Peter Hibberd, M.D., is a doctor whose advice is based on more than 28 years of hospital outpatient and inpatient experience. He is an experienced emergency medicine physician, surgeon, and consultant. Dr. Hibberd is certified by the American Board of Emergency Medicine. He is also a fellow and active member of the American Academy of Family Physicians, an active member of the American College of Emergency Physicians, and a member and fellow of the American Academy of Emergency Medicine. Dr. Hibberd has earned numerous national and international professional certifications, memberships, and awards.

Should I Trust My Doctor's Advice Regarding Pain Management?

Monday, 28 June 2010 03:19 PM

Question: I have had a morphine pump since 2001. I'm now told that I can't have any more hydrocodone along with my pump because my doctor says it's a red flag. Can you tell me why? The pain is real and at times I can't stand it.

Dr. Hibberd's Answer:

The fact that you are on a morphine pump tells me you have serious pain issues with serious physical reasons for chronic pain. Morphine is not used for emotional or factitious (non-physical) pain. The need for supplemental oral pain relief while on a morphine pump is not at all unusual. Hydrocodone is not a red flag for you.

However, this comment is a red flag for me to closely scrutinize this doctor. These agents are addictive, and good pain management dictates the use of multiple agents to minimize dependency. You have not described the use of other agents, so I suspect your care is substandard.

I recommend you change doctors immediately. The use of the term "red flag" by a professional to a patient suggests to me that the doctor has something to hide and is possibly suggesting inappropriate use, yet not willing to do anything about it.

Go to a good primary-care medical doctor for guidance and assistance with appropriate therapy and referral. There are many effective pain management options available to you that should be explored.

Medically indicated short term narcotic use is appropriate. Generally, long-term narcotic use for non-terminal conditions is unwise, if not inappropriate. Commonly used adjuncts to pain management include other drugs (antidepressants, NSAIDs, anticonvulsants, etc.), trigger point or local injections (saline, steroid, anesthetic, NSAID, and even "botox"), biofeedback, central and peripheral nerve stimulators, and even local nerve modulation procedures.

You need help, not avoidance! The "red flag" here points to the professional you have selected. Unfortunately, it now appears you are also addicted to narcotics courtesy of your doctor, in addition to having an inappropriately treated chronic pain condition. The next step is yours!

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