Doctors are frequently required to treat a patient showing signs of chronic pain, looking for relief. However, patients looking for relief from longstanding diseases, illnesses and injuries are often some of the most susceptible people to becoming dependent and ultimately addicted the opiates used to treat their symptoms. The question that begs to be asked is: how do you treat someone with these symptoms when the most effective form of treatment brings with it a heightened chance of addiction? This conundrum is one of the most serious paradoxes that doctors have to wrestle with on a daily basis.
Dr. Ian Forster, the medical director and consultant for Addiction Medicine at Edmonton’s LifeMark Health Institute, is on the forefront of this problem. Currently a member of the American Society of Addiction Medicine and the Canadian Society of Addiction Medicine, he has seen all types of treatments put into practice, with varying degrees of success.
“I think the most important thing is to remember that one way never works for all.”
Forster subscribes to the idea of individualized treatment, in which each patient is handled with extreme care and the focus is on attention to detail. This approach doesn’t have to be complicated either and can start with as something as simple as prescription refills.
“You start off giving people a week’s supply, and the general rule we have is you never give them more than a two week’s supply. And that doesn’t’t mean you have to see them every two weeks. The advantage of this method is that if things start to go pear shaped, you know about it very rapidly. If you’re giving them medication months at a time, you’re not going to find out they’re overusing as quickly, when they come back early to fill their prescription. So by keeping tight tabs on things we can have people on medication and really work to improve their functionality at the same time.”
At LifeMark, patients are offered a wide variety of treatment options. These include active rehabilitation, treatment for fibromyalgia and complex regional pain syndrome, psychological and psychosocial support, biofeedback, daily educational classes, access to dieticians, group support sessions and vocational programs. Offered through Alberta Health Services, the onus is on treating both the mental and physical side of what can be an all-encompassing diagnosis.
“Really when you look at chronic pain,” added Forster, “There are two parts. There’s the pain, then there’s the suffering. In other words, the social and psychological impact of the pain itself, and I think that’s the big chunk that we miss out on sometimes.”
Forster said it all wraps into a full package of treatment that is custom-tailored to each patient, rather than trying to blanket chronic pain sufferers with one treatment plan. This helps keep addictive tendencies under wraps, and closely watched.
“What people need is careful assessment to see what type of treatment modality they need. And it’s always easier to say you should never prescribe opiates to these people, or you should always prescribe opiates to these people. Although simple, both are incorrect and what it really takes is time and careful management of these people, rather than just writing prescriptions and telling them to come back in three months’ time.”