Health beat: Chronic pain patients wary of pill changes

  • Article by: MAURA LERNER , Star Tribune
  • Updated: June 22, 2013 - 4:46 PM

Not everyone is thrilled that doctors in Minnesota are trying to curb the use of prescription painkillers, as described in a Star Tribune story last week.

The switch has been fueled by the soaring number of people dying of accidental overdoses, such as former Wild hockey player Derek Boogaard. But some patients fear the swinging pendulum will leave them writhing in pain.

“I’ve been a chronic pain patient for 7 years,” one reader wrote. By his own account, every month he takes over 400 pills of oxycodone, a narcotic painkiller — on average, 16 pills a day. “Without them, I would not even be able to get out of bed.”

It’s the kind of story that makes doctors cringe.

“We’ve been hearing the message for so long that you’re not practicing good medicine if you’re not aggressively treating pain,” says Dr. Patrick Courneya, a medical director at HealthPartners. So it’s not surprising, he said, that some people are anxious about giving up the pills.

Yet research has shown that prescription painkillers are not as effective as people once thought for chronic pain, said Dr. Marvin Seppala of the Hazelden Foundation. “Someone with chronic pain, over time, is going to develop tolerance to opioids,” he said, meaning they need larger doses to get the same effect.

And addiction isn’t the only risk. For some, painkillers have the perverse effect of blocking the body’s natural pain filters. So people become hypersensitive to pain and need even more pills. “You wind up in a vicious cycle,” said Courneya.

Now, doctors are being urged to limit pain meds and encourage alternatives: physical therapy, exercise, counseling and old-fashioned Tylenol.

But it’s clearly going to be a challenge, Courneya said, to persuade people who are living on painkillers that it’s time to make a change. And to provide them with palatable alternatives.

Says Dr. Gavin Bart, an addiction specialist at Hennepin County Medical Center: “When someone is needing pain medications every single day, you need a better plan.”

maura.lerner@startribune.com

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