Polio Place

Post-Polio Health, Volume 27, Number 2, Spring 2011
Ask Dr. Maynard
Frederick M. Maynard, MD

Question: My physician retired, and my new primary care doctor is “reevaluating” everything. I am nervous because he is questioning my medications, and I am not sure he understands my history. Can you help me understand his approach and offer assuring advice as he and I get to know each other? I am especially concerned about my new doctor’s making me reduce the pain medications I need.

Answer: For a new primary care physician to want to “re-evaluate everything” about your health is a good thing because it means he/she cares enough about you to try and understand all your past and current medical problems and to gain a sufficient level of certainty that current conditions and symptoms are being optimally managed. I would encourage you to look forward to a re-evaluation as a chance for you also to review and possibly learn more about your own conditions – and to possibly teach another physician about the late effects of polio.

Reviewing all your medications taken with any regularity, especially those requiring the new doctor to authorize by prescription, is an essential part of this review. Medication use can be considered in four general categories: 1) Required, as necessary to treat a serious (potentially life-threatening) condition; 2) Recommended, as probably helpful to treat a serious condition; 3) Useful, to prevent recurrent symptoms (non-life-threatening); and 4) Useful, to treat/reduce episodic symptoms (written as prn – pro re nata – meaning use as needed).

Patients are frequently anxious about having unfamiliar new medical providers change medication use in the last two categories, and yet these are the categories where there is the most misuse of medications and the greatest potential to make beneficial changes. Frequently, medications for a non-serious condition, such as persistent heartburn, are continued for years although the condition is not usually a lifelong, permanent or persistent problem and there are many lifestyle changes possible to prevent the symptoms.

Your concerns about changes in pain medication prescriptions is understandable since only you experience your pain – it cannot be seen or measured by others. Nevertheless, regular pain medication use does lead to physical and psychological dependence and sometimes addiction. Pain medications also all have some negative health side effects, and it is important that they are regularly reviewed – by both familiar and new providers.

Post-polio pain problems are often complex, greatly varied in causation and rarely life-threatening. They can be treated, managed and prevented in many different ways and, therefore, are ideal for periodic review in the hope of finding new, more-effective and/or safer methods. In my opinion it is almost always preferable for a person’s long-term health to use nonpharmacological methods of pain control and especially to avoid the use of opioids, the most habituating pain medications, for non-malignant pain problems. Please try your best to embrace your new physician’s re-evaluation for what may be “new thinking” about your “old problems” that may lead to better solutions.

NOTE: 2016 Changes in Prescribing Opioids
The CDC reports that patients taking prescription opioids are at risk for unintentional overdose or death and can become addicted. From 1999 to 2014, more than 165,000 persons died from overdose related to prescription opioids in the United States. Up to 1 out of 4 people receiving long-term opioid therapy in a primary care setting struggles with addiction.

What are opioids? Opioids are natural or synthetic chemicals that reduce feelings of pain. Common prescription opioid pain relievers include: Hydrocodone (Vicodin); Oxycodone (OxyContin); Oxymorphone (Opana); Methadone; Fentanyl. Some polio survivors have been prescribed these for pain and the new guidelines for physicians has changed the process for obtaining them.

Here are a few resources to help you understand the changes.

The official guidelines
CDC Guideline for Prescribing Opioids for Chronic Pain is aimed at improving the way opioids are prescribed through clinical practice guidelines to ensure patients have access to safer, more effective chronic pain treatment while reducing the number of people who misuse, abuse, or overdose from these drugs.

Condensed information and infographics from the CDC, for example Nonopioid Treatments for Chronic Pain

What do you need to know?
Patients

Health Care Providers

The Journal of the American Medical Association published a JAMA Patient Page on March 15, 2016 called Opioids for Chronic Pain, which is also a summary.