Craig R. DuBois, M.D.
The Pain Evaluation & Treatment Center
7307 Creekbluff Drive
Austin, TX 78750
512-346-6969
http://www.paineval.net/our_physicians.nxg
Transcript: Role of narcotics for pain management
I mentioned in another setting that the role of narcotics in treating any kind of pain and in particular trigeminal neuralgia pain. When we think of narcotics, it’s a pain reliever. You break a bone they give you something in the ER. You’re having surgery they give you a pain medicine to help you get through it.
With a chronic daily or recurrent pain, narcotics are difficult for two reasons. One, if you have something like TN1 that’s very sharp and comes and gone maybe in five seconds, by the time you take something, it’s come and gone. So how do you take a medicine that works in about 30 minutes and lasts for an hour or two or maybe longer when the pain may not last that long? There are other cases though that we talked about the pain that’s more constant and boring and constantly there. Those people may respond to some narcotics. And narcotics have the whole social stigma of “Well, I don’t want to take that, I’ll get addicted.” And that’s another issue. You can get chemically dependent from taking a narcotic, of course. It’s no different than taking a blood pressure medicine or a diabetes medicine. You can’t stop those all of sudden or you’re going to have problems. If you’re taking a daily narcotic medication, same rules apply. You don’t stop. I don’t stop eating without withdrawing. Okay? None of us change suddenly anything we’re doing. You can take narcotics safely. You just can’t take them wild and crazy safely. So when we talk about narcotics for pain, it has to be controlled. It has to be recommended not here and there, helter skelter, but controlled dosing with a plan. In that setting, in the trigeminal nerve pains and the neuropathic pains, it can be used.
The difficulty patients will have is finding somebody who will help them find that dosage that works for them, deal with the side effects and the introduction of it. As far as the introduction, you have to take medicines. Start out slow and build up and find the level that works for you. And the side effects are always going to be there in some fashion. The number one thing that narcotics do is they slow down the bowel transport. Everybody gets constipated. What do you do? You just start at the beginning presuming that and you give them some things to keep the bowel moving: more fiber, more water, a little stima. It’s just a necessity because these things happen to slow it down. But they also cause itching in a lot of people. They may cause retention of fluid in the legs which can be very uncomfortable and painful and you just have to anticipate that some of these people are going to have them. You have to watch for them. The patients should be a knowing about them. And if you do that, you can use them safely and the side effects can be dealt with by prevention and sometimes the side effects will make it so you have to take the person off the medicine even if it was helping them if they can’t tolerate the side effects.
So it’s not a simple do I take it or not take it. In many cases its does it work for me and can I stand it?