Magazine article Clinical Psychiatry News

Chronic Pain, Addiction Behavior Are Different: Giving Shorter-Acting Opioids to Those Already Taking Long-Acting Formulations Might Create Tolerance

Magazine article Clinical Psychiatry News

Chronic Pain, Addiction Behavior Are Different: Giving Shorter-Acting Opioids to Those Already Taking Long-Acting Formulations Might Create Tolerance

Article excerpt

WASHINGTON -- Learning to differentiate between drug-seeking behavior and unmet pain needs can help emergency physicians cope better with chronic pain patients, who are frequent emergency department visitors, said Dr. James Ducharme at the annual meeting of the American College of Emergency Physicians.

It can be hard to determine when a patient is requesting medications for true pain as opposed to seeking them for diversion, he said.

However, if anything, patients are not given enough pain medication by emergency physicians--and, often, if they ask for a pharmaceutical by name, they are identified, usually incorrectly, as addicts, said Dr. Ducharme, who is professor of emergency medicine at Dalhousie University in Halifax, N.S., Canada, and clinical director of the emergency medicine department at Saint John Regional Hospital, N.B.

According to Dr. Ducharme, about 70% of people presenting to the emergency department have a pain complaint, but only about one-half of 1% are addicted.

When pain goes untreated, however, chronic pain patients, such as those with sickle cell disease, have behavioral traits that, taken alone, resemble those of addicts, he said. They see the ED as the place of last resort when they have not been helped elsewhere. Physicians often give these patients a short-acting opioid and then discharge them.

This is a mistake, though, because many chronic pain patients are already taking long-acting opioids. By giving them the shorter-acting formulations, the physicians may be creating tolerance.

Opioids also do not provide any long-term benefit to fibromyalgia patients or to those with neuralgic pain; myofascial pain syndrome; or chronic, stable, nonmalignant pain such as back pain. It is incumbent on the physician to explain this to patients, Dr. Ducharme said.

Migraineurs and others with recurrent conditions tend to know what works for them and will ask for the medication by name, but ED physicians may mistake that behavior for drug seeking, he said.

"It's not their fault if they know what they're talking about," Dr. Ducharme pointed out, adding that migraineurs also tend to visit an emergency department only once or twice a year.

However, migraine headaches, dental pain, back pain, and recurrent abdominal pain are common scenarios cited by drug takers to procure opioids, he said. Not surprisingly, many physicians doubt these patients' veracity. …

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