Scott L. Havsy, DO, JD, DAAPM
Certified in Pain Management

Prescribing Narcotics

Reducing a Patient’s Pain

 

 

The basic premise in treating a patient’s pain is to reduce their pain perception.  This can be accomplished through the use of Non-Steroidal Anti-Inflammatory (NSAID’s) medications, non-narcotic-analgesics such as Tylenol or Ultram, corticosteroids such as cortisone and methylprednisolone or narcotics such as codeine, oxycodone, Methadone, Demerol and Dilaudid.

 

Long term use of NSAID medications can lead to associated medical problems such as gastritis (inflammation of the stomach), stomach ulcers, and anemia, while the long term use of narcotics can lead to addiction and chronic pain syndromes.  Therefore, it is important to provide enough analgesia (reduction in pain) to make the pain patient comfortable so they may undergo appropriate rehabilitation.

 

When prescribing narcotics, it is important for the physician and pain patient to be on the same page when it comes to prescribing pain medications.  A “narcotics contract” should be signed by the patient and doctor and a medication log sheet should be filled out by the patient.  At any visit when the pain patient requires a refill of their medication, the pain specialist should review the medication prescribed, the dose and dosing schedule. 

 

Failure to follow the narcotics contract and reviewing the medication log, can lead to problems with the state licensing board for your doctor.

 

The main concern with prescribing narcotics long term is the possibility of pain patients becoming addicted to the drugs and becoming a chronic pain patient.  While incorrect diagnosis can also lead to long term addiction problems, many pain patients are predisposed to addiction problems.  Those with past illicit drug use, alcohol dependency or psychological issues, predispose pain patients to addiction.

 

When evaluating a pain patient, the doctor should assess the biological problem (injury causing the patient’s pain), psychological issues, and social factors that may cause a patient to become addicted to long term use of narcotics.

 

Pain patients should avoid physicians who routinely prescribe narcotics without looking for and treating the underlying cause of the patient’s pain complaints.