Empathy is key to managing drug-seeking pain patients
Empathy is important in helping chronic pain patients with “drug-seeking” behaviour, said Dr. Winslow Munidasa, a psychiatrist and addiction medicine specialist at Novena Medical Center Singapore, during the Pain Association of Singapore Annual Scientific Meeting (PAS-ASM) 2016 held recently in Singapore.
“Drug-seeking” refers to those patients who consistently ask for drugs regardless of whether they are in real pain or merely addicted to taking medications, said Munidasa. He also said “drug-seeking” patients were usually addicted to opiates, which relieve pain, and they could become manipulative in order to get their hands on more drugs.
Some signs of “drug-seeking” behaviour include visits to different doctors in order to get medication, giving inconsistent accounts of the pain experienced, frequent claims of stolen or lost medication, and constant requests for re-prescription.
“It’s amazing how often it happens and [the patients] have to come back a few weeks early [to ask for prescription renewal]," said Munidasa, recollecting accounts of his patients’ requests for re-prescription, claiming they lost their medication on public transport or that their domestic helpers were negligent and threw their pills away.
Munidasa said empathy played an important role in relieving “drug-seeking” patients, noting that an empathic approach might decrease “drug-seeking” behaviour, while a lack of empathy might escalate “drug-seeking” behaviour.
"If [the patients] feel that you are just putting them off, their pain tends to get worse," he said. “A lot of my clients with addictive behaviour, they [just] want to know you care about them getting well… They don’t care how much you know until they know how much you care about them."
Anxiety and fear often contribute to suffering. Patients who focus on their pain might feel worse, regardless of the extent of the wound or injury.
“While pain can be thought of as being felt in the body, it is the brain and the mind that perceive it,” Munidasa said. Showing empathy and care for patients can lessen their fear or anxiety, leading them to perceive less pain than what they actually experience.
Additionally, meditation, exercise, and other non-medical approaches can help distract patients in pain and reduce their reliance on drugs.
Munidasa said it is also important to identify a patient’s goal, which can be different from a healthcare professional goal of medicating them. A patient might seek emotional support more than pain relief, while a healthcare professional might want to withhold potentially addictive medication.
Good communication helps patients feel supported and they are more likely to comply with pain intervention strategies, he added.