Discussions that mention benzodiazepine

Pain Management board


Now there is not a law that says he can't, buty likely he's isn't comfortable presecribing any longer. Can I ask why you need pain meds, howe long you did the detox? Once you have the detox stuff in your file, If you really need continued opiate therapy to remain functional then you need a PM doc that truly understands about addiction Vs dependence and addiction Vs psuedo addiction.

Here is a excerpt from Dr Brookoffs article, One of the Leaders in PM in the country.
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Tolerance to Opioids
That most adverse side effects of opioids resolve on their own is an indication of growing tolerance with continued use. Tolerance can also be conferred by other factors. Severe pain, for example, allows patients to tolerate the sedative effects of opioids. Whether tolerance develops to the pain-relieving effects of opioids is a matter of controversy. Most of the data on opioid tolerance and physical dependence in humans involves subjects who were not in pain. Studies of patients with chronic pain who have taken opioids for a long time indicate that once the dose required for pain relief is established, it generally remains stable unless the underlying disease progresses.

Often, when a specific treatment or adjunctive therapy begins to work, patients who have been taking opioids for some time will begin to feel somnolent or sedated, or will not require rescue medications for long periods. That is the time to consider slowly tapering the long-acting pain medication.


Physical Dependence on Opioids
With long-term use of opioids, patients will experience physical symptoms (abdominal cramping, sweating, nausea, diarrhea, irritability) if the medication is abruptly withdrawn or the dose is markedly reduced. This type of physical dependence is not limited to opioids but can occur with other drugs such as antihypertensives and steroids. It is a medical condition and should not be taken as a sign of psychological or spiritual weakness. Withdrawal symptoms are easily avoided by using a tapering regimen when lowering the dose. This can nearly always be done, without discomfort, in an outpatient setting. When necessary, however, withdrawal symptoms can usually be relieved by slowing the taper or using small doses of clonidine or a benzodiazepine.


Appropriate Use Versus Abuse
Nothing is intrinsically good or evil, but its manner of usage may make it so


--St. Thomas Aquinas


The fear of drug abuse and drug addiction is the major reason that physicians are reluctant to prescribe opioid medications for patients in severe pain. The inappropriate use of a medication for a nonmedicinal problem is drug abuse. Using a pain medication to get high or euphoric is clearly inappropriate, as is using drugs to escape family or other problems that should be dealt with by other means. If a patient's physical pain has prevented him or her from living life fully, using a medication that allows a return to normal activities cannot be called drug abuse.

The appropriate role of medicine is to prolong and maintain life, promote function, and provide comfort from symptoms of disease. It is up to the physician to determine whether the prescribed medications are being used to participate in life or to escape from it. The patient's mood and activities, and the reports of family members, can be helpful indicators. Health care facilities are beginning to use validated quality-of-life instruments that should make the assessment of appropriate and inappropriate use easier. Appropriate use of pain medications can significantly increase the quality of life; inappropriate use invariably decreases it.


Addiction and Pseudoaddiction
Taken to the extreme, drug abuse can become drug addiction, a driving force that leads to compulsive, socially inappropriate, or even dangerous behaviors. The overwhelming majority of drug addicts report that their addiction began with recreational drug use. Medical use of opioids is generally not associated with addiction.

The most important predictor of continued abuse or addiction is previous substance abuse. If a physician prescribes a pain medication in good faith, anyone who leaves that physician's care with an addiction probably already had a problem when the treatment began. That is not to say that addiction disorders are not an important concern--they are serious health problems that must be evaluated and treated. If substance abuse or addiction is strongly suspected, the patient should be referred for evaluation by a psychologist or psychiatrist who has had experience working with chronic pain patients.

Inappropriately labeling patients as addicts can alienate them from their caregivers and family, deepen their isolation, and prolong their suffering. Denied the pain treatment to which they are entitled, patients often say that they feel isolated, anxious, and even desperate. The obsessive and manipulative behaviors that these feelings engender, which can sometimes be confused with addiction, are called pseudoaddiction. Russell Portenoy's tabulation of drug-seeking behaviors is a useful reference for discriminating between addiction and pseudoaddiction (Table 2). I go over this table with my patients so that they are specifically aware of what I consider to be inappropriate behaviors.


Table 2. Behavioral Assessment of Drug
Abuse or Addiction

Predictive Behaviors
Selling prescription drugs
Obtaining prescription drugs from a nonmedical source

Stealing or borrowing drugs from others

Using illicit drugs or abusing alcohol

Injecting oral formulations

Escalating dosage or otherwise not complying with
therapy despite repeated warnings

Seeking prescriptions from other physicians without
informing the prescriber or after being warned to stop

Demonstrating functional deterioration related to drug use

Resisting changes in therapy repeatedly despite adverse
drug effects


Nonpredictive Behaviors
Complaining aggressively about the need for more medicine
Hoarding drugs during periods of reduced symptoms

Requesting specific medications

Escalating dosage or otherwise not complying with
therapy on only one or two occasions

Using medication to treat unrelated symptoms

Reporting psychic effects not intended by the physician


Adapted from Portenoy, 1994

Hey Woolf, There are plenty of non opiaat methods to manage pain, If nothing else works and you have exausted all other efforts than a Pm cmay be of help. But 10 years of lortab is realy not the best way to manage long term pain. The lonhg acting meds don't havethe feeling off kiccking and and after a smooth sewrum level is establish virtually all side effects associated with abuse deisapear and all your left with is anelgesia and constipation. GOod luck with whatever you decide. In the old days before you go could right to a PM doc and get a script for OxyContin in the ffirst visit it wasn't uncommon to go through a dozen or more different PM docs that didn't believe in the use of pain meds and thought all pain can be controlled with relaxation and antidepressants. As many docs as you can see there are that many modalities to try to manage pain. If you have tried dozens of other methods than make a list of them all. the practioneer, where, when , contact info andf the results so your prepaired for you PM apt./ "pain management"
Good luck, Dave

PS most likely you will need a referral to a PM doc. If your GP thinks you have an addiction problem he will likely steer you away from docs that he knows prescribe opiates for pain. You may even need to change GP's to get away from your current docs attitude about your present condition.
Good luck, Dave