are wary of taking Vicodin (hydrocodone and acet- aminophen), OxyContin (oxycodone), Percocet (oxycodone and acetaminophen) or other opioid analgesics, often referred to as narcotic pain reliev- ers. But the perception—by patients as well as some doctors—that people inevitably become addicted to these potent medications doesn’t match the reality, experts say. Most research shows that the risk of addiction for patients taking opioid analgesics is less than 5 percent. A Cochrane review concluded that the risk for patients with non-cancer pain may even
Only 5 of 132 medical schools actually require courses in pain
about pain in general, there’s a real risk he won’t take the next step to push for more effective treatment. Left untreated or undertreated, your aches may
only become more severe and even harder to get under control, especially for primary care doctors who may see 30 to 40 patients a day, says Perry G. Fine, M.D., professor of anesthesiology at the Uni- versity of Utah, in Salt Lake City, and immediate past president of the American Academy of Pain Medicine (AAPM). “There’s no way you can diagnose a complex pain problem in an 8-, 10- or 12-minute visit.” WHAT YOU CAN DO:Working with a pain special- ist may be your best bet if you aren’t fi nding adequate relief with your primary care doctor. But you have to fi nd a specialist fi rst—and that may be no easy task. Fine points out that there are about 2,000 mem- bers of the AAPM. “That’s about one [AAPM] pain expert for every 40,000 people,” he says. So if you can’t fi nd a specialist where you live (start by asking for referrals in your community) but you’re happy with the rest of the care your doctor delivers, do what you can to help bring him up to speed; start, for example, by sharing current research on your meds or your condition. Experts emphasize that a trusting, collaborative relationship between doctor and patient can go a long way toward fi nding meaningful relief. Pain groups such as the AAPM (www.painmed.org) can help you locate specialists in your area, or you can reach out to nearby academic medical centers.
REASON
You and/or your doctor are afraid you’ll become addicted to painkillers.
2
With so much attention on prescription drug abuse in the news, it’s no surprise that some pain patients
be as low as 0.27 percent. “I’ve had patients who suffer unnecessarily because they’re afraid they’ll become an addict,” Fishman says. But the risk of their lives becoming ruined by pain is far greater, he says. (It’s worth noting that those with a history of sub- stance abuse are more likely to develop an addiction.) Doctors don’t just worry about creating an addict;
they also need to be concerned about their patients sharing or selling the drugs, and getting into car accidents or injuring themselves—and then holding the doctor liable. On top of that, some physicians worry that if they prescribe too many opioids they may get into hot water with medical groups, state licensing boards or even the U.S. Drug Enforcement Agency. “Usually, these are all unfounded fears,” says Fishman. But the upshot is that this fl awed thinking becomes a big problem for those who could stand to benefi t from strong painkillers: “Many practitioners are unwilling to prescribe opioids, and many phar- macists are reluctant to dispense them, especially when prescriptions are issued for what are perceived to be high amounts of opioids,” Gilson explains. This can also mean that some doctors write a prescription to cover a shorter period of time, or at a lower dose, and/or not renewing a prescription, so the person in pain doesn’t get enough of the drug for a long enough time for the drug to do its job. This can be a particu- lar dilemma for minorities, who are generally more undertreated for pain for a host of reasons, including lack of insurance and access to care, poor patient- provider communication and preconceived biases. A 2000 study in the New England Journal of Medicine even found that pharmacies in predominantly non- white neighborhoods were substantially less likely to stock suffi cient supplies of opioids than pharma- cies in white neighborhoods. Unfortunately, there are many misconceptions about addiction—and not just by the public. “The