From the Blog Musings of a Distractable Mind, a very good read concerning narcotics, pain and why MD's are often reluctant to prescribe them.
Narcotic medications are often the best drug for the job. Morphine and its derivatives are some of the most effective pain medications, and so people with painful conditions may be best treated with these medications. Similarly, Valium and other benzodiazepines are very good at helping with anxiety. A person having a panic attack is often best treated with something like Xanax.
These medications work - and therein lies the problem. Repeated use of these medications can result in two serious problems: chemical dependency and addiction.
Chemical dependency is a physical phenomenon described by two criteria:
Most of the scheduled drugs can create chemical dependency (the biggest exception being amphetamines), but other substances can also do this. Alcohol and caffeine are two of the best examples of things that are not (generally) prescription drugs but can create chemical dependence. I personally get a bad headache if I don’t have my coffee in the morning.
Addiction is different (although the term is sometimes used in place of chemical dependency); it is the development of compulsive behaviors associated with the substance or action. I think of addiction as being mainly a psychological phenomenon, as a person can become addicted to things they aren’t chemically dependent on (such as gambling, shopping, and checking the traffic meter for your blog - heh). A person can become addicted to anything that offers significant intense pleasure. In general, the quicker the onset of the pleasure, the more the addiction.
So how does this relate to narcotics? In a huge way.
The Right Way and the Wrong Way
There are two factors to consider when approaching someone in pain:
Patients with acute severe pain are unlikely to abuse pain medications, while those with chronic lower-level pain are at very high risk. So if someone comes in with a fractured arm, pain medication is fairly safe to use. Some physicians are still reluctant to prescribe narcotics even in this situation (being jaded by people who exaggerate or lie to get pain medications), leaving many patients to suffer needlessly. Having broken many bones (as a consequence of distractibility), I can say that pain medications make life much better when your pain is severe. So, for acute severe pain, short-acting medications are appropriate and low-risk.
Chronic pain is different. Some people have longstanding pain that is fairly severe - compression fractures in the back, chronic severe degenerative arthritis, and cancer pain can be relentless. It is very difficult for these patients to gauge the severity of the pain, as it becomes hard to remember what being pain-free feels like. It is very hard for the physician to determine the severity as well, as there is no pain-o-meter to stick on someone and measure how much they hurt. You have to take the patient’s word for it - which can be hard if the stated pain is inconsistent with physical findings. The result is that some patients suffer silently, while those who report severe pain are held in suspicion by the physician.
The best approach to treating someone who is in significant chronic pain is to use long-acting medications as much as possible and short-acting ones as little as possible. The reasons for this are:
Long-term use of any narcotic will result in chemical dependency, but that is not nearly as big of a problem as addiction.
This approach actually works for anxiety as well - with antidepressant/anti-anxiety medications like Zoloft or Paxil being used to minimize the need for benzodiazepines.
To read the entire article: