Pain and Pain Medicine usage lesson

[socrates2k1]

I was taught way back in high school, about drugs.
We had a police detective from the narcotics squad, come and give us a lecture about drugs, and it fits prescription to OTC to street drugs.

Think about your body, as running normally (yes, even with pain).  
Meaning, the way you feel right now, is "normal" for you.

When you take the pain medicine, it relieves your pain (gives you a "high" pain free, if you will).

Now, when you come down from your "high" (i.e. the pain returns), then your pain is actually worse, than before you took the pain medicine.

You see your body, when the pain medicine wears off, does not return back to "normal" (meaning, the "normal" you first felt, when we began), it falls below normal, meaning there is actually more pain then before.

So, if you take the same amount of pain medicine, you actually do not return to the previous pain free "high", and each time (you take the same amount of pain medicine), when the pain medicine wears off, you end up with more and more pain.  It's a vicious cycle.

Therefore, you eventually end up taking more pain medicine (increase the dosage), or you change to a different pain medicine (usually a stronger pain medicine).

Once you "max out" (dosage wise) on one medicine, you move up to a more powerful pain medicine, and begin the cycle, all over again.

Eventually, you run out of pain medicines to take, or quit taking pain medicine altogether.

This is the "vicious cycle" to having to take pain medicine.  We have chronic pain, so we have to take something or do something to relieve that pain.

End of lesson.


Take care and God bless.

Socrates

[HVAC]

Socrates,

I value your insights.

I am sorry for you and your wife's situation both sound hard.

I went two years with no medical care or medications because we had no insurance.

Pain is one of the most complicated parts of medicine. It is an individual thing.

Alex

[socrates2k1]

I know a lot about chronic pain, my wife has suffered with it for many years.
She has degenerative disc disease, that is working on her spine.
It is literally attacking her spine (vertebrae) from two directions, working it's way down from the top vertebrae (in her neck), and up from her bottom vertebrae (at her tailbone).  Eventually, they will meet in the middle, if you know what I mean.

She also at 55, has had both her knees replaced (both had total loss of cartilage).

She has tried all sorts of pain medicine combination's, from prescription medicines, to (Duragesic - Morphine) patches, spinal epidurals, etc., they all failed.

Believe it or not, the combo she takes now is Tramadol & Tizanidine,

I was taking Percocet & Vicodin, before I lost my health insurance & my prescriptions ran out.

I also had a prescription for Tizanidine.

I have taken Tramadol (with a prescription), in the past, for pain, and it was no better than taking a placebo, it has no affect on my pain, but it works for her.

Usually, she takes her medicines at night, before she goes to sleep, and they
literally "knock her out", she has literally fallen out of bed, several times, that's
how hard it knocks her out.

Her prescriptions are running out too, and she also has no health insurance, at this time.

My wife did fight for Social Security Disability, and finally received it, early last year.
However, she chose not to get Medicare, because I had her on my insurance.
Now that I have no (job) insurance, she has none either.  She was told if she wanted to get it now, she would not actually get it for, at least 5 months.

Many nights, I feel guilty telling her about my pain, because I feel she is in a lot more pain than I am, and has been for a very long time.

She simply tells me, it's two different kinds of pain, and not to try to compare the two.

I can tell you that taking OTCs, like acetaminophen & ibuprofen, barely take the edge off the pain.  However, I do not take acetaminophen, because of my NASH (liver damage).

I don't know if any of you watch the TV Show (on Fox), called "House".
If you do, what I say will make sense, (if you don't it may not).

The fictional Dr. House, lost his right thigh muscle (due to muscle death), so he walks with a cane and is in excruciating pain, chronic pain.

Well, the fictional Dr. House, takes Vicodin (lots of it), for his chronic pain.

However, his "friends" (also fellow doctors, fictional of course) are worried that he
has become "addicted" to the Vicodin.

Hello, he has "chronic pain", by definition, pain that will never go away.

What are we taught about pain, when you have it, take something that gives you
RELIEF?

Dr. House's friends, try to get him, to get off of the Vicodin, because he is addicted.

This makes both my wife and I wonder, what are they thinking, what is their reasoning?

If he has chronic pain, then he must take medicine, for the relief of said pain.

Yet, when he does take (prescription) medicine, for the relief of his chronic pain,
they worry about him becoming addicted to "pain killers"?

What a "catch 22" or "D & D" situation?

Have chronic pain, take a prescription pain medicine, however if you continue
taking it, you may become addicted (to it's pain relieving effect), therefore
since you are addicted (to the pain relieving medicine) you should stop taking
said prescription medicine.

Dr. House, just can't win. He has chronic pain (that will never go away) and therefore
needs relief with prescription pain relief medicine.

This scenario, I just do NOT understand, but that's me.  If I have chronic pain, then I deserve to take whatever prescription pain relief medicine, that relieves the pain!

[supermum_ms]

Ok, i'll say something here, didn't want to because i knew it would be a sensitive topic and hurting people ARE hurting, i'm currently watching my dd go through agony every day whilst she is waiting for 3 more wisdom teeth to get pulled. She's popping pain pills and still nothing is touching her pain, she's one tough cookie and knows all about living with pain, a back built like a pretzle will do that to you but she can and does handle that, though this new kind of pain has thrown her threshold out of wack and she's hurting.

I live by what you wrote, i dont like to take any meds, i'd rather try and tough it out more because if i do need pain meds and there are times when i really really do, the very idea that once they wear off, i'll be in even more pain until they kick in again, is more frightening to me than getting the relief. Is it totally irrational and stupid to even think this way (probably) my dh thinks i'm doing it all wrong, i know it would be a different story if my pain never let up, I'd be knocking anyone over to get something to take the edge off.

I'm lucky, my pain is fleeting, it can last for days but usually it will stop and start multiple times a day, so i get a break, i'm sure it helps that i laugh my self silly, i dont think i would be able to cope with it if i didn't have the ability to still laugh. Thats another thing i count as lucky, with my family history of depression i find it remarkably lucky that i dont get depressed but i do get too happy, a flip side of the same coin.

The only thing i didnt get was the high part, i've never been high from a drug in my life, now give me a litre of orange soft drink and i'll get so hyper you'll wonder what i'm on, high on sugar lol I suppose like any drug that can produce a high, if there isn't a medical reason for taking it and your taking it to get high, you'll keep chasing that high and will need more and more to get it. I think i've just realised i'm really ignorant to what is a high, i'm assuming its a feeling of stupendous wonderment, floating on a winter wonderland with out a care in the world.

Maybe thats not what a high is at all, maybe its mentally numb, totally disconnected to the real world where you simply check out for a time, devoid of reality, blissfull in its nothingness. Hmmm i was once given a drug for my fatigue, i couldn't move it was the worst feeling and i couldnt imagine ever wanting to feel nothing and not care if the world came to an end. I can see how something that shuts down your pain response could also shut it down to the point of feeling nothing, I can also understand why someone would want to check out for a while, not that i would want to but i can see why to some people they might find it apealling.

Its not fair that the few who do abuse make it difficult for others to even acknowledge they are in pain, stigmatised like a drug addict when they have a ligitimate reason for taking a pain drug. Over here there isn't the problem, or the stigma, i see your intent as being informative, of help and its probably been a bit confronting but please realise you did delve into a touchy subject that by all acounts was unexpected, given the level of pain some here still have to live with. Whats that saying, something about walking in my shoes and then you would understand, its really not surprising, if your confused by the response read the post and put your self in their shoes. Your intent isn't that clear, but I see it!

Its a great subject, meds are not enough sometimes to even touch it, so what do people do? I want to know cause maybe one day soon, i'll need some extra help.

Cheers..........JJ

[Quixotic1]

My rant was in NO way aimed at you and I appreciate you bringing up this societal taboo topic.  You were offering information.  We all know that and we don't equate the information with you.  

Some of us disagree with what you were told, but that is not a reflection onto you.

Please, do not feel that you were ganged up on or that we aimed ANY comment at you.  I cherish your new presence.  No apology is needed from you or anyone for voicing a strong opinion.

I totally understand your use of the word "high" for the state of having severe pain controlled.  Man, if that isn't a sort of high, then nothing is.  It's just that commonly the word "high" is equated with self-medication for kicks and with addiction.

Personally, as crappy as I feel most of the time, if I do get a little euphoria with an occasional dose of pain med, so what?  I can enjoy that as well as the relief of the pain.  It's rare that I ever feel good.   And I do know that this also is not what you were speaking of.

It's okay.  This was not a personal disagreement, just an informational one.

Rest easy, or I'll come wring your neck.

Quix

[Ufrustrated2]

>>Unfortunately, there is still a stigma attached to those who use those evil pain meds.  

no sheet! i have a friends who are so focused on asking me what pain meds i'm on versus, "how is the spine doing" how is the "ms doing". as hard as it might seem, these friends just don't seem to get it that i have rrms. and no, i don't tell them i'm on pain meds or any name. gee, talk about neanderthals...

>They are not without dangers, but they are often literal life-savers for those who experience life-altering pain.

i quit drinking 19+ years ago and taking any non-rx drug. for 17 years i never seeked out pain relief vrom the doctors. in hind sight, i suffered needlesssly and those around me did to due to the more than avg irritability. we talk about denial in aa, well, i have to admit i've been in denial about how i've really felt and thought for years. not good but then again when doctors aren't trying to help nor listening, my denial was a form of survival - i thnk. not sure if i'm stating my thoughts right now. LOL

two years ago i made a change in that thinking, and boy am i glad i did. i thought i was on the brink of insanity with really bad discomfort, lack of sleep, freaking fatigue, scattered thought patterens, etc.

the meds i take now help. my neruo and i have had to expeirment with a few. some work well for me and others that are supposed to, well, didn't do squat for me.

my personality has changed over the years due to chronic pain, anger, depression and stuff associated with these diesases i have. i can them diseases now versus being my former "negative mind trip", becasue i have diagnosis now and i have intellectual/acedemic ammo from this site and a few veterans sites.

hell, i can suck it up with the best of em, trust me on that. but we're talking about the wisdom in pain management. after 17 years of not managing it, i must prefer to management it and have that edge at bay. just no reason to be that miserable if ya don't have to be. i'm not in any contest to see how much pain i can take either. been there done that,

i'm a ramblin on now, time for bed

[grannyhotwheels]

Very well said Quix. As most of us with chronic pain, I try to stay ahead of the pain.  If that means I'm an addict then so be it.  I have fought my pain long enough to know how to control it.  I keep a small amount of pain medication in my system at all times but I only take the heavier stuff when I know it's needed.  We have to listen to our bodies and know when and what to take for the relief. Yes my breakthrough pain medicine has been upped over the years but with that came more lesions, more damage, and more pain.  It's not in my head that I need it, I go for days at a time without needing any breakthrough pain medication but when I do need it it's there and I thank GOD for that. I think that our bodies tell us when we need it and when we don't and it's up to us to take it accordingly.  I have never felt "high" from my meds but who knows that doesn't sound half bad. haha I'm only joking here okay?  My final word  is if your pain is bad enough for narcotics then it's between you and your doctor as to how much and how often.  For those of us without insurance there are programs that will help pay for the necessary medications and your doctor should be able to help with this.

I'll be praying,
Carol

[socrates2k1]

OK, I give up, you all win, I will say no more on the subject.

My deepest and most heartfelt apologies, to all.

Take care and God bless,

Socrates

[Karen99]

Socrates - no need to apologize.  It was my bad to become defensive, sorry.  It was not directed towards you in particular.  

    

[Quixotic1]

There is such a flaw in that description of how pain meds work that I am angered as usual at the neanderthal mentality toward pain relief in this country!@

Argghh!

Pain meds used for real pain do NOT reliably loose their effectiveness and create the need for higher and higher doses, thus creating addicts or making all pain meds ineffective.  Pain meds used for the "high" that some give do follow this pattern.

In this country there is now such a stigma on the use of pain meds - particularly narcotic ones - that it is seen as preferable to have someone lose all quality of life in pain, than to use a narcotic pain med.  This is part of the motivation (besides ignorance) that causes doctors to say that there is "no pain in MS."  That way they never have to get into prescribing anything for pain.

Many people use narcotic pain meds for many years or most of their lives without an addiction.  There is a huge difference between addiction and habituation.  If someone is on a narcotic for a prolonged period there will likely (but not) always be some withdrawal if they stop suddenly.  This is uncomfortable, but does not lead to the continued use/need once they are off the med.

The most common reason that a person may appear to be a drug seeker is that they have severe pain that is INADEQUATELY treated.  The doctor, with more concern about his liability or a prudishness about people who need pain relievers, undertreats the pain and leaves the patient in the state of partial treatment - thus suppression of natural (but ineffective) pain relief, so they have their true pain and as each dose wears off the pain is increased.

The people with a tendency to addict and there are many such people must deal with severe pain differently.  However, this genetic predisposition is NOT the majority of people.

Studies aimed at looking at the behavior of people in severe pain who have their pain adequately treated show that overall, they use less narcotic than people who only occasionally get enough to relieve pain sufficiently.  Again, if you relieve pain enough, less med is needed ro desired by the patient.  An example is post-op or acute injury pain.  If a patient has to rely on the clock and the schedule for the nurses to deliver pain meds, they are FAR more likely to request and require more meds than the person with self-administered narcotics.  People who are taking their meds purely for the relief of pain will typically wean themselves off as the pain lessens.

This is a very personal issue for me.  My story.

I have a weird symptom since a concussion in 1983.  Initially this symptom was occasional and fairly mild, but it interferred with my ability to practice medicine for a few days.  When I fatigue I get these painful, disorienting, swirling zaps inside my head when my eyes move to the left.  My neuro called it Sensitivity to Eye Movement (typically seen with migraines which I don't have and with head trauma.  I have had three significant concussions).  Since the severe vertigo hit in 1999, along with two more concussions, the problem now occurs almost daily.

Once it starts I can not think, read, knit, answer posts, converse, nor function.  I have been treated with at least a dozen and a half meds to try to suppress it.  Sleep for several hours was all that relieved it.  I discovered after surgery in 2002 that narcotics deal with it effectively without drugging me into a stupor.  I have been on the same fairly low-dose narcotics almost daily for the last 8 years.  The same dose works today that worked 8 years ago.  My overall dose has recently decreased (almost in half) as the sensitivity has began to lessen.

Am I an addict?  Do I drug seek?  Am I despicable?  The pain ignorant of our society would say yes.  Recovering addicts might say yes.  My docs and my pharmacist say no.  During the few intervals when my need disappears, I have a short (2 or 3 day period) when I am more restless and have difficulty sleeping.  Then, I am without desire for the med until the zaps reappear.  I have tried going without it when the electric zaps in my head are bad, and my only inclination is to end it all.  Somehow, the ability to think is very important to me.

The myth that all pain meds will require higher and higher doses until the person is an addict or all pain meds are ineffective is used to maintain the prejudice in our country against the use of pain medication.  It is similar to the false analogy of the "Domino Theory" of Communism (that if you let one country fall to Communism, the next one and the next one will inevitably fall, too) that got the public to support the Vietnam War.

Soapbox over.

Quix

[socrates2k1]

My apologies, you misunderstood my statement.

I was correlating a "high" with being "pain free"

My apologies, I mean pain free (or in many cases, just "less pain").

I do not in any way mean that the pain medicines any of us take, for pain, gives us a "high".  Please forgive me, if you misunderstood that, I apologize.

I was NOT referring to "street drugs" or "illegal drugs" of any kind.
Please forgive me, if anyone misunderstood, I apologize.

For those of us, with chronic pain, pain management is completely necessary!

I was simply explaining why, when you take medicine (Prescription medicine),
if you continue to take the same dosage, it eventually will not be as effective.

That is why people on prescription medicine, find that the dosage they take, starts to lose it's affect.

Therefore, their Doctor, either increases the dosage of the current prescription medicine, or the Doctor prescribes a stronger prescription medicine.

I, myself, was taking prescription medicines (for my chronic pain), but when my health insurance was canceled (I lost my job, therefore my health insurance),
I was unable to afford to refill my prescriptions.  So, now I try to rely on OTCs
like acetaminophen and ibuprofen.

Please forgive me, I was simply trying to explain how prescription medicines work in our bodies, and why the same dosage of prescription pain medicines will eventually not be as effective, as they once were.

Again, please forgive me, I have learned a hard lesson.

Socrates

[Karen99]

There is more to the lesson than Mr. Narcotic Detective told.  I believe he was addressing recreational drug use, rather than those with chronic pain that requires management to live a quality life.  

I have been saying Yes!  Yes!  to narcotics when needed for 10 years now.  I'm not addicted, haven't increased the dose, and haven't changed narcotics. I've yet to max out. My meds don't give me a "high" but a break in pain and function better, and am not worse.

Statistics show that those who graduate the DARE (dare to say no to drugs)  program actually have higher addicted rates than those who missed the program.  

Unfortunately, there is still a stigma attached to those who use those evil pain meds.  They are not without dangers, but they are often literal life-savers for those who experience life-altering pain.

    

[HVAC]

The other lesson of pain management is keeping ahead of the pain. If I take pain medicine before the pain takes a hold I find I take less pain medication and I can stay with lesser forms such as OTC.

Alex