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211940 tn?1267884866

Pain and Pain Medicine usage lesson

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

12 Responses
667078 tn?1316004535
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
562511 tn?1285907760
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.

    
211940 tn?1267884866
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

147426 tn?1317269232
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
562511 tn?1285907760
Socrates - no need to apologize.  It was my bad to become defensive, sorry.  It was not directed towards you in particular.  

    

211940 tn?1267884866
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
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