IS KILLING PAIN A PATH TO ADDICTION?

Rush Limbaugh's prescription drug addiction sent a chill through an
estimated 75 million Americans battling chronic pain.

Are Limbaugh's troubles a cautionary tale for the rest of us with a
cache of amber canisters for recurrent migraines, back pain or arthritis?

Joan Lanfear and others specializing in pain management worry about
backlash from the radio talk show host's widely-publicized problems.

"It's become a barrier," Lanfear said. "People fear becoming addicted
to pain medication."

An RN educator, Lanfear, coordinates pain management at Kalispell
Regional Medical Center.

She urges patients not to chuck the quality of life provided by their
legally-prescribed drugs. According to Lanfear, addiction comes from
abuse, not proper use, of pain relief drugs.

"People have a misconception about how prevalent prescription
painkiller addiction is...or, I should say, is not," Lanfear said.

Statistics from the American Pain Foundation and other such
organizations show addiction rarely results from use of narcotics for
pain relief. It occurs in less than 1 percent of all cases.

As coordinator of the pain management, Lanfear researches drugs to
keep the medical staff up-to-date on the latest protocols for
effective pain control. She described Limbaugh's drug, OxyContin, as a
good tool for pain relief.

"It provides long-acting pain relief with one dose by providing a
steady blood level," she said.

A schedule II controlled substance, OxyContin is the trade name for
oxycodone hydrochloride, The drug is a controlled-release form of the
opioid, oxycodone.

Opioids such as oxycodone, morphine and codeine differ from
over-the-counter analgesics like aspirin in that they have no
threshold for effectiveness. In other words, the more a person takes,
the better he or she feels.

Once opioids bind to receptors in the nervous system, they provide a
range of effects from pain relief to slowed breathing to euphoria.

Lanfear said people may develop a tolerance to opioid drugs and need
increased doses for pain relief leading to physical dependence.
Physical dependence on a pain killer differs from addiction and can be
treated by a physician with a slow withdrawal of the medication.

"That (addiction) is truly a psychological illness," she said. "There
is no high from taking drugs for pain..just relief from pain."

The American Academy of Pain Medicine, the American Pain Society and
the American Society of Addiction Medicine identify addiction by the
three "C"s:

craving or compulsive use,

loss of control

and use in spite of consequences (such as divorce, liver disease, or
loss of employment)

In recent years, Lanfear said medical science has recognized the
important role pain control plays in healing. She said better pain
control equals better patient care today.

"It's become a real focus of health care," she said.

When educating patients, Lanfear explains their role in helping their
health care provider manage their pain. They need to learn to
recognize and rate their level of pain on a scale from 1 to 10.

To judge an individual's pain tolerance, health care providers ask
where on the pain scale the patient could sleep through the night.
According to Lanfear, most say one or two but some say five or six.

"Some people are fine with moderate pain," she said.

The dose provides another variable. Lanfear said a physician begins
with a given dose than reassesses the effect.

"Narcotic pain killers have different effects on different people,"
she said.

As an example, she said her mother broke her ankle but walked on the
foot without much pain. An x-ray revealed she needed surgery with an
injury that would cause some people a lot of pain.

Even after surgery, her mother needed very little pain medicine to get
moving again. Even at 75 years-old, her mother scores high pain tolerance.

On the opposite end of the scale, patients with a low tolerance
sometimes become traumatized at the prospect of a medical procedure.

Lanfear recalled a woman who delayed needed orthopedic surgery because
of her terror of pain. She assured the woman that she had a right to
expect her pain to be controlled.

Lanfear also taught her release and diversion relaxation techniques to
reduce her anxiety. As a result, the woman came to the hospital
prepared with music and a laptop with pictures of her grandchildren to
help her relax.

"Previously, no one had treated her pain aggressively," she
said.

A mistaken belief that pain had physical symptoms like a rise in blood
pressure once caused physicians to mistrust a patient's claim of
severe pain. But research revealed that while the body adapts to pain,
the patient continues to suffer.

"People do tell the truth about their pain," Lanfear
said.

She said that most patients seek medical treatment in the first place
because they feel some kind of discomfort or pain.

Until the last couple of years, physicians had to worry about
over-prescribing controlled drugs. Class II drugs, like OxyContin,
bring a double whammy of monitoring from the Drug Enforcement Agency
and the Department of Justice.

Some overzealous prosecutions of physicians made it difficult for
doctors to have the leeway to treat severe, chronic pain. On the other
side, some physicians have been sued for under prescribing for
terminal patients.

"Those people don't become addicted," Lanfear said. "They have immense
pain."

To solve the problem, she said law enforcement and medical
professionals got together to allow aggressive pain management for the
humane treatment of intense, chronic pain.

"Chronic pain is any pain that lasts longer than six months that can't
be relieved," Lanfear said.

She urged people not to let fear of addiction keep them seeking
treatment for pain. By trying to just live with it, they risk
developing a chronic problem.

"After experiencing acute pain, the longer the person goes with it
untreated, the greater the possibility that it will never go away,"
Lanfear said.