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Chronic Pain and the Use of Narcotic Pain Medication.

  • Jon Koutcher
  • 06/25/2013

For chronic pain sufferers, narcotic pain medication is often prescribed.  Pain management is a controversial yet growing field in medicine. Prescribing controlled substances appropriately is often met with challenges:  manipulation of drug abusers and physicians over prescribing narcotics is balanced by a misunderstanding of the public towards narcotics and the individual suffering in chronic pain.

What is chronic pain?

Chronic pain is pain that lasts longer than six months.  It can be mild or excruciating, episodic or continuous, merely inconvenient or totally incapacitating.  The symptoms of chronic pain include:

  • Mild to severe pain that does not go away
  • Pain that may be described as shooting, burning, aching, or electrical
  • Feeling of discomfort, soreness, tightness, or stiffness

What are narcotic pain medications? 

The Federal Drug Enforcement Agency classifies drugs into certain categories or classes, one being narcotics.  Narcotic pain medication (also referred to as opiods) is used only for pain that is severe and is not helped by other types of painkillers. When used carefully and under a doctor’s direct instruction, these drugs can be effective at reducing pain.  Narcotics work by binding to receptors in the brain and blocking the feeling of pain. They work well for short-term pain relief. All narcotic agents have a dissociative effect that helps patients manage pain. It does not actually deaden the pain, but works to dissociate patients from the pain. Commonly used narcotics include:

  • Codeine (e.g. Tylenol #3)
  • Hydrocodone (e.g. Vicodin)
  • Oxycodone (e.g. Percocet, Oxycontin)

Narcotics are extremely effective for pain relief.  However, the word “narcotic” comes from the Greek word “narkos” meaning sleep; therefore, narcotics are drugs that can induce sleep or cause drowsiness and lethargy.  Narcotics can also cause constipation and mood changes.  In addition, every opiate-based narcotic pain medication has a potential to cause physical dependence, abuse or overdose.  Physical dependence will develop in many people simply due to sustained ingestion of opiate pain medication.  Dependence is often accompanied by tolerance, which results in the dosage being increased so the person continues to experience benefits from the medicine.  All long term users of narcotic pain medication become physically dependent, and if drugs are suddenly discontinued, their body experience symptoms of withdrawal, including sweating, aches and nausea.  The American Society of Addiction Medicine defines addiction as the abuse of any psychoactive substance with compulsion and loss of control despite adverse consequences.

Workplace insurers spend $1.4 billion annually on narcotic pain medication.  PMSI, a Workers’ Compensation service provider, has data to show that 70% of total pharmacy spending in Workers’ Compensation is related to medications used to treat pain.  The Workers’ Compensation Research Institute indicates that workers in Louisiana, Pennsylvania, Massachusetts and New York receive up to 125% more narcotics per claim than in other states.  Chronic pain has become one of the nation’s most costly health problems.

Chronic pain sufferers who take narcotic pain medication are often labeled, and the stigma that applies of being physically dependent on narcotics is difficult to shed. The medical community recognizes the debilitating and long term impact of chronic pain sufferers.  Standards of care are still being developed and studies are being conducted to determine the detriment of long term narcotic pain medicine usage.

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