Overprescription of opioids: the problem is mental laziness (or being too busy)
Linda L L Benskin
Independent Researcher/Educator for VHWs AND Clinical Research, Education, & Charity Liaison for Ferris Mfg. Corp
This article:
really got me to thinking. It seems a lot of doctors, NPs, and other prescribers really feel they are justified in prescribing opioids to every patient with pain, provided that the pain is real and the patient is not at high risk for addiction. Seriously?
The BIG problem is that doctors and patients need better education concerning appropriate tools for pain relief. Opioids are rarely the best choice, particularly for skeletal-muscular pain. They simply do not work well for this sort of pain. Also, this sort of pain, if the cause is addressed, does not last long, so there is no reason to prescribe more than a week's worth of medication.
Two elderly people close to me who had severe acute pain (within a day of the accidents) from broken hips (one was hit by a truck while crossing the street) both gained dramatic pain relief from alternating 400mg Ibuprofen q 6hrs with acetaminophen 500mg q 6 hrs (one or the other q 3hrs). In both cases, high doses of opioids had proven ineffective AND the side effects were unacceptable. With these more appropriate medications, they were able to immediately begin walking and other rehab, whereas with the opioids, they did not even move around in bed.
Another elderly man had his severe chronic back pain completely relieved when he was taught to lean over the back of his recliner far enough that his feet were barely touching the ground, which provided a low-tech form of traction. Why was he prescribed opioids and NOT a physical therapy home health consult? One good stretch and he was off pain relievers for good.
Many of my patients with chronic severe pain from arthritis, neuropathy, or post-polio syndrome find that opioids do nothing for their pain, but a PolyMem patch applied on the area of the body whose dermatome is affected eases the pain immediately, allowing them to return to their usual activities.
Opioids, taken long term, can actually INCREASE patient pain. Opioid-induced hyperalgesia was once rare, but with the increase in opioid use, it is becoming a more common problem. https://www.ncbi.nlm.nih.gov/pubmed/21412369
Do your homework, folks. We are better than this! Throwing the same prescription at every problem is NOT what you went to medical school to do.
Employee at BVGlazing Systems
7 年I would agree use opioids as a last resort. To me over the counter Tylenol and ibuprofen should be used first. Then when and if they fail move to stronger.
Clinical Program Consultant
7 年Not to mention, there are many non-pharmacological alternatives, like electrical stimulation, ultrasound, diathermy, infrared therapy, and massage, just name a few, which are quite effective.