Chronic pain management often consists of a protocol of “drug management”. Many adverse effects result from not monitoring how the drugs affect the patient.
Chronic pain complaints can be low back pain, sciatica, RSD, Fibromyalgia, Arthritis pain and psychogenic pain ( pain not resulting from any past disease or injury). The essence of the diagnosis is to treat the patient as best can since the symptom has now become the diagnosis.
Unless the treating physician is well versed in treating chronic pain patients one of the most used methodologies for treatment is simply to prescribe pharmaceutical products and anticipate positive results. The training of most physicians is to take acute pain situations such as muscle sprains, strains, bruises, broken bones, post surgical pain and prescribe anti-inflammatories, anti-histamines, and pain medications until the underlying pain problem heals or the disease process is over. The normal process of dealing with pain is the pain is caused by disease or injury and is residual to the disease/injury. The pain is a necessary and wanted symptom to alert the patient to the injury or sign of disease.
Patients that repeatedly present with pain complaints are often treated initially as acute pain patients anticipating the above treatment protocol will work. When it doesn’t work then the physician prescribes more pain medications, elevates the narcotic level, increases the dosage, or uses combinations of medications to make the patient comfortable. Often what is not being monitored is how the medications are affecting the patient’s mental health.
Does the patient become agitated or is quickly upset? Is the patient sleeping for longer time periods and wakes up tired or lethargic? Does the patient show a change of personality and becomes less trusting and defensive? Is the patient showing signs of depression?
It is common for patient behavior to change and often not due to the underlying diagnosis of pain, but to the drug treatment regimen which is compounding the total issues adversely affecting the patient.
The chronic pain patient has a layering of pain issues that stand on their own merit and need to be understood as what they are, the layers of being in chronic pain. Pain medications are merely one set of tools to be used but they must be used with extreme caution to the overall health of the chronic pain patient.