[PLFreitag]

Originally Posted by Noryn

So here is my question. Regarding addiction many are now stating that it consists of actual physical and chemical (rewiring is a frequent term) changes in the brain that occur. But if you have chronic pain these changes do not occur?

The issue at hand is the difference between addiction and dependence.

Addicts seek out drugs to escape, to get a buzz, to get high. They will steal or commit other crimes to get their drugs. They will even sell their bodies for that high. They need more and more to get to the same level of high. They seek the feeling.

I am dependent on my pain medication. I need the medication to get up in the morning, open my eyes, get dressed, and move about during the day. I don't get a high from my medication. I don't feel a buzz. I take the smallest possible dose that will enable me to feel human. You don't see me running around doing all kinds of stuff...even with the meds, some day the shades are down, the blinds are closed, and I'm lying on the couch or in my recliner under a blanket, praying to get through the day. I obtain my meds legally and have never stepped outside of bounds as far as these meds are concerned. I am monitored by a physician as well as a psychiatrist, which was required by my pain doctor in order to get the meds I needed for my pain. I am subject to random urine or blood tests any time they ask for them, and I would do so freely. I started at the lowest possible dose for my medication and actually, the first time I took it I got sick so I had to wait a couple weeks and try again.

Do we build up a tolerance like addicts? Yes, we do, because all bodies do that. We need, over time, a bit more medication to obtain relief, because our bodies adjust to the level we are at. The other thing is that as we feel better, we do a bit more, so we need to compensate for that. I don't mean I go out jogging now. What I mean is that now I can drive myself to the doctor or go grocery shopping or even sit at my sewing machine for an hour or two whereas 2 years ago I couldn't do that at all.

The line between addiction and dependence is a fine one but you will see that chronic pain patients are not obsessed with their meds **once they achieve the level at which they have adequate relief** and can function at an acceptable level.

My meds bring my pain from a constant level of 7-8 with breakthroughs of 9 or more to a constant of 4-5. I don't ask for more because my pain doc, being extremely careful because of regulations and monitoring, won't give it to me anyhow, and I had to fight to get what I have. Still, I am thankful because now I can do some of the things I need to do around our home to feel like I contribute something besides CO2 to the atmosphere.

As noted before, the addiction rate within the group of patients with chronic pain is around 3%. We aren't seeking a high or an escape. We just want to function. If an addict wasn't addicted to drugs, it would be something else...alcohol, gambling, shopping, sex, whatever...the wiring is already there. The drug or whatever else just flips the switch.



PLFreitag, a disabled and now unemployable RN

[PLFreitag]

Originally Posted by destinyz

My biggest problem is that most prescribed pills (tylenol, percs, etc) do not take away the pain but get me <really> high.

Short-acting pain relievers like tylenol, percocet and their relatives are intended for relief of short-term, acute pain, not chronic every day pain. For that kind of pain, what works best is a long-acting drug. There are several options: 1) timed release meds; 2) patches; 3) drugs like Methadone with a long half-life; 4) meds administered through a sub-q pump, along with some others I can't think of now.

Many docs will start with the short-acting drugs. They just don't work. When we tell them that, many of them think we just want something to take to escape. They often don't realize that our pain is just as real as someone with an acute amputation or a gunshot wound.

The archaic attitude of society concerning people in chronic pain needs to change. Until it does, those of us who suffer with it will continue to face discrimination, undermedication and prejudice.

Trisha

[ingelein]

Pain presents itself so differently in every individual.I have daily pain D/T RA and OA in multiple joints, I was given some heavy duty drugs that didn't seem to work any better than plain old Naproxen and PRN Flexeril.I had one Orthopedic surgeon refuse to give me a script for Flexeril, while trying to push Vicodin on me.

The other Orthpod, said that it was ridiculous not to give me Flexeril and he wrote a script for 30 several months ago, I still have half of them left. Nerve pain in spinal conditions actually lessen over the years I was told, because the nerves, "burn themselves out"? This is true for me, I used to have to take Neurontin for the constant nerve pain, but now that is replaced with numbness and no more Neurontin needed.

Pain is a crazy thing and needs to be understood and followed in a better manner by health care professionals, who seem to jump too quickly to the conclusion someone is drug seeking.Sorry off my soapbox now.

I am also a disabled nurse ,no longer working.

[PLFreitag]

My apologies...I should have specified that chronic pain requiring narcotic intervention. Sorry. I think in my own direction, if you know what I mean. To tell someone with atypical facial pain that tylenol should do the trick is insane. For someone else, it might be enough.
Again, I offer my apologies. No offense intended.

Trisha

[ingelein]

Originally Posted by PLFreitag

My apologies...I should have specified that chronic pain requiring narcotic intervention. Sorry. I think in my own direction, if you know what I mean. To tell someone with atypical facial pain that tylenol should do the trick is insane. For someone else, it might be enough.
Again, I offer my apologies. No offense intended.

Trisha

Trisha, I had three different bouts of severe facial pain, lasting about three weeks to a month, about two to three years apart, of "atypical facial pain", one doc diagnosed Trigeminal Nueralgia, gave me the Tegretol which did nothing, so I doubt that was an accurate diagnosis, I can attest to the EXTREME pain of this condition.I have never had another episode, since the last one of five years ago.I hope you get good pain relief with what you are taking now.Chronic severe pain is a rough road to travel.

[Noryn]

Originally Posted by PLFreitag

The issue at hand is the difference between addiction and dependence.

Addicts seek out drugs to escape, to get a buzz, to get high. They will steal or commit other crimes to get their drugs. They will even sell their bodies for that high. They need more and more to get to the same level of high. They seek the feeling.

I am dependent on my pain medication. I need the medication to get up in the morning, open my eyes, get dressed, and move about during the day. I don't get a high from my medication. I don't feel a buzz. I take the smallest possible dose that will enable me to feel human. You don't see me running around doing all kinds of stuff...even with the meds, some day the shades are down, the blinds are closed, and I'm lying on the couch or in my recliner under a blanket, praying to get through the day. I obtain my meds legally and have never stepped outside of bounds as far as these meds are concerned. I am monitored by a physician as well as a psychiatrist, which was required by my pain doctor in order to get the meds I needed for my pain. I am subject to random urine or blood tests any time they ask for them, and I would do so freely. I started at the lowest possible dose for my medication and actually, the first time I took it I got sick so I had to wait a couple weeks and try again.

Do we build up a tolerance like addicts? Yes, we do, because all bodies do that. We need, over time, a bit more medication to obtain relief, because our bodies adjust to the level we are at. The other thing is that as we feel better, we do a bit more, so we need to compensate for that. I don't mean I go out jogging now. What I mean is that now I can drive myself to the doctor or go grocery shopping or even sit at my sewing machine for an hour or two whereas 2 years ago I couldn't do that at all.

The line between addiction and dependence is a fine one but you will see that chronic pain patients are not obsessed with their meds **once they achieve the level at which they have adequate relief** and can function at an acceptable level.

My meds bring my pain from a constant level of 7-8 with breakthroughs of 9 or more to a constant of 4-5. I don't ask for more because my pain doc, being extremely careful because of regulations and monitoring, won't give it to me anyhow, and I had to fight to get what I have. Still, I am thankful because now I can do some of the things I need to do around our home to feel like I contribute something besides CO2 to the atmosphere.

As noted before, the addiction rate within the group of patients with chronic pain is around 3%. We aren't seeking a high or an escape. We just want to function. If an addict wasn't addicted to drugs, it would be something else...alcohol, gambling, shopping, sex, whatever...the wiring is already there. The drug or whatever else just flips the switch.



PLFreitag, a disabled and now unemployable RN

See this is my whole point. The experts now are claiming that addiction is more biochemical. These drugs cause changes in the brain (like I said the word rewire) is used. So you are saying an addict will "seek out drugs to escape, to get a buzz, to get high" but from what I have been reading it seems that there is more to it than just wanting to escape or get high. If this was the case, then is addiction simply a matter of poor self control?

Some people will tear your posts apart here so it can be frustrating because you have to clarify every little thing. (No I am not talking about an end stage cancer patient). But in my experience addiction can be as life altering as chronic pain. So I dont think addiction should be totally blown off just as I dont think treating pain should either.

I guess my big issue is this--if I have a chronic pain patient I am to tell them there is very little or no risk of addiction for taking medications but if I am treating an addict I tell them these medications cause changes in your brain which cause the addiction.

All in all though it comes back to my main belief--we are not nearly as advanced as we think we are--both as a society and in our knowledge of the human body. Addiction and pain control are great examples. Both are treated extremely poorly (with equally poor results).

[tabt]

IMO, and almost all current, objective scientic studies, the only thing to worry about is if oiods are mixed with acetaminophen or ibuprophen and given long term for chronic pain. Then the the liver, the stomach and/or the kidneys will be destroyed. Pure opiates, however, won't damage organ systems and have no ceiling dosage, if they are properly titrated. Doctors just don't like to prescribe them because they're afraid of doing anything that might jeopordize their crappy licenses, which they almost always get to keep anyway, no matter what they've done. Unlike, for example, nurses. I hate that doctors lie to patients about this stuff all the time and that nurses, once again, get stuck in the middle.

[Grace Oz]

My husband takes KAPANOL daily for chronic back pain as a result of a discectomy for ruptured disc, which resulted in him contracting MRSA.
He was hospitalised for 3 months post-op, back in 2001. I then nursed him at home for the next 6 months.
As a result of the MRSA, the L4-5 is now fused, and there's considerable scarring. The nerve travelling down the (L) leg is dead, (sorry, can't remember the name of the nerve!).
Without the KAPANOL, he'd be unable to exist as he does now by taking it.
The risk of any addiction pales into insignificance when it comes to the risk of him going nuts because of the pain.
Not to mention, being able to have a semblance of a life!
He's monitored by his GP and the drug regulating authority who have to give permission each time the GP writes a new prescription. He's also evaluated by a pain specialist.
He's been taking this drug since 2001 and on the rare occasions he's forgotten to take it, his pain level is off the scale.
In his case, the relief gained far outweighs any risk of addiction.

And, as one poster stated, those who genuinely need this kind of drug, don't abuse it.

[Peepsaretasty]

Originally Posted by CaseManager1947

...My doc, reluctantly put me on Neurontin 300 tid. and nixed a new MRI.I said enough. I found a new doctor, who listened to my change in sx, and agreed I needed a repeat study to see if there are changes. Patients with pain (esp back) are seen as drug seekers, pains in the neck (and elsewhere). I agree, some use and abuse the available system, but not everyone is doing so. Heck, I need and want to work, I just can't do it hurting. So there is my story; we will see what the evidence-based medicine (MRI) will show. I rated my pain as a 20 on Friday, and work most every day with level 8-10. Now, do I fit the definition of an addict?? I don't think so. I don't take in doses greater than prescribed, beat the Dr.s door down for more at 10 days into the bottle, or solicit for meds on the street; but I sure as heck still hurt all the time. Pain IS undermanaged in the US., still,even though the Joint sez we are supposed to be doing a better job of it (5th vital sign and all that). Walk a mile in my moccasins some day.

I have a similar problem but in my neck. I'm also working on my doc to get me another MRI or myelogram or SOMETHING. He says "oh it might be stressed because of university" and I say "i HANDLED the stress of university just fine until I got this pain every freaking day day in and day out, THAT is what stresses me! Then he says well stay home and rest. Yeah, and miss the house payment and starve!

On a side note, I recently started the neurontin and have seen real improvement (I've been worked up to 600mg taken throughout the day) Certainly able to work and study with less pain. I hope it works as well for you as it did for me (I understand that it can take several weeks to fully take effect)

I firmly believe that the greatest gift we can give is relief of pain. We may not be able to cure cancer, we might not be able to cure diabetes, etc but we can relieve the pain! God gave us opiods for a reason! I am heartened to hear of research such as the OP mentioned. I always feel bad when I hear of people denied pain meds who are obviously in real pain.

I just wish there was some way to tell the "seekers" apart from the real "needers" more specifically, I wish we could tell when the "seeker" was actually in real pain-that way we wouldn't run the risk of inadequate pain relief.

[TiredMD]

Originally Posted by tencat

I don't see it as my job to try to figure out who is 'lying' and who is in 'real' pain.

You're right. It's my job.

It's my job because it's my license on the line when I turn "fibromyalgia" into "fibromyalgia with opioid dependence". It's my malpractice insurance when the recovered patient-addicts come looking for a fat settlement for failing to recognize their developing addiction. The DEA (you know, the guys who give me that number that goes on every narc scrip I write) has my phone number in the rolodex, and yes, they come calling.

I won't treat chronic pain. Period. I have that luxury in a surgical field. I will blast them into nirvana with dilaudid for the first 1-2 days postop, but after that, forget it. Sorry you've been taking Morphine drops for 10 years for your back pain. Sorry you normally get Fentanyl lollipops for your chronic headaches. Want to get back to your usual insane narcotic schedule? Then get out of bed, walk, poop, and go home. Worried about withdrawl? Don't be, I'm a doctor, I can see that coming a mile away.

Sorry about your chronic pain. But not my problem.

So no, I won't start handing out narcotics for chronic pain. I don't care about these stupid studies ("risk/benefit" doesn't come from statistical analysis, it comes from assessments by providers of individual patients). I'm not worried about addiction; I'm worried about having these people coming into my clinic every two weeks for "just one more" Percocet scrip. I don't want to deal with it.

Every patient in America who needs regular, unending opiates for whatever pain syndrome they have should be seen by board-certified Pain guys. Every one of them. For the life of me, I will never understand these idiot Primary Care docs handing out Duragesic patches and PO dilaudid.