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Monday, November 15, 2010

Pain Pills- part 4

Post provided by Barbara Bergin, MD

So why do some people use a ton of pain pills and other’s don’t? Umm, it’s complicated.

1) Some people have a low tolerance for pain. It’s that simple and yet it’s that complicated. It’s hard to know whether it’s something psychological or physiological. No one wants to feel pain but everyone is different in their ability to tolerate it. And there is no pain pill out there that is going to keep you from feeling pain altogether, unless it also makes you stop breathing. Right…if you’re not breathing you’re not feeling pain. But there is some level of narcotization which will leave you not caring about the pain.

2) Some people have a high tolerance to the pain pills. That’s another enigma. I can’t explain that one in a few paragraphs. It’s also multi-factorial. Suffice it to say that it’s something genetic or physiological, or metabolic. It’s really not that important to know. The outcome with these folks is not any different than the folks who have no tolerance for pain. They end up needing a lot of pain pills.

3) Some patients get into the habit of taking a lot of pain pills. It just sneaks up on them and on their docs. They have a painful injury or surgery and they get plenty of pain meds when they ask for them. It seems reasonable to the doctor because their patient has a legitimate reason to take pain meds. After an extended period of using them, they just become habituated to their use and then it’s really hard to back down. Many patients have chronic conditions. It’s almost impossible to back down on pain pills in the face of persistent pain or worse; progressively escalating pain. It takes a tremendous amount of patience on the part of the doctor, along with willpower and newfound tolerance for pain on the part of the patient. It’s really one of the hardest problems I deal with.

4) Some patients are sharing their pain meds with friends and family. They’re very good hearted and really hate to see loved ones in discomfort. I’m sorry, but that’s against the law. And it’s probably the reason why some patients use up 40 narcotic pills in two days.

5) Some folks are selling their pain pills. It’s one of the other reasons patients use up 40 pain pills in 2 days. It’s also against the law. These patients get really good at fooling us docs. They’ve got it down to a science and it sometimes takes us awhile to figure it out. They know that and so they just keep doctor shopping, thereby staying under the radar.

The bottom line is that there are huge numbers of patients who begin to abuse prescription pain relievers, muscle relaxers and stimulants. It causes a lot of disability and costs the system a tremendous amount of money.

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