Diagnosis for Neuropathy Pain
Medications used in the treatment for the pain due to neuropathy can include narcotics. Narcotics have both helped and plagued countless generations of people who have pain. The nature of the opioid molecule, based on its ability to fit into some pain receptors on neurons, others on another type of nerve, “glia,” creates a situation in which the longer narcotics are used, the more is needed to achieve the same analgesic effect. This is called “tolerance.”
It also causes a dependence, which is different from addiction:
- Dependence is the emergence of unpleasant symptoms when opioid maintenance that is long-standing is interrupted abruptly or when dosages are reduced.
- Addiction is the reckless behavior to get the opioid medication any way possible, including via criminal diversion, doctor-shopping, or other illicit activities.
Therefore, all persons with addiction have dependence, but not all persons who become dependent on opioids become addicted. 15% of the population have a genetic tendency toward addiction, and because of these 15% testing must be done to ensure that a person being treated for pain is taking the medications prescribed and only the medication prescribed–compliantly and from only one prescriber.
Drug screens are considered a necessary part of any pain management that involves drugs with dependence, tolerance, or addictive potential. A drug screen that indicates absence of a prescribed drug means the patient is diverting it–usually by selling it or simply getting it for someone else; a drug screen that indicates a different type of opioid instead of the one prescribed means the patient is still seeking pain relief, but is probably selling an expensive prescribed medication and buying a different, less expensive, non-prescribed medication illegally. Drug screens also indicate the presence of other substances, such as marijuana, as well as cocaine, amphetamines, and other drugs of abuse.
The Legal Requirement
Drug screens were initially implemented due to the opioid/overdose crisis, but there is no legal requirement that a physician get periodic drug screens. The standard of care, however, includes them as part of pain management because of the dangers that opioids create.
Even without the legal requirement, the prudent doctor will get them to protect the patient him- or herself. The doctor-patient relationship is solely for patient wellness, and drug abuse and diversion interfere with that objective. A doctor so forewarned can intervene on the patient’s behalf with co-therapy involving rehabilitation, psychological therapy, medication weaning and/or substitution, and family interaction. A drug screen that indicates drug abuse of illicit drugs such as cocaine and methamphetamines can warn the doctor of a potentially lethal combination at work within his or her patient.
Because most patients who become addicted and break the law are truly in need of pain relief, it is not simply an either-or case of patient vs. law-breaker. When illegal actions occur, they typically occur in real patients who need real pain relief. This is what gives the patient’s doctor an advantage toward patient well-being when drug screens are used. Identifying these patients also can indicate when a patient is being under-treated; inadequate pain relief can sometimes drive addictive behavior. If a patient is being inadequately treated for pain, knowing this is an important part of pain management.