askthedoctor Managing Pain
Pain and Dementia Dementia can prevent some patients from verbalizing when they feel pain. Patients who usually are calm might become agitated and dis- play sudden changes in behavior and personality. If a nursing home patient becomes upset for no ap- parent reason, consider pain as a cause, and work with health care providers to appropriately treat it.
P 48 MILITARY OFFICER JUNE 2012
The fi rst step in managing pain is to eliminate the cause. When that’s not an option, medication and other pain-management modalities are necessary. By Rear Adm. Joyce Johnson, D.O.
Pain management often requires a combination of modalities. These might include acupuncture, nerve blocks, surgical ablation of nerves, radiation therapy, trans- cutaneous electrical nerve stimulation, or manual medicine. Medication is a common component of pain control. Diff erent drug classes are available to control pain, each with diff erent therapeutic eff ects and pos- sible consequences. There are many classes of pain medications, ranging from over-the- counter aspirin to powerful narcotics. Narcotics are prescribed for short-term
use, such as after surgery. They also are prescribed for chronic use, such as for severe metastatic cancer pain. Narcotics are available in various forms, including pills, patches, suppositories, and intrave- nous solutions. When taken for a couple of days, narcotics usually have no long-term complications. However, over prolonged periods they can cause dependence or ad- diction. Fear of dependence should not deter the use of narcotics for very serious pain in chronic, often terminal, conditions. Dependence is characterized by with-
drawal symptoms occurring when a drug is reduced or stopped suddenly. Common narcotic withdrawal symptoms include vomiting and diarrhea, pain and cramp- ing (in the legs, abdomen, and muscles), increased pulse and breathing rates, fever, mood swings, and irritability. Addiction diff ers from dependence.
People who are addicted to a drug crave it, and their drug use interferes with daily
activities such as work, school, and inter- personal relationships. Addiction is com- plex to treat and often requires lifelong treatment, with risk for relapse. For relatively minor temporary pain, it is often best to avoid narcotics. If taken, monitor their use so dependence doesn’t result. If dependence develops, medical treatment is generally needed that involves decreasing the dose over time and using other medications to minimize and manage withdrawal symptoms. A dependent person without addiction has a good prognosis. The decision about whether to take
narcotics for pain — even for a few days — should be made carefully and in con- sultation with your health care provider. Consider the severity of pain, other options for treatment, past experiences with nar- cotics and other drugs, the likely duration of treatment, and other factors. Talk with your health care provider well before the day of any procedure that might require pain management. Make certain you agree on both the method and duration of pain management. If you have chronic severe pain, narcotics can markedly improve your quality of life. Don’t be afraid to use them for metastatic cancer and for pain related to other life-threatening conditions.
MO
— Rear Adm. Joyce Johnson, USPHS-Ret., D.O., M.A., is vice president, Health Sciences, Battelle Memorial Institute, Arlington, Va. Find more health and wellness resources at www
.moaa.org/wellness. For submission information, see page 6.
PHOTO: STEVE BARRETT
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