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Medication Management
Medication management involves the use of a variety of medications with different properties to provide partial pain relief.
It is impossible to provide complete relief of your pain with medications alone. Some medications are to be taken on a routine basis
to provide a steady state level of the medication in your blood. Others are to be taken on an intermittent (break through) schedule for when the pain becomes severe.
Medications can be administered by a variety of methods including: oral, transdermal, transmucosal, intrathecal, and by injection.
There are many different classes of medications including:
- Non-steroidal anti-inflammatory drugs
- Steroids
- Narcotics
- Muscle relaxants
- Sleep aids
- Antidepressants
- Anticonvulsants
Many of these medications have abuse potential, can have adverse effects on the body, and are controlled substances. We therefore require that the patient be seen on a regular basis. It is unreasonable to expect multiple refills and to not be seen in the clinic. You must be evaluated in order to monitor the effects and continued appropriateness of the medication. Please see our medication policy overview. All patients prescribed narcotics must sign a medication management agreement. These are used by most reputable pain programs and clearly define patient responsibilities and terms for discharge from the practice. Patients are randomly asked to provide urine samples in the office to ensure that the medications prescribed are being taken and that no other controlled substances are present. We occasionally obtain prescribing information which tells us when a patient filled a prescription and who was the physician. Controlled substances should only be prescribed by one physician. On occaion we will request a behavioral screening and behavioral therapies if we are to contiue with the medication management. Many of the expenses are not reimbursable by the insurance carrier and therefore would hvae to be handled by the patient.
The following are some definitions related to pain and the use of medications:
- Acute Pain: Acute pain is the normal, predicted physiological response to an adverse chemical, thermal or mechanical stimulus and is associated with surgery, trauma and acute illness. It is generally time-limited and is responsive to opioid therapy, among other therapies.
- Addiction: Addiction is a neurobehavioral syndrome with genetic and environmental influences that results in psychological dependence on the use of substances for their psychic effects and is characterized by compulsive use despite harm. Addiction may also be referred to by terms such as "drug dependence" and "psychological dependence." Physical dependence and tolerance are normal physiological consequences of extended opioid therapy for pain and should not be considered addiction.
- Analgesic Tolerance: Analgesic tolerance is the need to increase the dose of opioid to achieve the same level of analgesia. Analgesic tolerance may or may not be evident during opioid treatment and does not equate with addiction.
- Chronic Pain: A pain state which is persistent and in which the cause of the pain cannot be removed or otherwise treated. Chronic pain may be associated with a long-term incurable or intractable medical condition or disease.
- Pain: An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.
- Physical Dependence: Physical dependence on a controlled substance is a physiologic state of neuro-adaptation which is characterized by the emergence of a withdrawal syndrome if drug use is stopped or decreased abruptly, or if an antagonist is administered. Physical dependence is an expected result of opioid use. Physical dependence, by itself, does not equate with addiction.
- Pseudoaddiction: Pattern of drug-seeking behavior of pain patients who are receiving inadequate pain management that can be mistaken for addiction.
- Substance Abuse: Substance abuse is the use of any substance(s) for non-therapeutic purposes or use of medication for purposes other than those for which it is prescribed.
- Tolerance: Tolerance is a physiologic state resulting from regular use of a drug in which an increased dosage is needed to produce the same effect, or a reduced effect is observed with a constant dose.
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