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Safe Dose of Pain Medicine - Is It the Same for You and for Me?


Updated March 23, 2009

Question: Safe Dose of Pain Medicine - Is It the Same for You and for Me?
"The dose of an opioid pain medication that is safe for you could be high enough to cause an overdose and death in someone else, especially children." I read that recently and asked rheumatologist Scott J. Zashin, MD, to explain the significance of the statement.


Dr. Zashin Explains His Perspective on Safe Use of Pain Medicines

"Narcotic pain medication can have varying effects in different people. As a result, if a narcotic is required for musculoskeletal pain, I will initially prescribe the lowest dose at the longest interval," Zashin said. "Some may find the medication causes drowsiness, so it is important to caution patients not to drive when first initiated on a narcotic and to refrain from driving if they feel fatigued or sleepy. Other patients may get a boost or "high" from the medication. It is this latter effect that may contribute to some patients becoming dependent on these medications."

Zashin continued, "Over time the use of pain medicine may cause a tolerance where more frequent or higher doses are needed to provide pain relief. In an ideal situation, pain medicine is used only for periodic pain relief on an as needed basis. In my practice, when patients require regular use of a short acting pain medication such as codeine or hydrocodone at or near the maximum recommended dosing, I will recommend a longer acting pain medication such as the Duragesic (fentanyl) Patch. This fentanyl patch is worn for 72 hours and provides a constant level of narcotic to eliminate the peaks and valleys which occur with shorter acting preparations."

"I then prescribe the short acting pain reliever for 'breakthrough' pain as needed but in a very limited amount. Patients using pain medications routinely should enter into a contract with their doctor which would require that only one physician is prescribing the medication as well as other rules to enable the safe use of these potent medications", Zashin concluded.

Are You Compliant With Your Doctor's Plan for Using Pain Medicine?

Safe use of pain medicine hinges on good communication between you and your doctor. Pain medicines are not to be taken lightly and they must be used appropriately. Your doctor will decide on an individual basis what your pain medicine and dose should be -- but it's up to you not to go beyond boundaries that are set. It's also your responsibility to tell your doctor honestly if you are tempted to use more than the maximum prescribed dose. Think about why you are taking pain medicine -- and if you start to require more than prescribed -- or you find yourself taking it for other reasons -- talk to your doctor.

Dr. Zashin is clinical assistant professor at University of Texas Southwestern Medical School and an attending physician at Presbyterian Hospitals of Dallas and Plano. Dr. Zashin is author of Arthritis Without Pain - The Miracle Of TNF Blockers. The book is useful for anyone on one of the biologic drugs or considering the biologic drugs.

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