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Chronic pain patients can identify medication dependence with new self-assessment

December 31, 2014
by Julia Brown, Associate Editor
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New Year’s is often a time of reflection and self-assessment. For chronic pain patients resolving to end their dependence on addictive prescription pain medications, a new online assessment is available through the Pain Recovery Program (PRP) at Father Martin’s Ashley, a program offering an integrated, multi-modality approach to treating chronic pain and medication dependence.

Developed by a medical doctor, clinical psychologist and licensed mental health counselors specializing in chronic pain, the Prescription Pain Medication Self-Assessment (PPMSA) helps people struggling with long-term use of prescription pain medications recognize symptoms of dependence and seek help.

Through the PPMSA, a person can become aware of their dependence by identifying with one or more of the following scenarios:

Symptoms of dependence to prescription pain medication

  1. Pre-occupation with the prescribed medication (doses, times, refills);
  2. Withdrawal symptoms when the prescribed medication isn’t taken (flu-like symptoms, increased pain, anxiety);
  3. Taking more of the prescribed medication than prescribed, taking in a different way than prescribed (chewing, snorting, IV) and/or taking medication prescribed for someone else;
  4. Supplementing a prescribed medication with alcohol or illicit substances; and
  5. Pain and/or function getting worse over time despite taking the prescribed medication.

According to the Centers for Disease Control (CDC) Vital Signs report, providers wrote 259 million prescriptions for painkillers in 2012—enough for every American adult to have a bottle of pills—and the number of people with dependence on prescription pain medications is skyrocketing.

Pain recovery specialist and manager of the PRP at Father Martin’s Ashley, Scott Dehorty, LCSW-C, said in a statement that the self-assessment was created to help people understand that prescription pain medications were never intended to treat chronic pain, that there are alternative treatments, and also hope.  

More information about opioid dependence and pain management will be shared at Addiction Professional Academy, a conference to be held Feb. 2-4 in Anaheim, Calif. For more information, click here.

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Comments

It is rare that I read an article that evokes such an emotional response. This article, "Chronic pain patients can identify medication dependence with new self-assessment" has to be the most misleading, inaccurate and poorly thought out piece of information I have read in a long time. It proposes that a person can identify if they are "dependent" on their long-term opioid therapy for chronic pain. Every one of the 5 criteria they use has more to do with poor treatment of pain or the predictable occurrence of physical dependence associated with long term opioid and other medication use (laxatives, SSRI's, etc) than addiction.
(1):"Preoccupation..." is generated by the fear of the pain coming back and is common with poor pain control.
(2):Withdrawal symptoms are an expected and predictable outcome of long-term opioid use. This is PHYSICAL DEPENDENCE and IT IS NOT ADDICTION
(3-4): "Taking more..." and "Supplementing..." are more indicative of poor and under-treated pain than addiction
(5): "Pain/function getting worse..." is generally a sign of the need for an opioid rotation or that the painful condition has progressed and gotten worse or another pain condition may have developed.

To make things worse, Mr. Dehorty states that "prescription medications were never intended to treat chronic pain...". I suppose he heard this from the usual biased and incompletely educated sources (PROP). Repeating incorrect information does not make it true. If you bother to read ALL the data, there is a wealth of information that describes very good outcomes with those who have taken opioids for 10 years or more. There is NO data that says long-term use of opioids are not effective!

These are the kind of things that make addiction professionals look bad and uneducated. It is sad that this sort of advertisement for a rehab clinic is published as if it were something helpful. It is not right to further demonize and shame those who actually need opioids for pain and accuse them of being addicts when the only thing they did was develop a painful condition.

The experts at the Pain Recovery Program at Father Martin’s Ashley developed the self-assessment to help consumers recognize possible dependence on prescription pain medications. The assessment is one of many tools that can be used by a patient or a loved one to determine ifprofessional help is necessary. We want those suffering with chronic pain syndrome to know that there is help.

Sirs,
In regard to your comment that "...The assessment is one of many tools used...to determine if...help is necessary." The point that seems elusive is that this "tool" that you have proposed that folks use is misleading, inaccurate and will likely lead to more misery rather than any relief of suffering. I'm not sure what "help" you are offering other than filling one of your beds. I wish there were better meds than opioids to deal with the pain that some suffer, but there is none at this time. NSAIDS are involved in more deaths than opioids, anticonvulsants and some of the antidepressants have horrible side effects. If you plan on taking away the raft from a drowning man, you need to replace it with something that will help and not hurt. As bad as the side effects can be from opioids they can be effective in chronic pain patients when respectfully monitored and opioid rotations are used.

I am sure you read the news of the National Institutes of Health research that was published in the Annals of Internal Medicine on Tuesday (http://annals.org/article.aspx?articleid=2089370) which evaluated “evidence on the effectiveness and harms of long-term (>3 months) opioid therapy for chronic pain in adults.” According to the researchers, “Accumulating evidence supports the increased risk for serious harms associated with long-term opioid therapy, including overdose, opioid abuse, fractures, myocardial infarction, and markers of sexual dysfunction.” At the very least, these findings strongly support the need for the medical community to seek alternative, non-opioid strategies to help people suffering from chronic pain and chronic pain syndrome. Our integrative, multi-disciplinary approach at The Pain Recovery Program -- which is part of our non-profit, 33-year-old treatment facility -- is one such strategy that is proving to be effective. I am happy to provide clinical evaluation reports and case studies that support the efficacy of our approach and invite you to contact me directly. We welcome collaboration with you, and other concerned professionals, to help people find a path to improved health and well-being.

Yes, I read the article you mentioned but seem to draw different conclusions. The article mentioned that "there was little or no evidence or data that long-term opioid use was effective for chronic pain". They also inferred that more studies needed to be done, which I think is appropriate if done correctly. Another fact that somehow did not get published was that "there is little or no evidence or data that long-term opioid use was NOT effective for chronic pain". It seems as though there is no "data" to prove or disprove the discussion of opioid efficacy. They also left out any mention of the daily suffering of those with undertreated pain which can be suicidal to some. Regarding the "...increased risk of overdose, abuse, fractures, myocardial infarction...sexual dysfunction", the risk for each is different. Overdose, abuse, fractures, MI are very rare. Deaths are seen when opioids are combined with other drugs, methadone is used, suicide and the opioid naïve. Death by one drug is actually rare. All this info comes from the CDC data when you take the time to read the fine print. Physical dependence is common and predictable but THIS IS NOT ADDICTION. Simple opioid rotation procedures can help deal with tolerance issues. Sexual dysfunction can also occur but can be medicated and controlled. None of the "risks" involved compare to the seriousness suicide. All meds are prescribed with the knowledge of the most reasonable "benefit to risk ratio" of the medication. Each individual with be different with confounders that will complicate things. General statements and data are useless when dealing with the individual in front of you! I hope you and your staff are willing and able to be your patient's ally as they struggle with their pain issues and not make things worse. If nothing else I hope I have been able to get you and your staff to consider that there is "another side to the story".

Thank you Billy for a thoughtful response to this awful assessment. As an expert in behavioral health and a person with a (legally-defined) disability and pain condition, I can attest that I and nearly all others I know who rely on medications to give them a decent quality of life would be forced to respond positively to most if not all of these assessment statements. That certainly does not make me "addicted." In fact I have nearly 30 years of continuous abstinence. What it does is make me is physically dependent or what Carl Erickson terms "medically reliant" on medications. Much like insulin, lithium, and many other medications, becoming dependent on these meds is exactly what we want to happen. More troubles occur when 1) people take less than the prescribed amount of pain medication so they are still in pain and/or 2) try to wait it out and wind up 'chasing the pain.' This doesn't mean one cannot or should not have conversations with their medical TEAM re: their use of medications. It also means that, in my case, I need to seek out and practice adjunctive treatments such as eating well, getting regular exercise, seeing friends and family, meditating regularly, and more as part of a holistic plan to treat my pain (and the rest of the constellation of symptoms that comes with my condition). This assessment is a wolf in sheep's clothing: it is designed to appear medical but instead I fear would increase one's shame and guilt/fear for taking these medications. Everyday we with chronic pain are bombarded with messages that tell us not to take medications/take medications; addiction is lurking out there, or other such confusing messages. I can personally attest to the hardship of dealing with the added stress a recent misinformed DEA decision has made on my life. Perhaps a true assessment designed without obvious bias and perhaps even including some of us with chronic pain, through a reputable agency with experience doing such, as the National Fibromyalgia and Chronic Pain Association (www.fmcpaware.org) would be useful idea? And BTW, many of us do worry about addiction but I have found this to be more of a cultural phenomena than a true medical concern (remember: most people who take opioid medications properly never get any euphoria; we merely get the negative side effects to some degree and some pain relief though it's certainly not perfect. But on balance, it is a better life for me than without. Each person must make that decision for themselves however without undo pressure). Perhaps a look at the terminology of the DSM5 would also be beneficial to stop the confusion re: the use of the word "dependence." Warmly, dee-dee stout

The self-assessment is simply meant to help an individual determine if he or she may be a candidate for an alternate, non-opiate approach to treating chronic pain. Hyperalgesia is real. If someone’s pain is getting worse on opiates and the dosages continue to increase while quality of life and function decrease, then it may be time to pursue a more integrated treatment approach. If someone’s medication regimen is working and his/her life is productive and health stable, then there would be no reason to consider a different form of treatment. We've found that many folks whose quality of life and health were degrading while using increasingly high levels of opiates have had remarkable improvements once they engage in a therapeutically-supported detox and integrated treatment program. I want to emphasize that the assessment is to be utilized by those whose current approach is problematic. We are not recommending any discontinuation or change in treatment on one’s own; the self-assessment is only meant to prompt further discussion with healthcare professionals.

After 4 years of searching and testing, no one could find what was causing my burning and stinging body that was continuous. I have lists of drugs used and procedures. Finally I was given a Fentanyl patch to try. It took the 4 year sting and burning away immediately. I have been taking the same dose for 14 years with no side effects and living a normal life which I didn't have before. Now with the doctors so scared to supply the drug to patients that have never abused, my doctor just stopped giving me the patches and no follow up on what I should do? I am 78 years old and would like to live the few years left with my garden and grandchildren. With the pain coming back I don't have hope of doing that again. I am in NH. I have no idea what I am going to do. Have been cut cold form 37.5 mcg (?) to nothing. I went to a drug rehab clinic for a few days and they made up a plan for me to taper off the med to 25 mcg and than the 12.5. They said my Primary Care Dr. would have to approve the tapering. He won't even look at my file. I don't know what is going to happen to me but the patch worked for 14 years, everything was fine so I am for people getting pain relief with what ever is needed if they don't abuse or at least getting some alternatives. There are only 2 Internists in my town and they have said NO.

This is a good example of why these reactionary responses with policy are ineffective and harmful. Not only do they not impact the intended target, they hurt the unintended individuals, like yourself. If you could email me directly and give me your number, I would like to speak with you further about what's happening to better offer some suggestions. Sdehorty@fmashley.com.

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