Re: interesting??

Hey Terry,

What's your doc got you taking? Just the medication, you don't have to
mention dose, just type of med and frequency. You probably mentioned it
already, I'm just too lazy to look at old posts.
There might be a better choice of medications for you, but the whole idea of
the long acting meds are to keep you medicated. It's a lot easier (not to
mention better for the patient) to prevent pain in the first place than to
stop it once you hurt. It keeps the medication level down by preventing
self-dosing. They don't want you looking in the bathroom mirror crying "God,
it hurt's. One more pill what the hell, I'm dying now." So you take an
early or extra pill, when if you'd have waited the 45 minutes for the full
effects of the normal dose, you probably would have found the extra pill
unnecessary.
Sure, the flare up's are the job of the breakthrough/rescue medication, but
it's supposed to be rescue med + long acting med for flares, both working
together, not one working at a time.

Take care--og


"tnt" <tnt@xxxxxxxxxx> wrote in message
news:042dnV7-q9EAd1PVnZ2dnUVZ_hOdnZ2d@xxxxxxxxxxxxxxx
Unless I'm reading this wrong it seems like all the checking and
regulations are set for you having the same pain at the same time thing.
My med.'s say take 2 every 6 hours. Well unless I'm very different from
the rest of you my pain doesn't have schedule. I comes when it wants and
goes when It wants. Sometimes it stays for a few hours and sometimes for a
few days. I have to take meds every 6 hours ??? sometimes 3 hours???
sometimes every hour, till the monster lowers it ugly head. At times I can
get by with very little or no meds. At times it's a pain in the ass. At
times you want to cry. At times you want to scream. At times you think you
will die. At times you want to die. I want someone doc that understands
this. When the pain is gone or at a low level I can, I will, I want to
STOP taking drugs.

Terry
P.S. Why are the terms dependent and addicted group together?? Yes I I'm
dependent because I need relieve from the pain when I'm not in pain I
don't or want drugs. I HATE THEM!!

--
Not my way Not your way
Yahweh
.
Opioids May Be Useful for Chronic Noncancer Pain Management in Primary
Care CME/CE

News Author: Laurie Barclay, MD
CME Author: Penny Murata, MD
Disclosures
Release Date: October 12, 2007; Valid for credit through October 12, 2008
Credits Available

Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)? for
physicians;
Family Physicians - up to 0.25 AAFP Prescribed credit(s) for physicians;
Nurses - 0.25 nursing contact hours (0.25 contact hours are in the area
of pharmacology)

October 12, 2007 ? A review article in the October issue of the Southern
Medicine Journal indicates the proper administration of opioids for
chronic noncancer?associated pain management in the primary care setting.

"Over the past decade, the pattern of chronic pain treatment in the
United States resembles a pendulum, swinging first in one direction and
then in the other, seeking only recently a modulated and more neutral
resting position," write Bruce Nicholson, MD, and Steven D. Passik, PhD,
from the Pain Specialists of Greater Lehigh Valley in Allentown,
Pennsylvania. "Since patients with chronic noncancer pain are a more
heterogeneous population than patients with chronic cancer pain, and
frequently have multiple comorbidities, the results of treatment with
opioid analgesics were, not surprisingly, more mixed than in tertiary
care cancer populations.... In order for the pendulum to attain a
modulated, more neutral resting position in which patients with chronic
noncancer pain receive adequate analgesia, it is essential to present
healthcare providers with necessary factual information to address their
clinical and medicolegal concerns."

Although opioids are considered to be the mainstay of chronic pain
management, their use is controversial for many primary care clinicians
concerned about dependence, abuse, addiction, and medicolegal issues
regarding state and federal regulatory authorities. Although these
concerns exist, opioids are thought to be effective and safe in selected
patients, and their use in this setting is consistent with clinical
practice guidelines and regulatory policy statements.

Patients with chronic, noncancer?associated moderate to moderately severe
pain typically require a controlled-release formulation of a long-acting
opioid or opioid combination drug product that will offer sustained pain
relief, as well as better sleep quality, compliance, and sometimes
quality of life. These drugs allow around-the-clock administration,
resulting in constant systemic drug levels and decreased potential for
end-of-dose failure.

In treating patients with chronic, moderate to moderately severe pain,
immediate-release opioid formulations should be used to provide analgesia
when breakthrough pain occurs.

Before starting patients on long-term opioid therapy, it is essential to
identify patients who may have difficulties in managing opioids or who
will develop dependence, abuse, or addiction. Careful screening with
validated questionnaires can be helpful in this regard. Although these
patients should not be denied treatment with opioids, focused monitoring
and case management are crucial.

The 4 A's are a useful mnemonic for ongoing monitoring: analgesia,
activities of daily living, adverse effects, and aberrant drug-related
behaviors. Healthcare providers should be able to distinguish between the
physical and psychological effects of opioids and to classify patients
with low, moderate, or high risk for substance abuse and/or addiction
based on careful screening. Based on their risk category, patients should
be monitored for the 4 A's at appropriate intervals. Clinicians must
thoroughly document all aspects of patient care.

Aberrant drug-taking behaviors, which are probably more predictive of
addiction-related outcomes, are selling prescription drugs; prescription
forgery; stealing or borrowing another patient's drugs; injecting an oral
formulation; obtaining prescription drugs from nonmedical sources;
concurrent abuse of related illicit drugs; multiple episodes of
unsanctioned dose escalations; and recurrent prescription losses.

Aberrant drug-taking behaviors, which are probably less predictive of
addiction-related outcomes, are aggressive complaining about the need for
higher doses; drug hoarding during periods of reduced symptoms;
requesting specific drugs; unapproved use of a drug to treat another
symptom; obtaining similar drugs from other medical sources; reporting
psychic effects not intended by the clinician; and 1 to 2 episodes of
unsanctioned dose escalations.

Specific areas requiring clinician documentation include history of
medication use, pain complaints, and substance abuse or addiction;
screening tool assessments, such as Screener and Opioid Assessment for
Patients with Pain (SOAPP) or the Opioid Risk Tool (ORT); pain
score/intensity; physical examination; results of diagnostic testing;
diagnosis and clinical indication for prescribing opioids; and assumed
and/or hypothesized pathology.

The treatment plan should document treatments, both pharmacologic (type
of medication, dosage, quantity, and date prescribed) and
nonpharmacologic (physical therapy, exercise, behavioral therapy, and/or
lifestyle changes as indicated). Treatment goals and anticipated time
course should be recorded, as well as compliance measures, such as urine
drug screens, pill, or patch counts.

Other essential parts of the medical record are informed consent,
including discussion of risks and benefits, and agreement for treatment,
which should delineate the patient's responsibilities and clinic
policies. Periodic review should include pain score/intensity and
perceived analgesia from current medications; physical, occupational, and
overall functioning; family and social relationships; mood; sleep
patterns; adverse events and their severity; aberrant drug-taking
behaviors; medication flow chart; and consultations and referrals as
indicated to provide appropriate and comprehensive care.

Because the adverse effects of opioid therapy can usually be predicted,
prevented, or treated, concern about adverse effects should not prevent
opioid treatment of chronic pain. However, early recognition of adverse
effects and aggressive management is an essential component of opioid
treatment.

Typical adverse effects of opioids include constipation, nausea,
vomiting, sleepiness, cognitive dysfunction, and respiratory distress.
Except for constipation, most adverse effects resolve as tolerance
develops. Constipation should be managed with use of both a stimulant
laxative and stool softener.

When there are neuropsychological adverse effects, direct dose reduction
may be helpful. Adding a nonopioid analgesic may facilitate dose
reduction. When the opioid dose is carefully titrated, respiratory
depression seldom occurs. Tolerance to the respiratory depressant effect
usually develops during long-term administration of opioid treatment.

"Primary care physicians are skilled at managing comorbidities in their
patients, yet they face a dilemma when it comes to managing chronic pain
because the pharmacologic treatment of choice, opioid analgesics, are
controlled drugs," the authors write. "Given the privileged nature of
their relationship with patients, primary care physicians should feel
secure in their responsibility to provide appropriate analgesia for
patients with chronic pain. Concerns regarding abuse potential should not
impede appropriate medical use of opioids."

Abbott Laboratories funded medical writer Rachelle Weiss, PhD, to assist
the authors with manuscript preparation.

Southern Med J. 2007;100:1028-1036.
Clinical Context




.

Relevant Pages

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