| Concept Medical Newsletter | ||
| Cancer Pain : Separating Myths from Facts | ||
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Current Misconceptions
Pain is a growing problem. Not just for physicians, but for patients and employers as well. When not treated properly or, in many cases, not treated at all, pain can result in depression, loss of function and many lost workdays. Much of this is unnecessary. The fact is , no one today has to suffer in pain thanks to effective medications like opioids. However, too many healthcare professionals are afraid to prescribe opioids because of common misconceptions. Myths about addiction and tolerance have been roadblocks to prescribing opioids for many years. Once you know the facts, these misconceptions should not prevent adequate treatment of pain. Addiction vs Pseudoaddiction Addiction is psychological dependence on substances to obtain a psychic effect. Compulsive use is the result. With addiction, patients no longer have control over drug use and continue to use the drugs despite harm. The truth is, addiction rarely occurs in patients taking opioids under a physician's care. Sometimes, physicians mistake pseudoaddiction for real addiction. Pseudoaddiction is drugseeking behavior that seems like addiction but is due to unrelieved pain. This behavior ends once that pain is relieved, often by titrating up to a higher opioid dose. Tolerance vs Pseudotolerance Tolerance is the need for an increased dosage of a drug to produce the same level of analgesia that previously existed at a lower dosage. Tolerance also occurs when a reduced effect is observed with a constant dose. Analgesic tolerance is not always evident during opioid treatment and is not addiction! Physicians sometimes mistake pseudotolerance for real tolerance. Pseudotolerance is the need to increase dosage due to factors other than tolerance, such as disease progression, new disease, increased physical activity, lack of compliance, change in medication, drug interaction, addiction, and deviant behavior. When a once-fixed opioid dose is no longer effective, the above conditions should be reviewed to exclude pseudotolerance. As you can see, addiction and tolerance are not the hurdles once thought to be when prescribing opioids. But understanding the myths about addiction and tolerance is only the first step. The AHCPR Guidelines recommend that "clinicians include patient and family education about pain and its management in the treatment plan" because patients and their families may try to avoid the use of opioids due to the very same misconceptions outlined above. For all kinds of patients in chronic pain, both malignant and nonmalignant, opioids should be taken more seriously and considered more readily by prescribing physicians and other healthcare providers. References: |
