Refusing Pain Medications

Refusing Pain Medications
June 28, 2019 / Reid M. Jacobs, APHSW-C, MSW

Earlier this month, we discussed the connection between pain and suffering <link> and briefly noted that some people refuse pain medications. We’d like to explore that further here.

People are often concerned about the risk of addiction that comes with these medications. The recent focus on the opioid crisis in the United States has made this a more prominent concern than ever before. The misuse and abuse of drugs is dangerous to health. However, hospice and palliative care patients often have a genuine need for the pain relief that opioid medications provide. Doctors are careful to “start low and go slow,” meaning that they will prescribe the lowest dose possible and slowly increase the dose until it is effective at managing the pain. As pain increases or the body adjusts to the medications, the doctor may need to increase the dose. Using medications as prescribed helps reduce the risk for addiction.

There is also some confusion about what addiction really is. It is normal for the body to adjust to a medication over time, requiring higher doses to get the same level of pain control. This is called building a tolerance. It is normal and not necessarily a sign of addiction. To address the tolerance, doctors may increase the medication dose or switch to another medication entirely. The risk of addiction is also tempered by terminal illness. Hospice patients with severe pain will likely need pain medications for the remainder of their life, in which case addiction is a moot point. Palliative care patients may have a treatable illness and might not have pain after the illness is resolved. The palliative care physician can help taper the patient off opioid medications when the time is right. Stopping medications with this guidance also reduces the risk of addiction.

Some people are concerned that opioids will make the feel loopy, spaced out, and sleepy. This could prevent a person from engaging with their family and friends. This is of special concern for hospice patients who don’t have much time left to spend with loved ones. However, severe pain can have the same effect. At the right dose, opioids can bring the pain to a tolerable level while avoiding drowsiness and confusion. This can take some trial and error, but hospice and palliative doctors are skilled at finding the right balance.

Still, there are some who choose to avoid opioid medications no matter what. It can be comforting to know that there are still ways to manage pain for these individuals. This can include over the counter pain medications, topical ointments, and a number of non-pharmaceutical interventions. Techniques such as mindfulness meditation, guided imagery, and a number of psychotherapeutic interventions can be successfully used to manage pain. Other options include hot and cold compresses, massage, acupuncture, and prayer. Other techniques focus on distracting the mind off of the pain. This can be achieved through music, journaling, and puzzles. Even the use of adult coloring books can be an effective way to manage pain.

Opioid medications can be an effective tool for pain management. Used properly, they have a low risk of negative effects and addiction, but some people will choose to avoid them. That is okay, and it’s good to know that there are other options available for those who do want to avoid them.