Nalini Vadivelu1, Harman Singh-Gill2, Gopal Kodumudi3, Aaron Joshua Kaye4, Richard D Urman5, Alan David Kaye6. 1. Department of Anesthesiology, Yale University School of Medicine, New Haven, CT. 2. Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT. 3. Undergraduate, University of Connecticut, Storrs, CT ; Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA. 4. Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA ; Undergraduate, Stanford University, Palo Alto, CA. 5. Department of Anesthesiology, Harvard School of Medicine and Department of Anesthesiology, Brigham and Women's Hospital, Boston, MA. 6. Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA ; Department of Pharmacology, Louisiana State University Health Sciences Center, New Orleans, LA.
Abstract
BACKGROUND: Drug tolerance has been on the rise in recent years worldwide, and consequently, pain management in our population has become challenging. METHODS: Discussed in this review are commonly abused drugs and considerations for treating acute and chronic pain states in patients with substance disorders. RESULTS: After marijuana, alcohol, and tobacco, the most widely abused substances are oxycodone (Oxycontin), diazepam (Valium), and methylphenidate (Ritalin). Urine testing can detect metabolites of drugs used by patients and is useful for assessing drug abuse, medication diversion, and drug interactions. The comprehensive treatment of pain in a patient with addictive disorder or tolerance must address 3 issues: the patient's addiction, any associated psychiatric conditions, and the patient's pain. Eliciting a detailed history of drug abuse-illicit drugs as well as prescription drugs-and ascertaining if the patient is currently enrolled in a methadone maintenance program for the treatment of drug addiction is vital. CONCLUSION: Medical observation, supportive care, multidisciplinary pain management, and timely interventions as necessary are the keys to safe outcomes in these patients.
BACKGROUND: Drug tolerance has been on the rise in recent years worldwide, and consequently, pain management in our population has become challenging. METHODS: Discussed in this review are commonly abused drugs and considerations for treating acute and chronic pain states in patients with substance disorders. RESULTS: After marijuana, alcohol, and tobacco, the most widely abused substances are oxycodone (Oxycontin), diazepam (Valium), and methylphenidate (Ritalin). Urine testing can detect metabolites of drugs used by patients and is useful for assessing drug abuse, medication diversion, and drug interactions. The comprehensive treatment of pain in a patient with addictive disorder or tolerance must address 3 issues: the patient's addiction, any associated psychiatric conditions, and the patient's pain. Eliciting a detailed history of drug abuse-illicit drugs as well as prescription drugs-and ascertaining if the patient is currently enrolled in a methadone maintenance program for the treatment of drug addiction is vital. CONCLUSION: Medical observation, supportive care, multidisciplinary pain management, and timely interventions as necessary are the keys to safe outcomes in these patients.
Entities:
Keywords:
Drug tolerance; pain management; substance-related disorders
Authors: Nalini Vadivelu; Alice M Kai; Gopal Kodumudi; Dan Haddad; Vijay Kodumudi; Niketh Kuruvilla; Alan David Kaye; Richard D Urman Journal: Curr Pain Headache Rep Date: 2018-03-19