Question: My physician retired, and my new primary care doctor is “reevaluating” everything. I am nervous because he is questioning my medications, and I am not sure he understands
my history. Can you help me understand his approach and offer assuring advice as he and I get to know each other? I am especially concerned about my new doctor’s making me reduce the pain medications I need.
Answer: For a new primary care physician to want to “re-evaluate everything” about your health is a good thing because it means he/she cares enough about you to try and understand all
your past and current medical problems and to gain a sufficient level of certainty that current conditions and symptoms are being optimally managed. I would encourage you to look forward to a re-evaluation as a chance for you also to review and possibly learn more about your own conditions – and to possibly teach another physician about the late effects of polio.
Reviewing all your medications taken with any regularity, especially those requiring the new doctor to authorize by prescription, is an essential part of this review. Medication use can be considered in four general categories: 1) Required, as necessary to treat a serious (potentially life-threatening) condition; 2) Recommended, as probably helpful to treat a serious condition; 3)Useful, to prevent recurrent symptoms (non-life-threatening); and 4) Useful, to treat/reduce episodic symptoms (written as prn – pro re nata – meaning use as needed).
Patients are frequently anxious about having unfamiliar new medical providers change medication use in the last two categories, and yet these are the categories where there is the most misuse of medications and the greatest potential to make beneficial changes. Frequently, medications for a non-serious condition, such as persistent heartburn, are continued for years although the condition is not usually a lifelong, permanent or persistent problem and there are many lifestyle changes possible to prevent the symptoms. Your concerns about changes in pain medication prescriptions is understandable since only you experience your pain – it can not be seen or measured by others. Nevertheless, regular pain medication use does lead to physical and psychological dependence and sometimes addiction. Pain medications also all have some negative health side effects, and it is important that they are regularly reviewed – by both familiar and new providers.
Post-polio pain problems are often complex, greatly varied in causation and rarely life-threatening. They can be treated, managed and prevented in many different ways and, therefore, are ideal for periodic review in the hope of finding new, more-effective and/or safer methods. In my opinion it is almost always preferable for a person’s long-term health to use nonpharmacological methods of pain control and especially to avoid the use of opioids, the most habituating pain medications, for non-malignant pain problems. Please try your best to embrace your new physician’s re-evaluation for what may be “new thinking” about your “old problems” that may lead to better solutions.
Post-Polio Health (Vol. 27, No. 2, Spring 2011)