiction must be distinguished from tolerance and habituation, physiologic responses that will occur if anyone uses opiates long enough at high enough doses. Addiction, by contrast, occurs in between 0.1% and 4% of people using opiates/opioids for chronic pain. That's a high enough rate that we worry a lot about it, but is still a small fraction of people.

2. The short-acting opiates/opioids do not work as well to control chronic pain as the long acting opiates/opioids. They come nearer to staying ahead of the pain, rather than playing catch-up. They may pose a lower addictive risk, but that's uncertain.

3. If the headaches are migraine, triptans often (but not always) work better than the opiates/opioids, without the addictive potential. Prevention sometimes also works and is definitely worth trying if the migraines are frequent and not easily taken care of with triptans. There is a migraine forum here that may provide other useful information.


07/09/2012 12:15 PM
NormaK
Posts: 28
New Member

Slada, I have liver problems so that is a big concern for me as well. I use patches now, they bypass the liver and go right to the blood stream. Many medications are available through a patch. I just thought I'd throw that out there. If you are concerned about liver damage you might want to ask your doctor about medications available in the patch form.

07/10/2012 07:52 PM
slada
slada  
Posts: 2417
Senior Member

I am so sorry Norma for your liver bypass and thank you so much for letting me know about patches I really didn't know.My health is in danger and I am so scary what may happen.I don't like to have fatty liver,this is not a joke but I can see here no doctor care for you and I am so mad.

Many hugs and kisses


07/15/2012 09:56 AM
NormaK
Posts: 28
New Member

I didn't have a "liver bypass", I meant that the medication bypasses the liver when administered through a patch. Oral medications pass through the liver to be broken down and distributed to the rest of the body, but that is "bypassed" when administered through a patch.

Wishing you the best of luck Smile


07/24/2012 07:27 AM
Pmarie
 
Posts: 182
Member

That is a good tip about breaking the tablet in half, and taking it more frequently. I will try it.

What are the longer acting opiates?

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