Thursday, October 4, 2012

Heroin dependent Persons More Sensitive to Pain

Heroin and I would imagine other opioid persons are more sensitive to pain (hyperalgesia) than a control group. No word if the hyperalgesia was a result of the heroin use or if person's with hyperalgesia are more likely to use heroin.  

For individuals who have been or are addicted to narcotics, and to a lesser extent other substances (alcohol),    are rarely treated for their physical pain.  When narcotics are given the dosages are rarely adequate in providing analgesia.  If the patient in on a maintenance regime, such as methadone or suboxone, very large doses are needed for pain relief, dosages which may be fatal in non-tolerant individuals.  Doctors have been conditioned to be very frugal when dispensing narcotic analgesics for fear of a patient developing " iatrogenic addiction."  The actual number of people whose opioid dependence can be traced back to treatment of physical pain is very small (citation needed).  This leads to under treatment of pain in all patient groups.  

Due to stigma and discrimination illicit drug users generally receive poorer medical care than the general population and this is doubly true for users seeking pain relief.  Users know this and rather than be subjected to discrimination and moralizing lectures about their drug use they tend to avoid hospitals and medical centers.  Of course this leads to poorer health outcomes as minor ailments are left untreated until they can no longer be ignored.  

This also means that, for better or worse, the fates of chronic pain patients and opiate addicts are intertwined.  Doctor's have been prosecuted for providing opioid medications in "excessive" amounts.  The judgement of what is considered "excessive" are not made by patients, individual doctors or even medical boards but by the expert medical opinion of law enforcement.  I suspect that many chronic pain patients are angered by opiate addicts and blame them for difficulties in obtaining proper pain medication regimes.  This is understandable although misguided.  The blame lies with the government and our opiophobic culture.  Law enforcement agencies like the DEA think they know better than patients and doctors how much pain patients should live with.  I hope these asshole agents and prosecutors get a horrible, painful disease and reap what they have sown.

Hyperalgesia in heroin dependent patients and the effects of opioid substitution therapy.[Abstract Link]

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