Pain medication tolerance ( it is not what you think, read on)

I learned something today from my PM doctor.
He said that as far as tolerance your body becomes tolerant to the meds after a couple months. Therefore the need for a raise in meds due to tolerance is simply bunk. Your body gets adjusted to the meds and the tolerance after two months and when the meds stop working as well as they used to it is because your body ( pain) has simply become worse.
Now I am like you and have always heard that after taking a medication for too long it becomes ineffective. But he says he has the research to back this up and is currently getting me copies to post here as I explained that no one would believe this because we have been told that tolerance is a huge issue when taking narcotics.
I had been explaining that I needed an adjustment because the dose I am on and have been on for years and years just isn't cutting it anymore. Well I had my annual MRI and he showed me on the scan results where indeed I am definitely worse off than when I had my last MRI last year. Anyone with degenerative disease knows it gets worse over time just as injuries to our back does.
So tolerance has to do with our bodies and injuries getting worse and the meds are effectively working just as they did we just got worse.
I will post the results and research when I get it. It does make sense to me and although it also makes sense that the meds lose its effectiveness after time. But My PM doctor is one of the best in the country, he actually got into pain management because he broke his neck and never got sufficient relief. He invented the blood transfusion machine years ago and is very up on anything to do with pain management. So I trust he knows what he is talking about. Something to think about in any case. We are not getting tolerant to our meds we are just getting worse. Not to scare anyone though:)

[jollyman069]

hi sandee.. that is unreal.. i thought exactly they way you did that my body had just gotten use to the meds. because when i go back in january i was going to tell my dr that iwas getting the releif that i was..so that is very interesing i cant wait to see the post on his research

[sandee1818]

I was just as dumbfounded. It is just common knowledge among us CP suffers that our bodies get used to the meds and we build up a tolerance resulting in having to raise our dose. But he says our body actually gets tolerant of the meds the first couple months.
I am anxious too to see the research results and data.
As I said though he makes a point to keep up with every thing having to do with pain management and even attends several seminars every year to keep current and to make sure he knows all there is to know.
He is a very good doctor and he is a chronic pain sufferer himself so he knows how we feel.

[HawktheSlayer]

Hi,

   Please post the research as soon as you get it. I have been bouncing between drugs for the pain, and I can never have a MRI of Cat scan again till the SCS unit installed in me is removed. This if the research is good does make me scared that mabey I have blown out another disk or the scar tissue is cutting through my nerves. Thanks in advance the info would be great to see.

R/
Adam

[Tuckamore]

Sandee this is exactly what my physician believes. I have not shared that with you all because I was afraid you would like think I'm batty and I had nothing to back it up. My physician has been telling me this for 2 years. And it goes against all I have been taught or learned here or elsewhere. My physician says my condition is deteriorating and that is why I require stronger doses of narcotics. I am not becoming tolerate to the meds.

Now it is a medical fact that we build some tolerance in another sense. Meaning we can tolerate a larger dose and still function better than the person who breaks a leg and is prescribed a narcotic for the first time. So in that sense we build a tolerance. But if our pain stayed at the same level the 15mg's of what ever, would continue to ease the pain as well as it did the day it was prescribed.

Think about it and it makes sense. Four years ago I didn't have significant trouble walking short distances. Today I cannot walk long enough to shop for a weeks worth of groceries without being laid up for 24-36 hours. Does it not make sense that the same dose of medication I took 4 years ago will no longer ease my pain?? And Adam I know how you feel, it is scary. How will we be in another 4 years? I guess that's where hope and faith comes into play.

I will look forward to the information from your PMP. I would like to share that with my physician. She may have seen it as she beleives the same as your PMP but I would still like to see the research.

Thank you so much for sharing this information with us!!  Peace, Tuck

[jollyman069]

you just wrote something that really got me to thinking.. I have been going to my pain dr for 3 years this month.. about 5 months ago he put me on avinza 30 mg 1 per day plus the percs 10/325's that i was taking.. i thought i was just gettring use to the percs.. now i have noticed this last month to month an a half that i am not getting the releif i was.. i go back on the 6th and am going to tell him i am hurting more then i was..plus i had a series of back injections too.. it really scares me to think of were i will be pain wise in 5 years????

[sandee1818]

Something else he was telling me is that when we as chronic pain Pt's have surgery for a any reason it is extremely important to have the surgeon consult with your PM doctor or you will be in alot of pain. As Tuck said a medication that would not phase us would be sufficient for someone who does not take meds regularly like we do. I am sure you all know this but I thought I would mention it anyways.
I know it is really scary knowing that instead of us becoming tolerant to our meds we are getting worse. I don't want to scare anyone though and you should not let it bother you or depress you as we all know we will get worse before we get better. We are waiting on the miracle pill or cure and until that happens we will continue to deteriorate. But that is true with everyone. with age we all deteriorate every day. We have to remain optimistic and hopeful. It has been proven that remaining postive does help:)

[jollyman069]

your right but i will be 48 this year and my body feels 78....lol..if i didnt laugh i would probably cry..lol

[Tuckamore]

Sandee brings up a good point.  Attitude is everything. Statistics say cancer and other grave illnesses have higher survival rates and faster healing in those that laugh and are optimistic. Healing is enhanced when one is positive and again....laughs a lot.

We all know it is difficult some days to be positive. But we need to find things that make us smile and bring joy into out lives everyday. Laughter release endorphins and speeds the bodies healing process. So I think we all should add that to our list of New Years resolutions, a laugh a day. Let's not lose sight of the joy in life.

[Mollyrae]

Sandee:

You give some great information and I agree but disagree at the same time. While I do understand that our bodys become worst over time..I also suffer from a degenerative disc disease..and the need for an increase is warranted but the tolorance in regards to pain meds is real and this also warrants an increase. I remember a time when I was first introduced to narcotics and I had pain that ravished my body. If I took the amount of meds back then that I take today, I would have overdosed. the degeneration that I suffer with hasn't changed much in the last 6 months or so but the need for an increase has changed alot as the meds are not as effective. I have also talked recently with my Doc and he agreed that my tolorance is definitly an issue with my added pain, therefor he increased the dose. He has stated that our bodys can become worst over time and the dose might not be high enough but he has also stated that the body builds a tolorance to the meds and doesn't allow the pain meds to work as effectivly as they should. So this is why I agree and disagree with your new information.

[Mollyrae]

I forgot to mention that the amount of meds I took back in the day that I first was introduced to pain meds which was 1/4 of what I take today was enough to make me comfortable. Today it would be like taking an asprin because of my tolorance not my pain.  Take care....

[stuckinopanaland]

Maybe I am not understanding correctly but 3yrs ago when I first started taking pain meds I could take one 5/325 percocet and get hot flashes and sick feeling and now I can take like 6 percocets with hardly any effect what so ever other than feeling normal? I am not doubting anybody just wondering if that is what the tolerence after a few months is what you are talking about?

[sandee1818]

The doc said after two months your body has become tolerant of the pain medication. Now I like you was a little taken back because this is not what I have always thought. I asked if someone took say hydrocodone for a year then what exactly will happen. He said they will become tolerant to the medication in two months and if the medication starts losing its effectiveness then it is because the persons injuries are becoming worse.
If you were taking say one tablet then your body kept becoming tolerant over time as you raise your dose then of course you would have to take more to get the same relief. I look at it like this, we still have tolerance issues but we just become tolerant after a couple months instead of over many months or years. We become tolerant after two months our body does and even if we get worse the tolerance has reached its high point if you will after two months and will not go beyond that. I hope I am making sense. I know how it is explained and how I conceive it in my brain but my brain isn't quite working with my voice this afternoon:)
I do get what your saying Mollyrae and you have a valid point but if if you think about it and we become tolerant to our current dose after two months then both tolerance and our condition worsening plays in the sceanerio.

[Mollyrae]

I can agree with that....That both our tolorance and increased pain levels play a role in the need for an increase. When thinking about it, I guess it has to be a combination of both  playing it's own roll in the course of things.

Thank's for the information, it's been helpful.

Take care.

Molly

[CareerLady]

Hi folks,

I just joined and am enjoying the thoughtful discussion. I believe I am having tolerance issues, so I am trying to stay calm and inform myself. I have to say I believe both things can be true, - that we can develop tolerance to pain meds + much of our change in medication needs may be due to worsening of physical damage. Pain is a complex phenomenon, and is caused by different amounts of tissue injury and signalling function, depending on who you are neurologically, and what has befallen your body, injury or illness-wise. Also, I don't think that 2 months is a magic number. There is probably a variance based on individuals responses. Anyway, here are some things I am thinking about.

First, the scary thing is that people NEED pain. It helps prevent us from doing further injury to ourselves. People who are congenitally unable to feel pain risk a lot of bad stuff, because they can't tell when they are seriously injuring themselves.  I know the idea of pain being necessary sounds cruel for people who have long-term pain from debilitating conditions like arthritis or some of the things you have mentioned. But in a sense, pain is like the warning track in a baseball stadium. It's trying to prevent us from crashing into the wall at full speed. It's adaptive in general, even though it's such a bear when you have chronic injury and damage.

Anything that gets in the way of feeling pain can be perceived by our bodies as an infringement on the warning system. That is, our bodies will try to restore "normal" perception of pain so that we will be properly advised as to what is going on with our skin, joints, muscles, tendon, ligaments, bones, etc. We can't afford to suppress pain very much or for very long; our bodies will respond by resetting the pain mechanism to report even more forcefully on smaller pain experiences.

What this is all a demonstration of is something called neural plasticity. The message of neural plasticity is that tolerance is an almost unavoidable response to the use of pain medications. Our central nervous system is trying desperately to keep us in touch with reality, and will continually renew  and in most cases, "upregulate", the way sensory experiences are processed. If your doctor doesn't talk about this, then perhaps its because this is all being researched more thoroughly now, and medicine is a conservative profession that doesn't go jumping on bandwagons. This is all part of a larger field of study called epigenetics that deals with the way that environmental causes interact with genetic endowment to change expression of genes involved in everyday function and behavior.

The only place where tolerance doesn't seem to be inevitable is something called central sensitization, which is what causes pain in a susceptible group of people. It has been implicated in some cases of fibromyalgia, pain from shingles, pain from diabetic neurpathy, and some types of back pain that linger after damage has been repaired. (But not all types...) Central sensitization is a hypersensitivity that is caused only by a neurological change (changes in neurochemical signalling), and is not caused by ongoing damage in the skin, joints, muscles, tendons, ligaments, bones, etc. That is why some people get almost miraculous pain relief from some of the newer drugs (such as gabapentin and pregabalin) and often don't even have any recurrence. It's because they were having pain for no good reason, and this type of pain can be eliminated by "down-regulating" the pain system.

I am not sure if this helps anyone, but I just wanted to add this to the discussion. As I said, I just realized I am having tolerance issues. I thought meds were going to solve my long-standing sleep disruption issues. After a few blessed nights of restful sleep, I am back to my usual state of exhaustion (and it took a lot less than 2 months!). I was SO hopeful. Like all of you, all I want is a normal life. The really nice thing is that researching all these medications and research has helped me see how hard scientists and practitioners are working to get us help. Here's to medical science! Good luck to you all in having comfortable, productive and fulfilling lives.

[Tuckamore]

Welcome to our forum. You have offered additional good information on the topic of tolerance. I beleive we all know that we need pain. It is our bodies way of signalling us that something is not right. It is a challenging and difficult task to juggle medications that effectively treat chronic pain and still allow our bodies to interpret "good" pain signals. And yes I agree there is "good" pain. That pain that signals, hello, something is going on here, something is not functioning correctly, look at me. The good pain must be differentiated from the chronic pain and it is often a challenging task.

Chronic Pain is a very complex issue and varies with each of us. The definition of Neural Plasticity is the ability of the brain and/or certain parts of the nervous system to adapt to new conditions, such as an injury. The research by various medical facilities and medical research groups is even more complex. Results and focus of these research studies vary. This is a very exciting time in the area of Chronic Pain Research.

The classification spectrum regarding "chronic pain" is immense. Terminal cancer pain is considered chronic pain, yet the patient certainly has great reason for pain. Fibromyalgia is also considered chronic pain and no one here would disagree with the statement that it is real pain. In my opinion chronic pain has become a catch all term for all causes of pain that last longer than thirty days. Again, in my opinion there are degrees and variances of pain principles and causation that need to be addressed on an individual basis.  

I am hopeful that advancements and concrete results in CP research will be forthcoming. Our quest will be to get the slow-to-accept-change medical community on boards with any new conclusive approaches. Currently ideas, opinions, treatments and approaches to CP vary widely from state to state, city to city and often clinic to clinic.

I am sorry that your search for a restful night of sleep has not ended. Many of us face that issue and understand your plight. I wish you a good nights sleep and welcome you to our community. I am hopeful you will continue to join in our discussions and add your comments to our threads.

Peace, Tuck

[fpainestam]

Hi again, everybody.  What an amazing high level discussion this is.  I, too, am looking forward to reading the promised research...fpainestam

[opus88]

hi everyone I just found this discussion in the archives...very interesting, Sandee,  is there somewhere I can find the research that was done on this tolerance vs. condition..I would be very interested in reading it.
It was explained to me that the body 'remembers' the pain whether it still exists or not re: neuropathic pain...and apparently the most difficult to treat!
the remembered pain is most apparent in 'phantom pain' after an amputation.

[TigerLily17]

Wow, I just can't wrap my head around this. I would have never imagined something like this and it is raising so many questions in me that I never would have thought of as I'm sure it is in everyone. I look forward to reading more about this.

Lily

[TigerLily17]

Sorry I just noticed that this wasn't a new thing, where can I find the info?
Lily

[opus88]

Hi Tigerlily yes it is very interesting and I just found this the a couple days ago as well.
I PM'd Sandee and she is still working on getting this research out there for us...so keep posted there will be something, although she did say she would be off site of awhile..

[kmart1977]

I have been reading through a lot of older posts as I have found a lot of the discussions very informative & interesting. So I know this post is old but it piqued my interest & I was curious as to whether or not the research being discussed here was ever posted & if so could someone help me find it?
To add my two cents into the conversation...
I have been on a low dose of norco (5/325) & neurontin (100mg) for right at a year for SI nerve damage/low back pain/localized lipoma pain, a condition/conditions that has only been partially diagnosed (FRUSTRATING!) up to this point. I suffer on a daily basis with this mess always on a moderate to severe pain level.
Recently (and extremely warily I might add!) I asked my doctor to increase my doseage (1-2 tabs 4 times daily as needed of norco & 1 neurontin at bedtime nightly) to 2 more norco daily & 1 more neurontin daily.
He refused this stating that since I didn't have a definitive diagnosis for my back pain (MRI showed no abnormalities aside from lipoma in right side sacrum at L5 level) as well as my age being a factor (I'm 33) he felt that I was experiencing increased pain levels due to having developed a certain amount of tolerance to the meds.
What I also found interesting was that he said he didn't want me to be entirely pain free for fear of me overdoing it & engaging in activities that could further aggravate my condition. I don't know if it's just me but he sure seemed to contradict himself with these explanations. He was basically saying that I was too young to have anything seriously wrong (he doesn't really believe me is how I took that!) with me & that he wasn't yet able to find a diagnosis for the pain in my back (I took this as him saying it's all just in my head!) yet at the same time said that if I were to get complete pain relief (from a 'condition' that's 'all in my head' because I'm 'too young' to be experiencing pain!) I would be risking injuring myself further (yet he insinuates there is no injury to begin with?) & aggravating my condition (the 'condition' he hasn't yet diagnosed?).
I apologize everyone if it seems that I'm whining or overreacting to this; maybe I'm just reading into this too much? I just thought this an interesting experience of my treatment to add to this discussion.
I guess I could understand his reasoning if he had already increased my meds in the past & I was on a high daily intake of pain meds but I am on the same amount I was started on a year ago & yes it does help me to a certain extent but my daily life is still significantly impacted by my struggle with this pain. I feel like I should at the very least be able to hold my baby while standing up for longer than a few seconds & not have to have help putting him in his carseat, etc, etc. I'm not sure if my doc thinks that just because I don't have to go to a job everyday that I'm able to just lay on the heating pad on the couch all day & tend to myself but if he does he is so off base it isn't even funny.
I also have noticed (of course it may just be me being overly sensitive as I just had my 1st urinalysis) that lately my doc has been treating me differently. I feel as if he's distancing himself from me, a bit standoffish & as if he's not taking me seriously. I swear it seems he's asking me the same questions over & over & I'm recounting my different types/levels of pain over & over & he's acting as if he's never heard them before. I'm beginning to think that along with several other factors (including my age & the partial diagnosis)the fact that I asked for this increase has made him suspicious of me in some way. I just really hate thinking that my doc doesn't believe me & thinks I just see him for meds. I've done everything he's asked, from PT to injections and will continue to do so.
Anyhow I ended up getting way off in left field here, sorry about that everyone! I just wanted to mention the doc's concerns of 'masking' the pain too much & causing further injury. Anyone have any thoughts on this? And I'd love to read that article/research if anyone knows where it can be found.
Thanks to everyone so much for listening/letting me vent! It was much needed!

[Mollyrae]

Hi Kmart....This is a really old thread....why don't you start a new one with your information. You will get better results. Thanks,
Molly

[orthonightmare]

Hi. My 1st posting. I have Chronic Pain(CP) from multiple sites for multiple reasons.
As a former ER RN, I witnessed a lot of patients dealing w/CP. I was disgusted by some of my colleagues who assumed that 99% of ER patients w/CP, were drug seekers. We did have our share of "frequent fliers", who were actually addicted and were seekers and they were handled appropriately. But, their actions brought suspicion, to legitimate Cp'ers.
Advice- go to your PCP for a referral to a Pain Management group or individual. I'll get off of my soapbox now.
Question. Has anyone experienced increased "Rebound Pain" after increasing their pain med. due to tolerance?
In other words, does the pain increase due to more medication, in a snowball type reaction? I have heard of this and am reluctant to increase my pain med.dosage, only to create a higher degree of pain.