Thursday, June 19, 2008

Lyme and pain management

Many patients who eventually come to see me for a Lyme evaluation have been treated in pain clinics for years. Many take large amounts of opiates (narcotic) medications. Many "Lyme docs" don't want to treat pain and refer patients to such clinics. Pain clinics are typically run by anesthesiologists or rehabilitation specialists. Many of these clinics specialize on injection techniques used to treat localized pain syndromes. Many use medications for chronic pain patients as well. I like to treat pain; so I will also address this aspect of the patent's problem. It is my goal to treat the underlying cause of pain, for example Lyme disease, so that hopeful the pain medicines can be decreased or eliminated. In the recent past many physicians were reluctant to treat non cancer pain with narcotics because of the fear of addiction. Thankfully, this is a paradigm which has largely changed. Pain is one thing that doctors can treat. Lowering pain levels allows for a better quality of life. It frequently allows the patient to increase activity and exercise which is part of the healing in Lyme disease. Chronic pain is associated with adrenal fatigue, cytokine release and immune suppression, all of which are detrimental to healing Lyme. And of course, not treating pain just is not kind. Addiction is a psychological syndrome, not a physical one. Addicts use a substance in a compulsive, detrimental way with a negative impact on the well being of the user. Patients who use pain medications in order to function normally are using pain medications in a therapeutic manner. Narcotics cause constipation this needs to be addressed with bowel stimulants. Narcotics can cause fatigue and this can be countered with stimulants or Provigil.
A patient who is using narcotics appropriately may develop physical dependence. This means that withdrawal symptoms will occur if the medicine is abruptly withdrawn. In this case the dose of medicine needs to be slowly reduced. This should not be confused with addiction which is a psychological disorder. Pain medicines are available in a variety of forms and doses. I will not elaborate further in this Blog. I do feel it is important to have pain managed. This does not cause addiction, except in very rare cases, and is very important in the healing process.

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