Management of chronic pain and anxiety is a significant challenge in primary care.
Rob Lamberts provides an excellent overview of how he manages pain requiring narcotic medications, and touches on other controlled substances like benzodiazepines.
Physician prescribing patterns can be quite variable, ranging from those who won’t prescribe controlled substances under any circumstances, to others who take a “candy-man” approach, giving short-term narcotics liberally.
I agree with Dr. Lambert’s approach, which is “to use long-acting medications as much as possible and short-acting ones as little as possible,” which makes “the risk of addiction much lower while doing a better job on the pain.” There is a place for short-acting medications, but it should be reserved for pain or anxiety that “breaks through” the control of longer-sustained drugs.
The plight of narcotic medications are caused by their own efficacy, leading to the current tragic situation where “they are under-used in people with real need and abused by those who shouldn’t get them.”
