How do you address the aspect of pain control in palliative care, when the patient or family are concerned about addiction to the pain medications?

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JanetAbrahmMD (Physician - Hospice / Palliative Care (Verified) ) - 04 / 23 / 2012

That is a very normal concern. But very few patients receiving medication for pain become addicted. Being addicted to a pain reliever means taking it “to get out of your life”; patients take pain medications to get back into their lives, to function in the ways they did before the pain robbed them of being parents, or bread winners, or soccer coaches. Being addicted means lying to get medications, taking them despite harm to yourself or your family, and taking them for reasons other than pain caused by your illness or its treatment. Patients who have life-limiting diseases, like cancer, and who have not had any problems with addiction to alcohol or illegal substances before they start taking opioids for pain rarely develop addiction. As I tell my patients, “You are not going to start stealing TV sets!” Patients don’t like the “high” feeling that they get if they’re on more pain medicine than is needed to relieve their pain. They are likely also to develop drowsiness or nausea if they’re taking too much. If any of these occur, the physician will reduce the dose to an amount that will relieve the pain without those side effects. If a patient has had problems, using substances aberrantly, his or her physicians will need to work with the addiction team the patient is seeing to provide the safest and best care and the most effective pain relief. Patients who take opioids for a long time will become what is called “tolerant” to their effects, and if they stop taking pain medication suddenly they will getting sick. But that is NOT addiction; it is the body’s normal adaptation to the medication.
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