Zu viel Medikation?

Hallo ich mach mir gerade Gedanken... mein Ehemann hat nach mehreren Operationen wegen einem Karpaltunnelsyndrom Metalplatten in seiner Hat. Zudem wurden Verblockungen der Wirbel C4 und C5 durchgeführt. Sein Arzt hat ihm eine ganz Reihe von Medikamenten verordnet, u.a. Oxycodone, Oxycotin, Valium, Morphium-Sulfat und zudem noch seine übliche Medikation mit Vioxx und Zocor. Wenn er abends von der Arbeit nach Hause kommt, schläft er fast sofort ein und kann kaum noch die Zeitung lesen. Er kann kaum 5 Minuten sitzen, ohne einzuschlafen. Bilde ich mir etwas ein oder erhält er zuviele Medikamente?

Dies ist eine Frage, die Ihr Ehemann an seinen Arzt richten muß.
Chronischer Schmerz erfordert eine andere Behandlung als eine akute
Schmerzstörungen. Daher könnten Sie recht haben, daß die Wahl der
Medikation nicht mehr angebracht ist. Ich persönlich mag keine solche diffuse Kombination verschiedene Medikamente. Aber es kann ja durchaus Gründe hierfür geben.. Manchmal gehen Patienten zu verschiedenen Ärzten und bitten um
Schmerzentlastungsmedikation oder Benzodiazepinen. Daher wissen die
Ärzte nicht von der Kombination der Medikation.

Wahrscheinlich wird es erforderlich sein, auch opiodhaltige Medikamente einzusetzen. Doch sollte man hier versuchen, möglichst ein Medikament zu verwenden und die erforderliche Dosis bestimmen. Ausserdem sollte man den zusätzlichen Einsatz von Antidepressiva erwägen. Diese Medikamente können eine schmerzmodulierende Wirkung haben und die Schmerzwahrnehmung selber positiv verändern.

Hat Ihr Ehemann psychotherapeutische Hilfe erhalten, um seine Schmerzen zu bewältigen? Es gibt spezielle kognitiv-
verhaltenstherapeutische Behandlungsprogramme für den Schmerz. Sie sind sehr
effektiv und helfen, den akutellen Medikationsbedarf zu reduzieren.

Die gegenwärtigen Nebenwirkungen oder die gegenwärtige Müdigkeit
könnten auf die Medikation bezogen werden. Vielleicht beeinflussen aber auch
andere Gründe das Problem (z.B. Schlaf-Apnoe-Syndrom oder eine andere
medizinische Ursache). Daher sollte ihr Mann diese Problematik beim nächsten Arztbesuch ansprechen.

Thanks for getting back to me. I really do appreciate it. As far as going to different doctors and getting mixtures of different pain medication, no, he has only the ONE doctor and every perscription has his doctors name on it. Therefore the doctor does know exactly what my husband is taking. As far as talking to his doctor about other options my husband has. In fact my husband went in and asked the doctor if he could have another cortisone shot but the doctor simply told him no. He had even went in and told the doctor that he would like to undergo some kind of alternative pain management. That is when he came home with the morphene sulphate. He also has been experiencing sexual side effects and again my husband told the doctor but was handed Viagra, which of course being on so many other meds didn't help in the least. I have tried to talk to his doctor but due to the patient privacy act he won't tell me anything. Any ideas on what I need to do next? I'm very concearned and feel helpless...

I suppose the main problem is to understand that acute and chronic pain need a different treatment. This is not very well known.

A patient with pain will ask for medication for pain relief or cortisone. The doctor was right to refuse cortisone. But he might feel helpless considering options to handle the chronic pain problem. Using pain medication for any pain problem that lasts longer than 6 months will do not solve the problem.

Chronic pain is characterized by major changes of awareneness of the pain and behavioural consequences in daily life. You need a different treatment approach to handle these problems. Medication is one part of it. But you would not try to fight the pain but offer a permanent level of pain relief with opioids or other medication. Additional options (I think they should be used) are antidepressants to influence mood and awareness of the chronic pain.

Your husband would need a special psychotherapy to learn how to cope with the chronic pain. The first think he would have to learn is that his awareness of pain can be influenced by his behaviour. If he tries to fight the pain with medication he puts much attention on the pain problem. So much of his energy will go into this fight. I would recommend to write a symptom diary of his pain. Starting early in the morning to late in the evening he could make a protocoll of the pain (rating 0= no main to 10= very severe pain). He should also try to write down any events that happen to him. He might notice that there are episodes at the normal day with less impairment due to pain. Why this? There might be pleasant activities were he is not so much involved in his fight against pain.

He could start to introduce more positive activities or relaxation. Many of our patients notice that they are less troubled by pain if they are doing interesting thinks (hobbies, listening to music). He will notice only small changes, his pain will not go away completly. But this are first steps to arrange with his problems. A self-help group and books or special treatment programs for chronic pain would be great.

We have special treatment centers for chronic pain in Germany. I am sure there are such options in your country as well.

But it takes a long time until a patient with chronic pain accepts this treatment approach. Most patients will go to their doctor and ask for a new drug or any other option of pain relief. He has to change his mind about it. This might take some time. But it is worth to try.