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Suggested Guidelines for Management of Acute Pain in Recovering Patients
Management of acute pain (e.g. post-operative, post-trauma) should be a concern for both the recovering patient and those providing their care. Precipitating a relapse is a major issue for the recovering patient and is always possible if pain is not properly managed. There is very little how-to information in the organized medical literature. The following are some how-to suggestions based on available literature, discussions with physicians and patients and the experiences of a number of physicians caring for recovering patients. These should help facilitate adequate, appropriate, and safe treatment of acute pain in recovering patients.
Background
- Recovering patients have a lower pain threshold than non-recovering patients.
- Recovering patients have a higher tolerance for narcotics than non-recovering patients.
- Recovering patients are traditionally undertreated for acute pain.
- Recovering patients receiving narcotics may attempt to manipulate the situation to obtain more medication for a longer time than necessary.
- A recovering patient is very concerned about relapsing (may or may not acknowledge this).
- Dosage has very little to do with precipitating relapse.
Basics
- Know patient’s previous addiction history (e.g. drug(s) of choice, when and how got into recovery, quality of recovery, relapses —when/how).
- Avoid drug(s) of choice
- Use adequate doses to control pain-may be 25-30% more than dose for non-recovering patient of some age, sex, weight, type of operation.
- Use non-narcotics and non-medication techniques when possible.
- Physician is willing to address patient’s concerns, involve patient in process will assure patient/family relapse is not inevitable or probable if situation is properly addressed.
- Discuss what options are available if active relapse should occur.
- Actively utilize existing support systems (e.g. AA/NA sponsor).
- Real physiologic withdrawal (not psychologic) may occur even after short (24° ) use of narcotics due to cellular memory.
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