Narcotic Therapy

By | April 11, 2011

It has been said that the discovery of opiates was one of the great advances in medicine.  It has also been on of the great scourges of mankind.  Make sure that it is right for you!

As we said in the section on Medical Management, long term narcotic therapy is not a prominent part of our practice.  Other than certain cancer patients near the end of life, I am not sure that I have ever seen a patient on long term narcotics who was really better off for having taken them.  There is almost always a better way of managing someone’s pain.

Narcotics are very helpful in a variety of acute pain conditions, but due to a phenomenon known as tolerance, this salutary effect begins to wane within a period of days to weeks.  Larger and larger doses must be given to achieve the same beneficial effect, while side effects become more and more prominent.  After a period several weeks the patients become dependent on the narcotics and will show signs of withdrawal if they try to stop or reduce their dose.  Many patients will complain that their pain is getting worse because they reliably have increased pain 4 to 6 hours after the last pill, when this is usually just a sign of dependence and early symptoms or withdrawal.

Even apart from the issues of tolerance, dependence and addiction, narcotics have an impressive list of side effects.  They can cause nausea, vomiting, constipation, respiratory depression, interfere with normal sleep patterns, and interfere with normal appetite.  Narcotics contribute to depression, interfere with normal bone metabolism, depress the immune system and decrease libido.

Because of the risk of abuse we at Schlesinger Pain Centers, like all of the better pain clinics in America have strict policies governing their use.  For non-cancer patients there is a strict limit on the number of pills and the strength of the medicine that will be prescribed.  Random urine drug testing is mandatory.  Pharmacy records will be checked periodically.  Finally, no narcotics are ever prescribed on the first visit!


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