Chronic Pain FAQs
Do you think that opioid-induced narcotic hyperalgesia is real?
I believe it has happened to some patients, but have seen it very infrequently in the past decade, and the literature does not support this as a significant clinical problem at this point. However, the current data may support opioid-induced hyperalgesia, post-surgery, in patients who have received certain kinds of fentanyl products. The main thing is to talk to the patient and always determine whether the medicine is doing more "for the patient" or "to the patient," and adjust the therapy appropriately.
-- Response provided by John F. Peppin, DO, FACP
I believe it has happened to some patients, but have seen it very infrequently in the past decade, and the literature does not support this as a significant clinical problem at this point. However, the current data may support opioid-induced hyperalgesia, post-surgery, in patients who have received certain kinds of fentanyl products. The main thing is to talk to the patient and always determine whether the medicine is doing more "for the patient" or "to the patient," and adjust the therapy appropriately.
-- Response provided by John F. Peppin, DO, FACP
How can you check or investigate the possibility that your patient is diverting his/her prescribed medication?
This is clearly not easy, as behaviors that you see are concerning to you, could well be a sign of an illegal activity. It is important to follow patient patterns and behaviors and keep your ears open for red flags. A critical element is in record keeping and monitoring patterns. One way we do this in my practice is to have a very good relationship with those individuals who are investigating drug diversion.
-- Response provided by John F. Peppin, DO, FACP
This is clearly not easy, as behaviors that you see are concerning to you, could well be a sign of an illegal activity. It is important to follow patient patterns and behaviors and keep your ears open for red flags. A critical element is in record keeping and monitoring patterns. One way we do this in my practice is to have a very good relationship with those individuals who are investigating drug diversion.
-- Response provided by John F. Peppin, DO, FACP