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Use markers to differentiate drug seekers. (Severe Pain Patients).

ATLANTA -- Severe chronic pain is virtually always accompanied by physiologic abnormalities, and biologic markers should be used to help distinguish drug seekers from patients with a legitimate need for opioids, Dr. Forest Tennant said at the annual conference of the American Society of Addiction Medicine.

In a preliminary study of 50 pain patients who were tested for elevated blood pressure, pulse rate, erythrocyte sedimentation rate, and morning cortisol and pregnenolone serum concentrations, 48 (96%) demonstrated at least one abnormality, and 32 (64%) had two or more, Dr. Tennant reported in a poster session. Hypertension was the most common marker, found in 28 (56%) of those screened.

Screening also detected tachycardia in 21 (42%) of the 50 patients, hypo- or hypercortisolemia in 19 (38%), hypopregnenolonemia in 18 (36%), and elevated erythrocyte sedimentation rate in 10 (20%). The abnormalities reflect the activation of the pituitary-adrenal axis, said Dr. Tennant of Veract Intractable Pain Clinics in West Covina, Calif. After 4 months of treatment with a long-acting opioid for pain suppression and a rapid-acting agent for breakthrough pain, only 14 patients (28%) had high blood pressure, and 6 (12%) had tachycardia. The effect on cortisol levels was more extreme, with the proportion of patients with hypo- or hypercortisolemia going from 38% to just 5%.
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Author:Lippman, Helen
Publication:Clinical Psychiatry News
Date:Nov 1, 2002
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