certain pains don’t completely respond to the opioids and certain others don’t respond at all. I was always under the impression that opioids could always relieve pain. We just need to get the dose high enough. This new understanding completely changed my understanding of pain. I once believed pain was a simple condition – easy to understand and easy to treat. When all else fails we always have morphine. Pain is not a simple condition. It can be very complicated in that; there are actually different types of pain, each one with its own characteristics and physiologi- cal differences. The biggest difference is that not all types of pains will respond to the opioids the same way yet they will respond to other medicines, as we shall see. In fact, Maureen Carling, in her pain algorithm has identified eight different types of pain in which only two of eight will fully respond to the opioids. Three others will partially respond and three will not respond at all. This fact alone sheds much light on
the huge problem of our conventional pain therapy. Physicians are taught to prescribe the opiates based on the severity of the pain, not on the actual type of pain. In fact most pain meds, including the narcotics, carry the FDA approved indication for “moderate to severe pain.” We are taught to use the 0 to 10 scale to “assess” the pain and then prescribe the appropriate medication based on the severity. Nowhere are we assessing the actual
type of pain. We were never taught about different types of pain or that opioid resis- tant pain even existed. What we commonly see, is a patient presenting with severe pain and the result would be a prescription for a potent narcotic regardless of the type of pain and regardless as to whether the type or types of pains they had would be effectively treated by that particular medicine. Over and over again, we hear of pa-
tients on very strong narcotics report that in spite of their drug therapy they are still in pain. Many see increases in their dose and
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yet no reduction in their pain. Some report that the drugs just take the edge off. A recent patient experience exemplifies this situation. We will call her “Sue.” Her physician pre- sented Sue to us shortly after being admitted to the hospital with an apparent Oxycontin ® overdose, which was prescribed follow- ing a surgical implantation of a mesh in her lower abdomen. We were able to formulate a topical pain gel based on an assessment of her pain, which was mostly opioid resistant. We dispensed this prescription to her on a Friday as she was discharged. On Monday, I called to reassess the situation and so that we might recalibrate the formulation based on what we had accomplished and was told by the patient that the pain was “completely gone.”
Most patients don’t respond that quickly and we often find that the longer someone has been in pain the longer the process of pain relief is. Normally our program requires a constant re-assessment and then corre- sponding recalibration of the therapy in or- der to properly titrate the medication, which means, to adjust the dose of a particular medicine to the most effective level for that specific patient.
When the appropriate medicines are used and then properly titrated the results are remarkable. Not only are we seeing pain relief, we are seeing a consistent reduction in opioid use which is almost always patient driven and occurs almost 100% of the time. These same patients who might be accused of drug seeking are reducing their narcotics on their own. This is an astonishing experi- ence considering it contradicts almost every- thing I had been taught and believed about addictive and drug dependent behavior. Maureen has identified eight differ-
28 Natural Nutmeg October 2012
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