Wednesday, March 9, 2011

Chronic Pain Thoughts, Tidbits, and Insight: Response to an article

THIS WAY IN: How to Use Pain Meds Safely
Neurology Now
February/March 2011; Volume 7(1); p 10–11,15

Click on Download article, PDF or view each hyperlink

This is a good article on the benefits and pitfalls of opioids. I believe, opioids should be considered for treatment of pain with medications, especially when other treatment modalities have failed. I have to disagree that doses must be elevated due to tolerance, because some research shows that is not true for all people. Antidepressants and anti-seizure medications are also abused and people die from them, but we don’t hear about these cases because BIG pharma somehow keeps these incidents undercover. The FDA doesn’t go after the data on incidents regarding these type of medications. Most of what we hear is what can be sensationalized by reporters. Reporters want headlines that sell. The political money band plays on.

Any medication/drug taken for a reason other than intended is abuse. Improving function is the goal, obtaining enough pain relief to participate in myofasical therapy, get out of a chair, bathe, comb your hair, put on makeup, smile at yourself in the mirror, participate in the day, and interact with family and friends without having to painfully force air over the vocal cords in an effort to talk.

The Pain Patient (Pseudo-addiction) (Cooper and Miller, pg.171-172)

*Medications improve their quality of life. They are in control of their medications.
*The pain patient will want to decrease the medication if side effects are present.
*The pain patient is concerned about physical problems.
*The pain patient follows the contract for the use of opioids. (Pain specialists
will most likely have you sign a contract with them stating that you will follow
their prescribing instructions.)
*The pain patient will have medication left over.

The Addict

*The medications cause a decreased quality of life. An addict is out of control with
*The addict will want to continue medication regardless of side effects.
*The addict is in denial.
*The addict doesn’t follow the contract for the use of opioids.
*The addict doesn’t have medication left over. Addicts lose prescriptions and always
have a story.

The preceding lists are an excerpt from Fibromyalgia Network, April, 2001, based on Dr. Heit’s work at the Georgetown University School of Medicine (2001) and Dr. Heit’s presentation, “Opioid Prescribing: An Update on Clinical, Ethical and Legal Guidelines” from the Journal of Law, Medicine & Ethics, 22(3) 252–56, (Fall) 1994.

The laws currently written are to protect us, however, the shenanigans of drug seekers and physicians who feed their habit to make a dollar, helping them rid their addiction, keeps the patient in debilitating pain, wallowing in misery and emotionally handicapped. And then they have the gall to insinuate we are to blame for our pain state.

On the other hand, more patient education regarding the pitfalls of opioid therapy is needed. With conditions such as ours it takes a multimodal treatment course to feel better. When our pain in not under control it is impossible to tolerate treatments and activity known to help. It is unreasonable for us to expect, even with pain meds, to be pain free. It is not, nor should it be the main goal. What we need from any of our medications is enough relief to participate in activities and treatments. We are entitled to have enough pain control to avoid the snare of a hypersensitive state, which will keep our brain in a constant wind up. Once this wind-up phenomenon takes place, it takes twice the effort to bring the pain response back under our watchful supervision. We know, or should know, what aggravates our pain (Chapter 2 – Communicating Your Healthcare Needs, pgs. 65-132). It should be up to us to decide what enough is and what too much is. The road to a more productive life is paved with pain medications that afford us the opportunity to move, one step at a time. The golden brick is that one with the face of, movement, thought, physical therapies and emotional support engraved with your name.

A course of treatment that has worked for some is a tapered opioid vacation every couple of months for about a week, so the body doesn't get used to craving more and more. They are called mini med vacations and are supplemented with other meds to help and it is supervised and administered by a qualified physician. More studies need to be done on this because my biggest fear is that we don’t know the end place on opioid dosing until it is too late. Why take unnecessary risk? I understand pain only too well, but as most of us who have been on opioid therapy will tell you, it never takes the pain completely away, and still allows you to get up and move about. We must participate and have our own plan. We need to be empowered. And, we need control over what medication helps us. If the government continues to walk hand and hand with pharmaceuticals, one day our rights pain relief, will be completely stripped. As honest chronic pain patients we need to take this responsibility seriously.

I understand that what works for me, may not work for someone else. For me, it is about balance of spiritual, mental, physical and emotional, collaboration with my healthcare provider, and acceptance. I like to think that because of chronic life altering pain, I have learned the importance of appreciating days I might otherwise take for granted.

I think the alternative drugs, the Savellas, Lyrica, Cymbalta come with their own package of unwanted side effects and alter the brain chemistry and interact with many other medications we take for comorbid conditions such as migraine and IBS. The pharmaceutical industry has financial and political power beyond our comprehension. If a patient ONLY needs one medication and these class of drugs work for them, I am all over it. It is about improving function, but it should be our option, not something dictated to us by our government, putting themselves between the patient and the physician for profitability.

Give us the right to choose what is best for us. Let us have the medication that promotes enough pain relief so we can participate in trigger point therapies, Yoga, T’ai Chi, acupuncture, myofascial release, active release therapy, or even a light massage. Shouldn’t that be a right, not a privilege?

We are intelligent people here. Our goal is to feel well enough to wake up to a bright day. We must not ignore the pitfalls of opioid use, but we have proven over and over again that the pain patient is NOT going to abuse their medications. If one man steals in a community does that mean it is a community of thieves? Even if I do start to abuse my opioid, one in ten will, can’t you inform me of this possibility? Will you offer a remedy for me so that I may live one day with manageable pain? We admit we need to be better educated in what can happen with escalating doses and medication interactions. THAT is what the physician should be giving us when we are on opioid or any medication therapy. If they cannot provide that information for us, then they need to make appropriate referrals.

Harmony and Hope, Celeste

Written by Celeste Cooper, RN, author, Integrative Therapies for Fibromyalgia, Chronic Fatigue Syndrome, and Myofascial Pain: The Mind-Body Connection (co-author, Jeff Miller, PhD).

1 comment:

Diana Lee said...

This is a wonderful post, Celeste. I wholeheartedly agree with you. I wish we knew more about how far a regular pain patient who has no addiction issues can safely go on opioids (alone & when combined with other meds) without risking death. I think people like Heath Ledger and Anna Nicole Smith as great examples. We are quick to assume they were addicts, but their meds weren't really that different than many chronic pain patient's meds.

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