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How Much is Too Much?


By Becky Wiese

A longstanding tradition, even priority, for physicians in the U.S. mandates they return patients to an acceptable level of comfort after a physical trauma. Regardless of whether the pain results from an injury due to accident, physical malfunction, or surgical procedure, once the critical functions are intact and first aid are carried out — in other words, the patient is breathing, not bleeding, and breaks and/or burns have been addressed — the next priority is to make sure the patients feels better. In other words, eliminate the pain.

This goal often leads to an aggressive treatment for pain control. Physicians advise patients to “stay on top of the pain” and medicate before pain sets in so as to have the least discomfort possible. This strategy may be beneficial for patients during acute phases of trauma, but when allowed to go on too long, can also lead to abuse of pain medications, especially in instances in which narcotics are used for pain control

Narcotics decrease the amount of pain a patient feels by binding to special pain receptors in the nervous system. With fewer pain messages being sent to the brain, the feelings of pain lessen. Narcotics don’t treat the cause of the pain or improve the patient’s condition — they simply mitigate the perception of pain in the brain.

In the short term, this may be a good way to allow a patient to rest and recuperate after trauma. However, long-term usage may pose a variety of problems.

One such difficulty is that the brain and body work together to feel more pain in order to get more medication. This “breakthrough pain” might signal that the body has developed a tolerance to the narcotic. So the dose is increased, but the pain continues as the brain eventually adjusts to the new amount of pain medicine, leading to a perpetual cycle of increased medication followed by increased perception of pain in order to get more medication.

Dr. Emilio Nardone, a neurosurgeon at Central Illinois Neuro Health Sciences (CINHS), believes that patients who need long-term pain control due to degenerative conditions — that is, patients with chronic pain — do not benefit from long-term narcotic use for controlling their pain.

In fact, due to the tolerance that builds up over time, he believes that using narcotics for more than 6-12 months actually makes it more difficult to treat and control the patient’s pain.

This issue has been commonly seen in doctors’ practices — including Dr. Nardone’s own experience, and now public awareness is increasing due to media reports and evidence from medical research. The fact that narcotics can be addictive, abused, and cause dependency has been seen as a problem for a long time. Often a patient will experience strong withdrawal effects upon stopping usage of the narcotic, especially if they are not weaned off slowly.

The question becomes, then, are narcotics a good choice for patients with benign (i.e., not cancer related) long-term needs for pain control? Are narcotics the best option for patients with osteoarthritis or chronic back pain?

Dr. Nardone often advocates allowing the innate capability of the body to feel pain in order to fight the pain. “We have the capability of fighting pain, and there are other nontraditional and non-medical approaches that have also shown success in helping alleviate pain,” he suggests. Some alternative methods are becoming more accepted in mainstream medical care, including acupuncture, biofeedback, meditation, relaxation training, and other psychological treatments. Many of these methods use the body’s natural abilities through the mind-body connection to alleviate the pain.

In addition, pain specialists now know more about how the sensation of pain occurs in the nervous system and brain and have found ways to manipulate the chemical messages that transmit pain through the nerves. This knowledge has, in turn, enabled them to develop more sophisticated treatments for chronic pain relief, which now may include implants and electrical stimulation in addition to more effective medication.

Dr. Nardone says, “My experience has also shown that patients who have not used narcotics for pain control prior to surgery typically have a better outcome post-operatively in controlling pain than patients who have used long-term narcotic pain medication.”

He believes certain conditions need narcotics, but only with the guidance of a physician and pain specialist. “And even then, the best use of narcotics for pain control is in the short term when treating injuries from accidents or post surgery. After the relatively acute stage, it is important to wean the patient off the medication in order to stop the cycle of enhanced sensitivity to pain due to long-term narcotic use.”

Feeling no pain might not be the best option after all.

Central Illinois Neuro Health Sciences is located at 1015 S. Mercer Ave. in Bloomington. For more information or to schedule a consultation, you may contact them at 309-662-7500 or through their website,

Photo credit: smartstock/iStock, zilli/iStock