By Steve Ariens, Ph.D.
We often hear about chronic pain patients need to increase their dosage because of tolerance to their medication(s).
Many of the people that put out all these “facts” tend to blend various facts about pain medications – opiates in particular – and apply it to all those who use opiates both legally and illegally.
Factually, those people who use opiates illegally – to get high – to silence the demons in their head and/or monkeys on their backs… will rather quickly develop a tolerance to getting “high” off of the same amount of opiates … so they tend to increase the amount of opiates that they take to seek that “high” that they were able to reach when they initially started abusing some substance.
Normally, after a rather short period … one to two years… the substance abuser can no longer get a high from the substance that they have in the past, because of tolerance…but they are forced to continue using the substance because of WITHDRAWAL or what a substance abuser calls “dope sick”.
Now the chronic pain patient, many of whom are under treated in the first place. Their pain is caused by a disease state and all too often disease states tend to deteriorate over time and will cause additional pain.
Additionally, many chronic pain patients start down their pain path while they are in their younger years.. And aging itself will cause more aches and pain on top of the aches and pains they are experiencing from their disease state.
Then there is activity induced pain. Most chronic pain patients only wish to be able to act/function like other people… to be “normal”. Many circumstances will cause them to not “pace themselves”.. trying to do something, keep up with friends or family at a family gathering, or just try to do personal care issue and tasks around the home.
Some profess that rotating opiates helps prevents a patient’s tolerance, but there is no black/white formula of xx mgs of drug A is equal to xx mgs of drug B. What ends up happening is the patient’s pain management is titrated up on drug B and everyone ends up happy believing that they are addressing “opiate tolerance” for the pt.
A patient’s need for increased dosing, doesn’t need a PhD in Pharmacodynamics, just a little common sense will explain a lot.