Published on November 29, 2016
Can I become addicted to my pain meds? This is a very common question among cancer patients, and Dr. Suresh Reddy and Advanced Practice Nurse Tiffany Richardsâ??both from MD Anderson Cancer Centerâ??address this normal worry. Dr. Reddy discusses the differences between physical dependence and psychological dependence and why it is important for your specialist to establish the difference. Tiffany follows up with the importance of constant open and honest communication with your healthcare team about all of your symptoms. Pain and discomfort, both physical and mental, are harmful to your cancer care. Your team has multiple ways to manage your pain while avoiding addiction.
This virtual town meeting was produced by Patient Power in partnership with The University of Texas MD Anderson Cancer Center, Patient Empowerment Network and Myeloma Crowd. On behalf of our partners, we thank AbbVie Inc. and Takeda Oncology for their support.
Transcript | Is Cancer Pain Management a Problem for Some Myeloma Patients?
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So let’s talk about the narcotics for a second. You know, if my father developed myeloma, he’d want to get the best care to fight the cancer.
But if he were dealing with pain and he had a consultation with you, and you said we want to prescribe morphine in some form, this is a guy maybe who never took any drugs, very anti-drugs. And he said oh, my God, I'm afraid of addiction; I don’t want to do it. I’m sure you’ve had many conversations with people who were otherwise suffering, and the family members. So talk about that for a minute.
Sure. I have atime when I see the patients, dispelling that myth about addiction in opioids. No question, there is an amount of addiction that goes with opioids. As you see in press recently, it’s a huge epidemic in this country. So what we do is for a person like your father, who is having pain but what we want to make sure is he does to have what we call a risk factor to get addicted to these medications.
So now it is a standard to ask these questions about these factors, which are generally do you have a family history of addiction, number 1, and do you have a family history of alcoholism or any drug issues in your family? These are the risk factors. And number 2, do you have any issues with drugs previously or with alcohol, including smoking, really? We’re finding people—they’re all substances. These are all factors which lead you to go back to them, because they make you feel good.
And narcotics also do that, because they share the same part of the brain which makes you feel happy, which is the limbic system. So after excluding all these risk factors, we tell them that the kind of addiction you’re referring to is the psychological dependents. Usually people develop physical dependence; we tell them to differentiate between the two. Physical dependence is if you take narcotics for a long period of time, and if you stop suddenly, you can go into withdrawal.
So that’s why we make sure that we stop them slowly. So that’s a physical dependence, and that happens in almost everybody. So that, sometimes people mistake it for psychological addiction, which is a craving for a medication whether you have pain or not. It’s like any other substance, really, for example alcohol. And you use this medication for non-pain reasons. Some people use it to go to sleep, some people use it to feel good and for dis-inhibitationand make you feel good. So we will be watching for this.
So maybe you could hand the mic to Tiffany. I want to broaden this out, Tiffany. So somebody is getting treated for myeloma and sees one of your doctors, and they’re dealing with different issues and one of them is pain. Could be fatigue, could be neuropathy; could be—we have a whole bunch of stuff on the screen—diarrhea or others. So that’s where there’s got to be this communication. And you’re querying them all the time, right?
Right. So at each visit, we’re asking them about their symptoms, what side effects that they’re having—and also asking the caregivers to chime in, as well. Because sometimes patients may minimize the symptoms that they’re having, because they want to stay on treatment, and they don’t want dose reductions to occur. And so oftentimes if there’s a caregiver in the room, the caregiver will be making verbal faces and mouthing words, trying to say—like if they’re having moodiness and irritability, the patient will say oh, no, I'm fine. And then the caregiver is shaking their heads, like no, they’re not fine.
And so then that prompts more discussion about that. Because we obviously want to know. We don’t want to create a situation at home where the patient is having a lot of moodiness and irritability, and now we’re causing problems and strife between family members.
You have sitting next to you the Section Head for Palliative Care at this huge medical center. Probably UT Southwestern, Dr. Anderson, you have various departments that can help with this pain management. And at many of the myeloma centers, typically there will be an expanded healthcare team. Someone in your role, like the nurse practitioner, is often the window on that where you can make a referral, right? So if the family is there and whether it’s about pain or these other issues, speaking up can create that referral, correct?
Exactly. So if the patient is having more pain, or if their pain is not controlled, then I can refer them to their pain doctor or whoever they are seeing. If they’re seeing psychiatry, they may need some adjustments on their anti-depressant or if they’re on anti-anxiety meds, that may need to be tweaked. And so it’s really having a communication between not just the patient and caregiver but also other members of the healthcare team, as well.