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“What should I do? I’m in pain, but I don’t want to take nar


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“What should I do? I’m in pain, but I don’t want to take narcotics, because I’m afraid I’ll become addicted.”

April 24th, 2013 - by Dr. Jack West

http://expertblog.lungevity.org/2013/04 ... addiction/

Unfortunately, pain is a common symptom of many cancers, including lung cancer. But perhaps what is more important is that far too many people with cancer suffer needlessly from pain because they, their family members, and/or their doctors are wary about them taking opioid medications like morphine, oxycodone, etc., out of a fear that these will cause the person to become addicted. Pain medication is a complex issue, but there are a few important points for people to be aware of to ensure that patients are as comfortable as they can be.

First, pain doesn’t fight cancer. There is nothing noble about suffering with cancer pain if it can be relieved effectively. Sometimes focal radiation will help with pain, sometimes non-opioid medications like Tylenol (acetaminophen) or NSAIDs like ibuprofen will do the job, but many patients have enough pain, in various parts of their body, that stronger, opioid pain medications are very, very appropriate and may be by far the most effective way to manage cancer pain.

Second, needing pain medication doesn’t make someone an addict. Even if they need pain medication for a long time, perhaps forever, this doesn’t mean that a person can’t function well with pain medication, and this dependence on opioids should be distinguished from addiction, which is an inappropriate use of a drug. People may also require higher doses of opioids over time to achieve the same effect, due to tolerance, but this also isn’t the same as addiction. Instead, I would consider it most analogous to think of appropriate use of opioid pain medication like a person with diabetes being dependent on insulin, or someone with hypothyroidism depending on thyroxine as thyroid replacement: these are needed for a person to function, but their appropriate administration just restores normal functioning. It isn’t an addiction if appropriate use normalizes an abnormal system.

There are many complicating factors. It isn’t rare for patients to rely on opioids for reasons other than pain, so there is a real risk of these drugs being used inappropriately, but that isn’t a good reason to withhold them for people who have a very legitimate need and could have cancer-related pain relieved with opioids. Too many patients suffer because they or their family are misguidedly cautious — it’s really quite unlikely that a patient using opioids appropriately when really needed will become truly addicted if they improve and no longer need the pain medication. And sadly, it’s all too common for me to see primary care doctors, ER physicians, and other health care practitioners give woefully inadequate pain medication, such as a dozen Percocet tablets for someone riddled with painful bone metastases, out of a caution that is really just a reflection of their own ignorance of how to properly manage cancer pain.

Finally, as a semantic point, the term narcotic implies that this is an illicit street drug, but opioid pain medications should not have a stigma associated with them when used properly.

Of course, this isn’t to say that we should be too generous with opioids in people who don’t need them, because there is a real risk of abuse and addiction, but that is not a reason to withhold opioids at sufficient doses to the people suffering from cancer-related pain that can be relieved if these drugs are given and used appropriately.

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