Over medicating?

Hi I was just wondering... my husband has had several carpal tunnel surgeries and has a metal plate in his hand.He also has C4 and C5 vertibrates in his neck fused together. His Dr. has him on what I think is too much medication but hopefully you can tell me. He is on Oxycodone,Oxycotin,Valium, Morphene sulphate, not to mention his "normal meds" Vioxx and Zocor. When he gets home from work he falls fast asleep with his mouth wide open trying to read the paper. He cannot sit still for more than 5 minutes before he falls asleep. Am I crazy or is he being overmedicated??

This is a question your husband has to address to his doctor. Chronic pain requires a different treatment than acute pain disorders. So you might be right that the choice of medication is no longer appropriate. I do not like a mixture of different drugs like this. But their might be reasons for this. Sometimes patients go to different doctors and ask for pain relief medication or anxiolytics. So the doctors do not know about the mixture of drugs.

I think it might be necessary to use opiods but usually we use one drug of each class and try to avoid a mixture. Antidepressant medication can be a very useful help for patients with pain disorders. Antidepressant to not only have a positive effect on mood but can also modulate the awareness of pain. Benzodiazepines (like Valium) should be restricted to a short-term use (however, we know of patients who take benzodiazepines for years).

Has your husband got psychotherapeutic help to cope with his pain? There are special cognitive-behavioural treatment programs for pain. They are very effective and would help to reduce the present demand of medication.

The present side effects or tiredness might be related to the medication. Maybe other reasons influence the problem (e.g. sleep apnea syndrome or any other medical condition). So your husband should address his problems at the next consulation with his local doctor.

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.