Concerns About Pain Management: Risks of Addiction to Controlled Medications

Q: Concerns About Pain Management: Risks of Addiction to Controlled Medications

Hello： In principle, it is not appropriate to provide further information about a medication when the name is uncertain. <br>However, if the controlled pain medication referred to as "damoro" is possibly Demerol, then it is important to note that Demerol is a Schedule II controll

Concerns about the potential for drug addiction or substance abuse?

My wife is very sensitive to pain.
Two years ago, she fell in the bathroom and fractured her rib.
She underwent a nerve block procedure at National Taiwan University Hospital to reduce her pain, but it was not successful.
Since then, her nightmare began, and she has undergone a series of tests and treatments, but her body has not fully healed.
I have a question I would like to ask the doctor: There is a controlled pain medication called "dilaudid" (I may not be spelling it correctly).
Many doctors have informed us that this medication is a controlled substance and should not be administered frequently.
However, my wife is allergic to many pain medications and can currently only use dilaudid for pain relief.
My concern is that over the past two years, my wife has been using this medication for pain management, and I worry about the potential for addiction and dependence.
My wife has heard from an anesthesiologist that proper management will prevent addiction.
However, whenever she is hospitalized, she receives this medication every four hours, with stays ranging from two days to over a month.
I am genuinely worried about how to address my wife's pain.
Over the past two years, she has undergone three abdominal surgeries.
We have been in and out of the hospital numerous times for her pain issues, whether in the emergency room or as an inpatient.
There have also been instances where we were discharged from the hospital because they could not continue administering dilaudid.
I would like to know the correct usage and dosage limits for this medication.
Thank you, Dr.
Liao, for your guidance!

Xianliang, 30~39 year old female. Ask Date: 2007/11/21

Dr. Liao Lingmei reply Pharmacology

Hello: In principle, it is not appropriate to provide further information about a medication when the name is uncertain.
However, if the controlled pain medication referred to as "damoro" is possibly Demerol, then it is important to note that Demerol is a Schedule II controlled substance used for the treatment of moderate to severe pain.
This medication has a short duration of action and is not recommended for long-term continuous use.
If a physician assesses that the patient's condition warrants its use, there is no need for further concern.
The general recommendations for administering this medication include intramuscular injection, subcutaneous injection, or oral administration, with a dosage of 50 mg to 150 mg every 3 to 4 hours.
For intravenous administration, the dosage is typically infused at 15 to 35 mg per hour.
The patient-controlled analgesia (PCA) dosage varies based on the patient's condition, and the amount used should be the minimum effective dose to relieve pain.
This dosage may differ among patients, and if the patient experiences excessive reactions, alternative medical interventions can be employed, thus there is no specific dosage limit available.
Most controlled substances carry a risk of addiction and dependence if misused.
However, if prescribed for short-term use by the original treating physician, the risk of addiction and dependence is minimized.
Patients should not independently decide or request medications from a physician who is not their primary care provider, as there are instances where patients with addiction issues seek out emergency physicians for injections, creating challenges for healthcare providers.

Wishing you health and happiness.

Reply Date: 2007/11/21

More Info

When it comes to managing chronic pain, especially in patients who have undergone multiple surgeries and have a history of pain sensitivity, the use of controlled substances such as opioids can be a double-edged sword. Your concern about your wife's potential for addiction to a medication like "damoro," which is likely a reference to "Demerol" (meperidine), is valid and shared by many caregivers and patients alike.

First, it's important to understand that medications like Demerol are classified as Schedule II controlled substances due to their potential for abuse and addiction. They are effective for managing moderate to severe pain but come with significant risks, particularly when used over extended periods. The risk of developing tolerance, dependence, and addiction increases with prolonged use, especially if the medication is administered frequently, such as every four hours, as you mentioned.

Your wife's situation is complicated by her allergies to other pain medications, which limits her options for pain management. This is a common scenario in pain management, where patients may have to rely on a specific medication that may not be ideal due to its addictive potential. The key to mitigating the risk of addiction lies in careful management and monitoring by healthcare professionals.

1. Controlled Use: As you noted, the statement from the anesthesiologist about "controlled use" is crucial. This means that the prescribing physician should regularly assess your wife's pain levels, the effectiveness of the medication, and any signs of dependence or side effects. If her pain is not adequately controlled, it may be necessary to explore alternative pain management strategies, such as non-opioid medications, physical therapy, or even interventional pain management techniques.

2. Dosage and Administration: The typical dosing for Demerol is 50 to 150 mg every 3 to 4 hours, but this can vary based on individual patient needs and responses. It's essential that your wife's healthcare provider tailors her treatment plan to her specific situation, considering her pain levels, response to the medication, and any side effects she may experience. Regular follow-ups can help adjust the dosage as needed and minimize the risk of addiction.

3. Multimodal Pain Management: Given the risks associated with long-term opioid use, a multimodal approach to pain management is often recommended. This can include the use of non-opioid analgesics, adjuvant medications (like certain antidepressants or anticonvulsants), physical therapy, cognitive-behavioral therapy, and other non-pharmacological interventions. This approach can help manage pain effectively while reducing reliance on opioids.

4. Monitoring for Signs of Addiction: It's essential to be vigilant for any signs of addiction, such as increased tolerance (needing higher doses for the same effect), withdrawal symptoms when the medication is not taken, or compulsive use despite negative consequences. Open communication with her healthcare team about any concerns can facilitate timely interventions if needed.

5. Patient Education: Educating your wife about her medication, its potential side effects, and the importance of adhering to the prescribed regimen can empower her to participate actively in her pain management plan. Understanding the risks can also help her recognize when to seek help if she feels her pain is not being managed appropriately.

In conclusion, while the use of controlled substances like Demerol can be necessary for managing severe pain, it is crucial to approach their use with caution. Regular monitoring, a tailored treatment plan, and a multimodal approach to pain management can help mitigate the risks of addiction while effectively addressing your wife's pain. It is advisable to maintain open lines of communication with her healthcare providers to ensure that her pain management plan is both effective and safe.

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