The December Pain-Blog Carnival is December 31.  The submission deadline is December 24.

Twice a month, I’ll answer readers’ questions (This month, I’m trying to get through a back-log, so am answering a few more.  Thanks for your patience!).  Click here to submit a question.

Heidi writes:
I wonder if other people on prescription pain killers have issues around taking them as often as they really should?  Some people might fear addiction or be reluctant to take medication.  I find myself “holding out” when I should be taking the medication my doctor has prescribed to improve my quality of life.

Heidi raises several important points.  People err on 2 ends of the medication issue.  There are those, like Heidi, who are concerned about medication and tend to under-take what’s been prescribed.  On the other hand, there are those who over-use medication, who always reach for a pill before trying anything else to help themselves.  Let’s take a look at the first scenario.

Under-using Medication

The biggest reason I see for why people don’t use medications is concern over addiction to medications, especially narcotics.  It’s important to separate addiction from tolerance or withdrawal symptoms.  True addiction is a medical disorder where a person uses narcotics despite problems such as:

• being unable to function at work

• having problems in relationships because of abusing medication

• using doses higher than prescribed

• going to multiple doctors to get more and more medications, in particular narcotics

• using medication for symptoms other than pain, for example stress or depression

• using medication to get high

This is different from tolerance, which is a condition where higher doses of narcotics are truly needed to treat pain.  Addiction is also different than withdrawal symptoms, which is just your body’s response to being without a medication it’s used to.  You can certainly have withdrawal symptoms or tolerance without these indicating you’re addicted.  (For example, you can have withdrawal symptoms after you stop medications for sleep, allergies, or high blood pressure.)

Only about 5% of people on narcotics develop true addiction.  If you have any of the above warning signs of addiction, speak with your doctor.  If it’s just an unfounded worry, work to get beyond this, so you can get the most benefits from medication that’s prescribed for you.

There are many other reasons people under-use medication, including:

• being too stoic

• fear of being “weak”

• family pressure to not use medication

• unwanted side effects

• medication isn’t effective

• depression – being too discouraged to take care of yourself

• medication costs too much

If you under-use medications, these are some of the risks you run:

1. Missing out on better pain control.  If you take medication appropriately, you might get better pain control.  Think of how this might really improve your life, as well as the lives of those around you.

2. Playing catch-up with pain, rather than preventing it.  Trying to get pain under control after a flare-up is usually harder than preventing it in the first place.  Avoiding flare-ups by regularly using medication is a much better way to go.

3. Your medical team will think the medication isn’t working.  Let’s say you’re prescribed 2 tablets a day of medication, but instead you take only 1, or sometimes none.  If you go back to your doctor and report things haven’t improved, she’s going to think that the medication isn’t working.  She might prescribe a higher dose, a different medication, or more aggressive treatment, when you actually never had a good trial of the medication to begin with.  This interferes with you getting the best medical care possible.

How do you get over your fears of medication?

1. Too stoic or fear being weak?  Instead of focusing on what medications you’re taking, or how much, focus instead on improving your functioning through whatever methods work for you.

2. Family pressure to avoid medication?  Have them read this series for family members and go with you to your appointments, so they can have their concerns addressed.  Then they may be able to better support you in your pain management plan.

3. Side effects or medication not working?  Discuss these issues fully and directly with your doctor.  You and he should work together to help you be as comfortable as possible, and function as well as possible.  And that takes you being assertive to let him know what works and what doesn’t.

4. Depression?  Again, speak with your pain management team, so this can be treated.

5. Too costly?  Speak with your doctor about this concern.  There often is a less-expensive medication which can be substituted.  Or, there are prescription assistance programs, where you can get your medication for free or at a reduced cost.

What thoughts do you have about Heidi’s question?  Please share them in the comments!

Other articles you might like to read:

• Narcotics and Opiates

• Family Issues and Narcotics