Reasonable Goals Of Pain Management

A reasonable goal of pain management in most cases is to reduce pain by 50% or more without reducing function and typically, increasing function.

There are 3 goals to pain management:

1. Pain relief - partial or total


2. Maintain and hopefully improve function


3. Tolerable side effects

One of the main fundamentals of narcotic treatment is to control the pain with the least amount of side effects. Unfortunately, there's not a spreadsheet telling providers exactly how much to prescribe to make that happen. A lot of pain is subjective.

The two important effects of opioids are pain relief and pleasure. Once the opioid hits its receptors in the brain and spinal cord, pain relief occurs along with stress reduction and euphoria. The brain is encouraged to release dopamine, which causes a brief rush followed by a relaxed state.

Side effects reported by those who take opioids include blurred vision, difficulty concentrating, nausea, vomiting, constipation, itching, sleepiness, low energy, fatigue, anxiety, and depression. One consideration when starting narcotics should be an exit strategy for those where the opioids are not working or when the side effects exceed the benefits.

The problem a lot of patients find is that despite being on pain medication, their pain level is still high and function is decreased. They aren't playing with their kids, socializing, or performing well at work or school. Many people find themselves prisoners of their pain medications.

Many people who take narcotics for more than a month or two develop physical dependence. The longer someone takes opioids and the higher the dose, the worse the withdrawal will be upon stopping. Physical dependence is a state of adaptation manifested by a specific withdrawal syndrome that can be started from abruptly stopping, rapidly reducing the dose, or administering an antagonist of the drug(s).