Treating PMS in a Patient with a History of Narcotic Dependence

Opioids are commonly used to treat chronic pain, including ongoing, debilitating pain caused by PMS. In patients who have a history of narcotic dependence, however, the use of opioids for pain treatment presents an obvious issue: Prescribing opioids for pain management increases the risk of a potential relapse into narcotics dependence. While some may shy away from prescribing opioids for this very reason, to not prescribe pain-reducing medication also creates a potential for relapse, as patients may seek narcotics on their own to manage uncontrollable pain. In patients who have a history of narcotics abuse, there is a delicate balance between pain management and potential drug abuse that must be struck. Here is a guide for women’s health specialists trying to find that balance.

Balancing Legal Issues

In today’s world, all physicians must be cognizant of potential legal issues associated with their decisions, especially when prescribing opioids to patients who have a history of drug abuse. According to a paper in Primary Care Companion, the legal concerns associated with these cases can be mitigated by clearly documenting the following:

• Indication for medication
• Dosage
• Dosing interval
• Amount given

Consulting Other Experts

Often, women who have chronic pain from PMS come to physicians who are specialists in women’s health, not necessarily in pain management or addiction medicine. Part of being a good physician is recognizing where your knowledge is limited and seeking the advice of other medical doctors who are experts in other areas. Before prescribing opioids to a woman with a history of narcotic abuse, it may be wise to consult a physician who specializes in pain management and another who works in addiction medicine.

Devising a Treatment Plan

When opioids are the best way to treat chronic pain from PMS in a patient who has abused narcotics in the past, a well-devised treatment plan is a must. To reduce the risk of a relapse into abuse, it might be wise to:

• Require the patient to get all of their pain medications from one doctor and at one pharmacy
• Reduce the opioid dosage to the minimum effective dose
• Wean the patient periodically to reassess her pain control
• Use other pain medications if possible

Continue Learning About Women’s Health

Treating chronic pain in women who have a history of narcotic abuse is one of the most challenging scenarios in women’s health. Treating it requires current knowledge in multiple fields of medicine. If you’d like to learn more about women’s health as it relates to other fields of medicine, our continuing education programs are full of informative, engaging and relevant information. Sign up for our next conference to learn more about the field. Alternatively, if you were unable to attend one of our live conferences, or just want a refresher, be sure to take advantage of our online and audio courses. They’ll give you the information you need.