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Re: pseudoaddiction/possible candidate?

Re: pseudoaddiction/possible candidate?

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Posted by MLWhitworth, MD on March 28, 2000 at 17:57:29:

In Reply to: Re: pseudoaddiction/possible candidate? posted by ila on March 27, 2000 at 21:53:38:

As we have well established here, your GP is dangerous so it would be well advised to change GPs if at all possible if there are others in Darwin. As for approaching your GP with info regarding pseudoaddiction, it would be in your best interest to present the opinion of the pain management doc you saw and ask if you could be placed on a regimen initiated by the pain doc, but managed by the GP with a followup every 6-12 months or so with the pain doc. I agree with the pain doc in that you may have deconditioning secondary to pain. The relationship between chronic pain and chronic fatigue syndrome is not well defined although there are certainly subsets of the population with one condition that have the other condition.

: Dear Dr. Whitworth, hope your spirits are high. Thanks for the answer. I have another question on that topic. How does one know if they are "pseudoaddicted"??

: From my diary, I calculate that I have been undermedicated for chronic pain for three years at the least. The GP I was referred to when the diagnosing Dr. moved to the local hospital has played on my fears of drug addiction for that long.

: When I became educated on drug use for chronic pain re. drug dependence not addiction, I became more assertive in my requests for medication, hence the move to low doses of oxycontin.

: Also, I took your advice re. not cutting oxy in half and proceeded to take the full 80mg once a day. Of course, I advised the GP of the need for this move.

: Unfortunately, he is not impressed and has indicated that he will move me back to 40mg tablets when I next require a script.

: The pain manager I saw on the 17th stated I am extremely undermedicated and require higher doses of oxy, adding that my body is deteriorating through extreme deconditioning which needs to be reversed before any constructive moves towards stabilisation can be actioned.

: "I do not drug seek". Although it is a very tempting alternative, it would be impossible to do in this town/area.

: My consulting with the pain doc has not endeared me or the physio (referred me) to the GP.However, from the choice of the GP's in town, he is the best. How do I address this issue with him at my next consult without alienating him, even though he is aiding in my "downfall", so to speak.

: Alternative options for supportive medical assistance is 320km's away. I am not in a financial or physically viable position to be able to travel that far every time I need a script or medical advice.

: Even then, there is no guarantee that the options available in Darwin are on a par with my needs.

: I didn't think about that option, I will ask that question when next I see the pain manager.

: Also, as a result of undermedication, is it possible to end up with chronic fatigue syndrome??
: What are the symptoms??

: As well as mountains of pain, I find I am lethargic at all levels. It is hard to move, get exhausted doing the smallest things, including posting/reading on my computer, reading makes me dizzy/nauseus and tired. Exercises, including my walks, send me into a cold sweat, dizzy, eyes twitch etc.

: Or maybe the undermedication plus stress has awakened the ross river virus in me?? Don't know, do know that everything is so hard these days.

: Pain in knees/ankles to toes is deep, achy, throbby pain with intevals of cramp and sharp, knife hits. Don't know what to do. Walking them out used to calm them down. Now it sends them rippling up and down the left side.

: Would really appreciate some assistance and advice here. Will relay this info to the pain doc when next I see him. Have relayed your advice to the physio and my GP. The GP does not appreciate your advice, the physio does.

: Take care and regads, ila:

: Pseudoaddiction is undermedication by the physician due to his unwillingness to use higher narcotic doses secondary to unwarranted addiction concerns, lack of education regarding narcotics, or concerns about his licensure. This causes predictable behavior in patients of "drug seeking". Of course if side effects become intractable, then the appropriate narcotic dose may never be reached.
: : Ally has possibly received her information regarding methadone from an addiction clinic who's staff is generally completely uneducated about chronic pain. These clinics emphasis is on withdrawal of all narcotics from former heroin addicts. They fail to see the difference in treating heroin addiction and chronic pain with methadone...they blaim the drug for all the ills of the world rather than the condition leading to heroin addiction in the first place. The addiction potential of chronic pain patients is very low, less than 1%. Also remember, these drug rehab clinics are staffed with addiction specialists whose emphasis is drug free, whether that is medically indicated or not. They peddle their services at the rate of thousands of dollars per week but fail to ever address whether chronic pain can be treated with narcotics...their answer is simply drug free period. Not realistic for all patients....they play on the patient's fears of the use of methadone.

: :
: : : Dear Dr. Whitworth, hope this post finds you in good health.

: : : Read your post to JohnV and Ally's notes and subsequent reposts. You say that the Dr's inadequate medication drops result in the paradox "pseudoaddiction".

: : : I'm confused - are you saying that that Dr's cause extra problems to the pain sufferer by under medicating them, as a result, the pain sufferer looks to other Dr's for pain meds and end up an addict because they're taking a whole lot of different meds??

: : : Or is the pain sufferer too scared to come off the meds they're on because their needs have never been met for so long that what they're really feeling are phantom pains?

: : : How would a rehab clinic know this? Shouldn't Ally be receiving counselling before she enters the clinic?

: : : How can this be allowed to happen in this day and age?

: : : take care, ila

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