Appropriateness of Opioid/narcotic medication/controlled substance as part of a patient’s management plan is at the sole discretion of the physician after evaluating the patient. The provider is not obligated to initiate or continue any regimen that the patient feels had worked in the past or that the patient is currently on at the direction of another physician.
Despite the legitimate medical use of these powerful medicines for patient benefit with regards to pain control, their risks shouldn’t be downplayed. Thus far the evidence supporting long-term analgesic efficacy is weak. But it is still used in chronic non-malignant pain with patient’s well-being and safety being of utmost importance. Besides the usual adverse effects of nausea/vomiting, constipation, and itching other untoward effects exist that are not well-known to the general public. These include tolerance, dependence, addiction, diversion, reduced immune function, hormonal abnormalities (e.g. testosterone deficiency), mood disorder, to name a few. To this end, the providers perform a thorough assessment and prescribe these medicines in doses that minimize the risk of these effects occurring.
Our physicians have restrictions on the strength/dose of narcotics that they prescribe. They will share their specific appropriate doses after the evaluation. Also, they have a ceiling on an allowable daily dose of opioid in each patient. They believe in a multidisciplinary approach to pain management with a plan tailored to each patient’s needs.