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Red Flags for Pain Medication
Dr. Steven Grinstead
Relapse Prevention Expert, Author & Senior Consultant Trainer for Gorski-CENAPS® Corporation
Many people in chronic pain are afraid to take their opiate pain medication because they have heard horror stories of people getting hooked on pain pills. This leads to a decision to under-medicate and then they end up suffering as a result. On the other hand not taking effective precautions could lead to developing an addictive disorder. If you happen to be in recovery for alcoholism or another drug addiction the problem is even worse. If you under-medicate it could trigger a relapse. Of course the other side of the coin is overmedication; which could lead to rapid tolerance building and finally reactivation of an existing addictive disorder that was in remission.In the following exercise you will see a list of Red Flags or indicators that someone is using their pain medication in a manner that could eventually lead to problems or even addiction. Both you, your support network, and your treatment providers need to be familiar with these red flags and to seek professional help from a person trained in addiction who also has experience, understanding, or training in pain management if problems surface. By doing this you will be able to work with your healthcare providers to make better decisions about using potentially problematic pain medication.
Below is a list of Red Flags or indicators that you may be using your pain medication in a manner that could eventually lead to problems or even addiction. Both you and your treatment providers need to be familiar with these red flags and to seek professional help from a person trained in addiction who also has experience, understanding, or training in pain management.
Quiz
Instructions: Please review each of the items below and rate each on a 0 to 10 scale with 0 meaning this item is not, or has not been, a problem to 10 meaning this, is or has been, a serious problem.
- After adjusting to the medication you still experience a sense of euphoria.
- You are starting to have a preoccupation with your pain medication.
- You start having urges or cravings about your pain medication.
- There is an abnormal increase in tolerance requiring frequent increases in dose.
- There is a decrease in your non-pharmacological pain management activities.
- You are starting to use non-prescribed substances including alcohol and/or other drugs i.e., marijuana, over-the-counter analgesics, methamphetamine, etc.
- You are unable to take your pain medication as prescribed—type, quantity, and/or frequency.
- You are experiencing problems with thinking, feelings, and/or behaviors.
- Your quality of life and/or relationships are being negatively impacted by your use of pain medication.
- You continue problematic use of medication despite experiencing negative consequences.
- You use medications in physically dangerous situations, i.e., driving a car, operating power tools, providing childcare to young children, etc.
- You experience withdrawal symptoms if you go too long between doses or stop your medication abruptly.
Some of the items above may be difficult to determine, which is why collaboration is so essential. This collaboration should include the patient, the patient’s support network, other healthcare providers, or any other sources that could help validate the needed information. It is time for a referral to an appropriate addiction specialist to make a more accurate assessment of a potential medication abuse/addiction problem if several of the red flag areas have scores above a 5, or a few have scores in the 8-10 range.
After completing the Red Flags exercise and looking at possible defense or denial patterns it is time to make a decision. Is it possible that you may need to change your relationship with your pain management medication? What are you willing to do if you have discovered that you experienced some—or many—of the Red Flags and can see that you may have been caught unaware that a medication management problem was occurring?
If you answered yes about needing a change, you may want to develop the type of pain medication agreement that I use with most of my patients, especially those who have a history of having problems with misuse/abuse of their pain meds. Remember that this is something you will want to share with your pain management team. They may even have their own medication agreements or contracts that they will expect you to adhere to while under their medical care.
Call to Action
What did you learn about yourself and your medication practices and what are you willing to do different as a result of what you learned? What could get in your way of following through and what is your plan to overcome any obstacles? Please share your results of these questions and the Red Flags exercise with a trusted person who will be honest and help you be accountable if you do need to make any changes.