Occurrence and management of iatrogenic analgesia addiction Flashcards
Define iatrogenesis?
Causation of an adverse/undesired effect/condition resulting from medical/surgical treatment
Describe how iatrogenic addiction generally arises in clinical practice?
Patient becomes addicted to a drug that was originally prescribed for a medical condition
What kind of drug can cause iatrogenic analgesia addiction?
A drug that targets reward circuit in brain and targets compulsive drug-seeking and taking
What are the 3 processes of taking analgesia that can ultimately result in iatrogenic analgesia addiction?
Tolerance
Dependence
Addiction
What is meant by drug tolerance?
Increased drug doses are needed to achieve same effect due to repeated or prolonged exposure to the drug
How many analgesia doses are typically taken by a patient before tolerance develops?
After repeated use or from single usage
How does analgesia tolerance develop into analgesia dependence?
Body has adapted to having that analgesic regularly that you need that particular analgesic to function normally
What are the 2 forms of dependence?
Physical
Psychological
What is meant by physical dependence and psychological dependence?
Physical dependence: Withdrawal symptoms present when drug is stopped abruptly/taken in smaller doses
Psychological dependence: Craving for the drug which can last for months to years
Define drug addiction?
Chronic, relapsing disorder characterised by compulsive drug seeking and use despite resulting adverse consequences
What is the relationship between drug addiction and Substance Use Disorder (SUD)?
Addiction is the most severe form of substance use disorder
Which 3 brain regions cause drug dependence to develop into drug addiction, and what behaviour develops in the patient from this?
Effects on basal ganglia, extended amygdala and prefrontal cortex of brain by analgesics causes compulsive seeking behaviour which leads to addiction
What brain circuit does the basal ganglia play a role in, and what neurotransmitter mediates this circuit?
Basal ganglia plays role in reward circuit, which is mediated by dopamine
What 2 aspects of the patient’s lifestyle are controlled by the reward circuit of the brain?
Production of positive motivation, such as pleasant effects from natural activities like food
Formation of habits and routines
How does analgesia affect the basal ganglia and reward circuit so that the patient develops compulsive drug seeking behaviour?
Analgesia over-activate reward circuit by increasing dopamine release from neurons by unnaturally large amount which provides euphoria
Circuit eventually adapts to analgesia presence and it desensitised to anything else that previously activated reward circuit, as they no longer meet the increased dopamine threshold
Compulsive seeking of analgesia is now the only way to provide the euphoric high, creates craving for analgesia
How does analgesia affect the basal ganglia and reward circuit so that the patient develops compulsive drug taking behaviour, which leads to habitual drug taking?
Analgesia has been integrated into normal habits and routines, forms habitual substance taking
What feelings are produced by the circuit of the extended amygdala, and how does this correlate to substance use?
Circuit produces feelings such as irritability, anxiety, unease
This circuit is triggered by substance withdrawal
How does prolonged analgesic drug use affect circuit of the extended amygdala and lead to compulsive drug-seeking behaviour of addiction?
Prolonged substance use causes circuit to become increasingly sensitive, so that drugs are needed to provide temporary relief from increasingly intense withdrawal
What 3 aspects of the patient’s lifestyle are controlled by the prefrontal cortex?
Mediates circuit of impulse self-control, thinking, making decisions
How does prolonged analgesic drug use affect circuit of the prefrontal cortex and lead to compulsive drug-seeking behaviour and use of addiction?
Function of prefrontal cortex is decreased by prolonged drug use, so that there is less balance between this circuit and reward and withdrawal circuits, resulting in loss of impulse control over drug-seeking and drug-taking behaviours.
Give 8 examples of risk groups of analgesia addiction?
Poverty
Employment and history of legal problems
Personal/family history of substance misuse
Lack of access to medical care
History of severe depression/anxiety/mental health disorders
Thrill-seeking or risk-taking behaviour
Heavy tobacco use
Chronic pain
Give 3 common ways in which iatrogenic analgesia addiction is managed?
Life history review
Assertive training
Methadone maintenance with psychotherapy
Why is life history review an effective way of managing iatrogenic analgesia addiction?
Patient usually feel need to make up for lost time in neglecting themselves and family, which makes them feel overwhelmed and inadequate
Meeting with therapist for review on what they want to make up for can provide patients with reinforcement and support on solving each problem in orderly way
Why is assertive training an effective way of managing iatrogenic analgesia addiction?
Patients tend to have passive, non-assertive behaviour and can have assertion deficiency diagnosis so training allows patients to deal with conflict situations without seeking substance use after
What is assertive deficiency diagnosis?
Patient is passive and accepting of unreasonable circumstances
Or
Reports anxiety and psychosomatic symptoms in response to situations which require assertive behaviour
Why is methadone maintenance and psychotherapy an effective way of managing iatrogenic analgesia addiction?
Methadone is a long-acting opiate so can be given under programme control only and avoids take-home medication.
Psychotherapy allows development of coping mechanisms
