Julia M Aharonov, DO  
Female, 56
Pontiac, MI

Specialties: Addiction, Drug abuse and dependence

Interests: My family
Advanced Rapid Detox
Pontiac, MI
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Opioids for Chronic Pain  (First Do No Harm)

Jul 26, 2012 - 19 comments



Chronic Pain

This is an extremely timely article that was just published mostly for general practitioners in the Annals of Family Medicine Magazine. I thought that it some numbers in it were both troubling and fascinating to want to share it with all of you. In a nut shell it says what I have been saying all along - doctors write too many opiate prescriptions for far many chronic pain patients.

Nearly 15,000 people die from  opiate prescription overdoses than both heroin and cocaine combined.

Opiate prescription has increased 6 fold from 1997 to 2007 and has been accelerating since.

There are better (in my opinion) treatments for chronic pain that are much safer than opioids,such as physical therapy, cognitive behavioral therapy, anti-depression medications, and treatment of underlying psychiatric illnesses such as depression and anxiety, dietary and life-style changes, etc.

High dose long term opiates have not been shown in multiple studies to improve long term pain scores of chronic pain patients - and that is the most important fact of the whole article.

Please read this short abstract if you want more details and are not afraid of medical lingo.

From Annals of Family Medicine
Opioids for Chronic Pain
First Do No Harm

Roger A. Rosenblatt, MD, MPH; Mary Catlin, BSN, MPH

Authors and Disclosures

Posted: 07/24/2012; Ann Fam Med. 2012;10(4):300-301. © 2012 Annals of Family Medicine, Inc.

Among the remedies which it has pleased Almighty God to give to man to relieve his sufferings, none is so universal and so efficacious as opium.
Attributed to Thomas Sydenham, circa 1680

Overdose deaths from prescription painkillers have skyrocketed in the past decade. Every year, nearly 15,000 people die from overdoses involving these drugs—more than those who die from heroin and cocaine combined.
National Center for Injury Prevention and Control

Opioids are a large family of biologically active peptides that bind to and activate receptors in humans and can reduce pain and induce euphoria. Humans have a voracious appetite for opioids to the extent that our own brains produce them (eg, endorphins), and many people avidly consume those that are produced by plants or synthesized by factories in our environment. Opioids have shaped the course of human history and are arguably one of the most powerful, ubiquitous, useful, and deadly substances in our medical armamentarium.

Our society is agonizingly ambivalent about what role opioids should play in our lives. There is no question that opioids are effective analgesics in the treatment of pain caused by acute injury or surgery, and they are invaluable in the palliative care of patients with cancer and other lethal diseases. But we have criminalized the nonmedical use of opioids and deploy vast armies of combatants in the (largely ineffective) war on such drugs as heroin and opium. The greatest medical and recreational use of opioids in the United States falls between these two extremes and is fostered by the prescription of opioid medications for chronic noncancer pain.

What should be our policy that determines how and when to use opioids for our patients with chronic noncancer pain? The 2 articles in this issue of the Annals discussing opioid use and misuse illustrate the complexity of this question. In Grattan et al's study of patients on long-term opioid therapy for chronic pain at 2 of the largest health plans in the country, patients with no history of a substance use disorder were much more likely to "misuse" opioids if they were depressed. The misuse that patients admitted to during a telephone interview was using their prescribed opioids to treat stress or insomnia rather than pain itself or using more opioids than had been prescribed. Perhaps most interesting is that misuse was common even in patients without depression, occurring in more than one-third of patients.

Patients with severe depression as measured on the 9-item Patient Health Questionnaire were even more likely to misuse opioids than were patients with no or moderate depression. Although this self-report of opioid misuse is already surprisingly high, it may well be even more common than reported in this study. Given that patients are more likely to deny overuse when questioned, and that those patients who didn't respond to the interview may represent a group who are less compliant with instructions, it is reasonable to surmise that opioid misuse probably occurs very frequently in any population using them for prolonged periods of time.

Zweifler focuses his discussion on the most difficult issue that clinicians wrestle with as they try to help patients with chronic non-cancer pain: pain is impossible to measure. Pain is a normal (and protective) physiological response to the physical and emotional vicissitudes of life itself, and anyone who lives long enough will have chronic pain as an obligate consequence of aging. Zweifler cuts this clinical Gordian knot by recommending a strict standard for initiating opioid therapy for chronic disease: "objective evidence of severe disease." Although this dictum has the virtue of brevity, it fails the test of clinical utility. Chronic pain is predominantly a condition that is experienced in the central nervous system, and the event that first triggered the pain may no longer exist or may be impossible to determine. A guideline that requires definitive objective confirmation of severe disease—especially in an era where magnetic resonance screening can show clinically irrelevant anomalies in a large proportion of patients—is likely to lead to as many false-negative and false-positive diagnoses as the much-maligned visual analog pain scale that is currently in widespread use.

So what is the clinician to do? This is what we know about the use of opioids for chronic non-cancer pain:

    The volume of prescribed opioids has increased 600% from 1997 to 2007.
    During roughly the same period, the number of unintentional lethal overdoses involving prescription opioids increased more than 350%, from approximately 4,000 in 1999 to more than 14,000 in 2007.
    Risk of overdose or death increases with higher doses of opioids, especially in patients who concurrently use other respiratory depressants such as benzodiazepines.
    There are treatments for chronic pain that are much safer than opioids, including, but not limited to, physical therapy, cognitive behavioral therapy, low-dose tricyclic medications, and treatment of co-occurring psychiatric illnesses.
    High doses of opioids do not reliably decrease patients' report of the magnitude of chronic pain, nor do they improve patients' overall health and function.

Thus it is reasonable to conclude that opioids for chronic non-cancer pain are not appropriate therapy for most patients in primary care settings. When other interventions fail or are inadequate, cautious evidence-based consideration of low-dose opioids as an adjunct to other therapies may be considered. Entering into chronic opioid therapy requires a long-term commitment by clinician and patient alike to use this powerful, precious, and dangerous medication with care and diligence. As clinicians and as patients, we need to develop a generous measure of respect for the power of opioids to do harm as well as provide relief from pain.

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Avatar universal
by Thumpermk, Jul 27, 2012
This article hit the nail on the head. I have Fibromyalgia and have had it for 10 plus years. Initially the doctor gave me various anti-inflammatories and the one that worked was taken off of the market(Vioxx). The pain was so severe that I was given Tylenol #3 and a muscle relaxer. I am also on 2 anti-depressants. I did not like the feeling from the first 2 meds, but did not know how to function as a wife and worker outside of the home. I began through trial and error adjusting the dose of the meds and finally came up with a combination that takes the edge off, but does not make me high or dangerous. I cut both pills in half and take 1/2 of each first thing in the morning to help get me out of bed and last thing at night to help me sleep. The doctor thinks I am strange(in a good way) because I half the pills. I also do stretches throughout the day and sometimes have to take a dose during the day. Let me repeat, THIS DOES NOT MAKE ME HIGH, IT ONLY TAKES THE EDGE OFF!!!! I am a medical professional and have to be ready to handle emergencies at a moments notice, I have to be be alert and we get drug screened on a regular basis. I always fail the initial screen because of the opiates, but when the advanced screen is done the results show a trace and I pass. I have 2 adult daughters that have Fibromyalgia and both of thm have altered their diet, do stretches, and alter their clothing/shoes to make them more comfortable. On the flip side I have a sister with Fibromyalgia who loves the high and takes 2 Tylenol #3 and 2 Soma and that is every 3-4 hours. She does not stretch, diet or do anything but stay high and lay in bed. Please, please use caution and take this article to heart. YOU CAN HELP YOURSELF and it does not require you to be drugged and nonfunctional. Additionally, when you actually do need pain medication, it will be difficult to control your pain because of your high tolerance from abuse of these opiates.

Avatar universal
by shellycemt, Jul 28, 2012
good for you your one of the lucky ones who may have a higher tolerance to pain meds but I myself aand many others just cant go on with their lives due to the inflamationand burning searing pain that comes with not only fibr but I have occipatal neuralgia and post hepatic neuralgia from when i had shingles i also have homeopathy of both feet and legs, with osteoarthritis and spinal steno sis, degerative disk d/o as well as  pinched nerve in my neck affecting ie cmy shoulder and arm, im due to have 2 surgeries on both my knees in the nest few months to suck out all the crunchatiledge you hear when i walk with pain, i also am post op 5 days from a nose reconstruction due to skin cancer on my nose for the third time as there was no more skin to use as a flap so they took it from my ear. I wear bandages as i sit here as the 2 surgeries mon one to take the cancer out then to the or for reconstruction.im 52 probally most ppl wuld say i dont look my age i was homecoming queen in high school so i take great pride in continuing to look attractive for 52 even my 16 yr old son says im very attractive for my age which i found to be such a complement as his father has been with 2 beasts since divorcing me and he hates them both and i will say i am the most attractive out of his girls lol.. MY POINTTTTTTTTTTTTT i am on pain meds not a horrific amount but to some maybe it is 180 mg hydrocodone a 24 hr cycle every 4 hours and 20 mg methadone for nerve pain 3 times a day and they together basically give me some quaulity of life which if it was like it was in the 80's when they all wern't awre of peoplewith chronic pain issues or maybe back then they didnt have all the disease and disorders they have now but if I was to try to do life on lifes terms id be in bed crying and chewing motrins by the handfuls without much relief as the neuropathey started first and i was with a fire ct and he wasvery straightlaced older than me and had never crossed any lines with pain medication and hed seen so much od's on the ambulance he was dead setagainst me seeing somebody, so when it would comeon at his his house id have my bottle of motrn 800 mg and just start eating them and eating them curled in a ball whining i couldnt walk id b under a blanket and finally isaid screw it im def going to take charge of this b4 it ruins my life. I thankfully found a dr who was more than willing to write me pain meds and i have for 6 yrs been basically on the same medication except when the fibro and nuerlgia started in my upper back i would go to this pain clinic and they would give me cortisone injections at the base of my skull and my shoulder areas 6-7 shots that hurt like hell but relieved the pain my dr  new methadone now was being prescribed to ppl with nerve issues from the day I began it a year or so ago i have yet to have to got to those every other month shots!  one more peace of freedom from that burninggggg omg pain. the rest is hard my knees are gone im 52 as i say and i do know pl youngr than me have had knee replacements but i live in a condo with my mom who cant get up the spiral staircase and once i have my operations im unsure how i will get up and down thse stairs and if i need help can she be there forme to come up s im petrified of having the knees done but if i wait to long my mom isnt in the best of health and i so sadly could loose her and this woman is a saint there has never in allmmy years and all my friends seen a mom as devoted to loving her children unfortunatly for her sshe had 3 and my older brother was muerdered at 36 in 1997 and then me i was 34 and few yrs later my younger brother was also 36 he was a firefighter and got shot in the spinal colum and was apralized from the waist down and he was on 2000thousand 10 mg meth and 745  15 mg oxys and my dr works with my brothers old dr my mom took care of him all by herself throughher 70;s and the other day when talking to my pain dr he said i heard something disturbing about your brother shelly that passed away 11/11/08from his wounds..he said OMG to theamount of medication my brother got he was floored he kept repeating that omg do you know that would KILL someone KILL someone???? Im like yes some hospitals staays nurses refused to give him hismeds till the pain clinic dr came u and oreded they give him what hes prescribed we my family have a high tolerance to pain med as my dr always says michelle the meds i give you never seem to affect you ur alwayss wide eyed and bushy tailed and I said they never willl i dont get dopey from meds i take them as prescribed not like ppl i know that got lucky they dont have myuch wrong with themm but there so cnvincing with the old back issues that noone can prove or disprove and they  are out of thier meds with in  a week to 10 days and feel like cra cause they ate up 180 15 mg oxys in tht time and of course there gonna crash and b sik. i have never ever ran out of medication as even though id like to take an extra one occaisionally i know i cant i could run out and thats part of the contract not running out..but my whole story was based on the fact thatdr's need to, listn to thier pts and there are xrys and tests for many things but thre also are just your word ur hurting so its hard cause the fakers make it more difficult for the ones who relly need their painmeds. so congratualations to you and your family but dont make others feel there wrong to take meds as they just might make the diff of living and surviving!

Avatar universal
by Fla305, Jul 29, 2012
Are these overdoses from just opiates or from mixing with alcohol or a concoction of other meds like benzos and downers? Every OD I read about they find all kinds of stuff in their system and not just opiates. It's when they start drinking alcohol on top of it which thins the blood. Then they nod and go into respiratory depression.

3167587 tn?1343964176
by oneofthegoodones, Aug 02, 2012
i too have NEVER gotten high from my pain management, and i thank god, i respect the meds and my dr, i can not function without the relief i get from my meds, just sitting here and typing causes me so much pain, i would give anything to just feel like my old self before my multiple conditions including fibro and chronic pain syndrome, my neck and back are shot, surgery could go either way specialists have told me one day i will wake up and decide to have the hardware put in but until that do to continue to be proactive in managing my pain.  we are here the people who cry themselves to sleep and just want to function, that respect their meds, please trust that Drs have to know we are here,  we need the meds.

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by Chrisk57, Aug 03, 2012
I have kidney disease and severe chronic kidney stones in both kidneys.. it is not cancer it hurts like hell 6 years i have dealt with this. 6 years I have been on oxycodone, without it I would most likely not be able to move so I say **** off with this non cancer no opiate ********. Damn hippys

3169562 tn?1344052545
by SunriseFisherman, Aug 03, 2012
@shelleycemt -
I am in no way doubting your or anyone's health issues in your message, I just have studied pharmacology at a university level for many years, I love to know interactions, side effects, dosages etc etc... I had to make a comment about your obvious lies about your friends narcotic dosage and a small issue with the way you are actually making chronic pain patients who are responsible look bad. This does not mean you are not a perfect patient, I'm not assuming anything... I know your english and odd way of 'looking like a opioid oldtimer badas$" is hurting our cause...anyway, on to my post..please take it with good intentions, is was wrote not to be rude or hurt anyone.  
So, 2000 methadone and 745 15mg oxy? There is no way in hell that amount of narcotics would A) be able to be prescribed without a instant DEA review in person of the office and loss of his DEA number and most likely close the place  B) The pharmacy would laugh at that quantity, as it's 66 pills of methadone alone daily.... I have a high tolerance due to many chronic conditions and that is overdose territory easily without the oxy thrown in....that must have been a yearly amount?  I know what you were trying to prove with that very hard to read message, but even as a chronic pain patient, you did a horrible job arguing your point..... it seemed you were high typing it, you need to act calm and use punctuation to start. You almost seem manic, wild energy, rants, and this can easily happen when anti-depressants are used for a non narcotic option for pain and one of the side effects is possible mania if you have a small mental health illness that has not been diagnosed, IE bi polar. I'm sorry if I sound rude, but sometimes being that passionate seems like you're fighting  when your experiences and opinions is the way to give another point of view. There will always be people that will argue, it's a argument that boils down to your issues that cause pain, if it's able to go away or is the illness a lifetime thing, and finally the doctors care for your life, slowly go up strength if needed, and use XR or ER type medications as first line treatment, breakthrough pain can start out as NSAIDs or anti convulsants, anti depressants are great too, but you seem a little excited and hyper, so we will wait on those.... :)  ok, hope you understand my point. IMHO, opioids should not be used for only cancer pain. Humans get pain that makes them unable to function without cancer. Those opiates save their way of life. Are they over prescribed? I believe they are... but other drugs used for pain are dangerous too, people with real chronic pain will not abuse meds..... and the main thing to remember is pills should never be your whole regimen.... personally, I love physical therapy in a swimming pool, walking my dog (WALK!) lol, and some good ol' great sex a few times a year. MYYYYY POINTTTT -Agree to disagree... the DEA will bust some of the over prescribers, there will still always be a street scene to buy pills, and over doses are a part of a much bigger picture of abuse, depression, and just plain dumbness. Good day

Avatar universal
by Lirona, Aug 04, 2012
If you read the article this was in part based on, also published in the Annuls of Family Medicine, reference 5 is mischaracterized. That article ( see http://annfammed.org/content/10/4/304.abstract?ijkey=16e5aa401ba0e1e817355c88f061a1e031e5a93e&keytype2=tf_ipsecsha ) has to do with patients who are depressed misusing opiods. The article CLEARLY states the authors' objectives to be, "This study aims to examine whether there is an association between depression and opioid misuse in patients receiving COT who have no history of substance abuse."

There is a big stretch to apply that to anyone who has non-fatal conditions that include chronic pain.

Patients reaching age 45 and older has increased as well, as have chronic illnesses we are now aware of, such as HCV (hepatitis C), which was often obtained by medical personnel and those who had blood transfusions (many articles state "before 1990", although those of us "working in the trenches" know a lot of blood wasn't being screened until years later & occasionally there is still an occasion of persons receiving tainted blood.

Testing for many conditions had gotten better, as have treatments, which includes an increase in opiod use to prevent suffering. I don't think any of us would consider picking up a scalpel without having some kind of pain control available to a patient so they wouldn't suffer.

I had a gal working for me that had been to the ED a number of times and her PCP blew off her pain. I referred her to someone else so she could be evaluated, as it was clear something was not right. She suffered for months and "toughed it out", as she was beginning to feel that it was her, yet most of us that knew her knew something wasn't right. Along with many other chronic pain patients (or even acute ones for that matter), she said she began to feel it was "all in her head", as she had been told, or it was inferred by the several GPs & ED doctors she had seen. She had already been labeled a "frequent flier" in the local ER after 3 or 4 visits to the ED.

I'm not sure how she finally got to the oncologist, but after she had been blown off, told it was "in her head" so much she started to believe it might be, she was finally diagnosed with stage 4D (metastatic) breast cancer. Had she not been blown off, she might have had a fighting chance. She died 3 months later. She was only 45.

Opiods are abused, there is no doubt about it. Unfortunately in the media, and in some medical journals, we see skewed results that often stigmatize the use and the abuse of opiods, and the patients that use them often hide the fact that they are even using them because they are bashed and questioned by friends and family if they do share their medications. The media has stigmatized opiods to such a degree that I've yet to see a single positive advertisement or TV show that shows responsible use of opiods and how they can change a life from a non-functional life to one that is functional.

I'm not sure where the "6-fold" increase numbers came from, but they are wrong!

While it is true that 9 or 10 deaths from 1980 to 2008 "involved drugs" (of any type, including deaths from primarily other causes & certainly NOT all overdoses, yet this may be where the 6-fold number came from, which was clearly mischaracterized.)

"Drug poisoning deaths increased sixfold from about 6,100 in 1980 to 36,500 in 2008" according to the CDC. The CDC article goes on to say "Drug poisoning deaths involving opioid analgesics more than tripled from about 4,000 in 1999 to 14,800 in 2008."

So the article referenced conveniently added another 200 deaths to make their point, which is clearly against even responsible use of opiates. These deaths involve opiates, and often those who die with opiates in their system usually have other drugs, often alcohol, in their systems as well.

I agree that many primary care physicians lack the training to manage opiates for either cancer or non-cancer chronic pain. Other modalities should be tried first, but not without looking into the cause of the pain, which often is not apparent and should be referred to neurologists, rheumatologists and pain specialists, and depending on the location of the pain, a cardiopulmonary specialist & cardiopulmonary testing should be don when there is a suspicion of clotting &/or inflammatory disease. Patients that are in moderate to severe pain, when a physician is not comfortable with treating the pain with opiates need to refer their patient to a competent physicians that can test, monitor and prescribe opiate medications and other forms of pain management, including electronic implants, CBT, etc.

We finally came up with pain as another "vital sign". I have to disagree with the author that pain is "normal" as a part of aging. No one should be left in chronic, intractable pain suffering. Any physician who allows this to continue without evaluation and treatment is doing harm by stigmatizing not only that patient, but lowers the trust level between doctors and patients.

Physical therapy is almost always a part of any pain management program, and often there are ups and downs, but overall function, when adequate physical therapy is available (insurance is often a barrier to adequate PT or OT, which needs to change, but until that changes, a physician needs to work with a patient & physical therapist that is dedicated to ongoing care as needed, to  develop a program, such as a gym membership, etc. that works for the patient & so a patient can continue to either maintain function as much as possible, or to improve function.)

Chronic pain has many, many sources. The key is to discover the source and to treat patients appropriately for their condition. Patients with degenerative disease which causes pain are not likely to improve function past a certain point, yet require physical therapy in order to maintain what function they do have, or to reduce the degeneration as much as possible.

A compassionate and effective program, that may involve a number of specialists, including infectious disease, endocrine, rheumatology, cardiopulmonary and other specialists may be required to evaluate and effectively treat chronic pain patients, get to the source of the pain and to keep these patients from suffering.

My hope is that physician training in the future will mandate treatment and management of chronic idiopathic pain with opiates as a treatment, along with other treatment modalities and when to refer a patient to specialists for evaluation and treatment.

If you are uncomfortable with treating patients who are in chronic pain, please refer them to an internist who works with the patient and other specialists in order to get to the bottom of the problems these patients are facing.

Pain is not a normal part of aging, it is the body telling us that something is not right. Sure this may be emotional, yet I've often found that depression is a result of illness and while it may exacerbate the pain in a downward spiral, we can intervene and stop it if we intervene aggressively and get the bottom of the cause of the pain. Only then can we effectively treat the problem, and we may have to dig deep to find it, but it is there if we don't let articles such as this blind us and further stigmatize a patient by referring them, inappropriately, to the nearest psychiatrist or psychologist. These specialties may help, and more often pain specialists are often co-majors in psychology, and patients may need help to deal with the pain they are in, but it is rare (if at all) that talking to someone will cure anything more than a tension headache.

Some drugs, such as Lyrica, SSRIs, SNRIs, etc. can directly affect pain centers, thus they work well for some patients, yet certainly not all. Many sources of pain simply don't respond to these drugs, yet do respond to opiate intervention, which needs to be closely monitored, but is often necessary for many patients to prevent suffering.

Bowing to the stigma of this class of drugs only adds to the suffering these patients endure, does the patients and society a disservice.

Please read the referenced article (13th reference) from the article you referenced entitled, " Agency Medical Directors Group. Interagency Guideline on Opioid Dosing for Chronic Non-cancer Pain. 2010 Update at this link...
http://www.agencymeddirectors.wa.gov/Files/OpioidGdline.pdf .

Avatar universal
by Cornflakegrrl61, Aug 04, 2012
@Lirona..very insightful,balanced,and compassionate comment!i have to deal with non malignant pain(it certainly FEELS malignant to me!!) due to crohn's disease and adhesions from ten abdominal surgeries,all related to my crohns. I am also a recovering addict who is very involved in NA and I go to both a gi specialist and a pain specialist who are fully aware..by my own admittance to them..of my addiction. I am also on hydrocodone 5mg twice a day ad other non narcotic medicines for pain. I do physical therapy when I am able to,I am involved with a therapist in some very good work. MY point..I know I am a complex patient that needs extra consideration. I believe I am headed for another bowel obstruction..I know my body well. I do not think opiates should be limited to acute and malignant conditions. There had to be some MODERATION..a balance. I have been in the position where opiates were thrown st me in a crazy amount and then NO pain medications at all..it seems to be a reaction to the political climate IMHO. I live in a state that is now extremely paranoid for anyone to have a prescription for opiates and very regulatory towards health providers I writing them. Do I feel there had to be monitoring and responsibility from health care providers?of course! But please do not penalize those of us who cannot function on a daily basis due to chronic pain! I was a very vibrant,athletic person who worked internationally volunteering in developing countries before I was diagnosed. My life has shrunk quite a bit and chronic illness and pain have taken a toll. I still fight the good fight and am vey proactive in my care..so much so that I am traveling five hours away to seek a second opinion at a renowned IBD clinic next month. I refuse to give up,although there are plent of dad I crave to just lay down and forget it all. This is my life dammit!i want it to be as good as it can be and part of that is taking personal responsibility for my own care and my health. This is my first post on this site but I had to speak up!

Avatar universal
by foundone, Aug 06, 2012
I have a hard time believing the stat that >33% of all chronic pain patients misuse their medications.  I suggest this may be related to the survey design--for example, patients not working might be more liable to misuse medication, and they also would be more available to respond to the survey.

Also there is a difference at least in my mind between misusing and abusing.  If someone is prescribed vicodin prn for back pain and takes it for a migraine headache, technically this can be considered abuse, although to me it is more a matter of misusing their prescribed drugs.  Contrast this with someone who comes home after a hard day at work, takes three vicodin to mellow out, and chases it with a few beers...this is clearly a much worse case of abuse.  And then there s a large number of people purchasing vicodin from friends or over the internet for personal drug use (Ryan Leaf comes to mind)...the point I am making is that it is completely unfair to lump all three of these groups of people together, as they are in the paper above.  Clearly, if someone is abusing opiods to get high, they need help.  But the reason opiods are being prescribed more and more is because chronic pain has a dramatically negative effect on peoples lives, doctors are realizing this, and opiods are one of the safest and most effective treatments for this problem.

Also remember that the US demographics are changing (aging baby boomers), and chronic pain conditions are more common in elderly, so the paper sighting this increase in prescribing of opiods, without looking at this as a factor, is completely alarmist and poorly researched, in my opinion.  There are other important demographic factors as well, for example, the decreased availability of street drugs-->increased price, with prescription drugs being used as a substitute.  Also, many of these studies, with regards to chronic pain patients, and drug abuse, have been sponsored by companies that sell drug testing or drug compliance products, so they have a direct benefit from portraying chronic pain patients such as myself as widespread abusers.

Avatar universal
by Bon2405, Aug 11, 2012
Please define the difference between use and abuse. If some is using these pills it usually means they need them. If someone is chasing a HI then there are better things to use than Tylenol, seriously what an unsympathetic sister you are. You clearly have a milder form of fibre, I one day the tables are turned and you get to walk a mile in her shoes.

Avatar universal
by tattooer, Aug 17, 2012
I have ulcerative interstitial cystitis which is a very painful condition where the bladder lining is covered in bleeding ulcers. I was put on methadone 4 years ago. At first it helped.but within a year I was taking 12 a day and knee deep in addiction. I now am down to 3 a day after a long process of slowly tapering down. I will be off them totally within a couple mote months. I believe pain management created addiction and most imortantly. I have much less pain on 3 a day then I did on
12. Our bodies naturally accomidate to these drugs and it take more and more
To get same results.  I can only say my truth but opiates do not work for long term treatment. I was a huge proponant if pain meds but in reality was a drug addict trying to rationalize. Thanks.  Got out alive.

Avatar universal
by tattooer, Aug 17, 2012
P.s. I don't judge others for what they do and my truth is just that...mine.  I respect evetyones choices. Bless you all and I understand the suffering.

Avatar universal
by Melo411, Sep 18, 2012
"Lirona" should write articles on pain management, instead of some of the authors like this one, so that people can understand that not everyone is using these drugs to get high! There are many people in pain because of autoimmune diseases, like myself, who do NOT like to take pills but have NO choice since there aren't any alternatives. I take 50mg of Tramadol twice a day for pain (thanks to Rheumatoid Arthritis, APLS, Hidradenitis Supprativa, Microscopic Colitis & fibromyalgia!) since prior to the Tramadol, I was having a difficult time functioning / having quality to my life. My PCP & Rheumatologist are aware of my dislike of medications so they discuss all with me to see if I will try it before writing any scripts. I honestly wouldn't have tried the Tramadol if I had known it was an opiate (I just found out when I stumbled upon this article & an addiction recovery blog about it!!!) because my doc.'s presented it as a safe, non-narcotic without any bad side effects. Over the past 2 years (since I've been "sick"), I have tried cymbalta (gained weight), lyrica & Celebrex and found they didn't help me, only gave me unwanted side effects. I would LOVE to go back to a medication-free existence...unfortunately, I don't believe that'll happen without cures for at least two of my diseases! Regulators should NOT have the power to dictate to doctors, PA's, APRN's or other knowledgable healthcare professionals, how or what they can prescribe for their patients. I worked in healthcare for 18+ years so I am well aware of healthcare being a racket, especially the pharmaceutical industry & there will always be pill seekers & doc shoppers who just want to get high or sell the pills for profit, but everyone cannot be lumped into those categories.

Avatar universal
by Melo411, Sep 18, 2012
Forgot to mention....
I don't feel any kind of high from the Tramadol I'm taking (probably since it's such a low dose...especially when compared to others who commented on this website) & I wasn't even aware of ppl abusing it or being addicted to it since I was under the impression of it being just another NSAID (like some of the other drugs I've unhappily had to take). I guess I was naive in this instance and still wouldn't have known if I hadn't stumbled across this info/website while looking up something else.
My doctors have wanted to prescribe some stronger med.'s for me but I refused them because, like I said previously, I don't like taking medication so I still have some pain & discomfort but I'll deal with it...until my diseases progress to the point that I can't.

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by AngelicNurse, Jul 16, 2014
Here is my story. In 2007 I had back surgery for A pinched nerve in my lumbar area. One week later the surgery site became infected and I became septic.  It took a Year for the nerve pain in my Rt leg and foot to go away.  After the sepsis I ended up with Fibromyalgia, hypothyroidism,  and anxiety. I was mainly taking gabaetin  Prozac , flexril for muscle spasms.  In 2010 I started to have sciatic pain to my Rt hip and down to my knee. A deep aful pain.  I went to see a good pain management specialist and Dr. Padilla said it was arthritis from the surgery and my facet joints.  So we planed to do A RFA. That burns the nerves by radio frequency that cause the arthritis. The nerves grow back but it takes up to 2 years.  In between the 2 test injections prior to the RFA I took Viciden 7.5/500 and muscle relaxors for pain. But once the RFA was done it took about a month and the sciatica pain was gone and I was off the narcotics!!   That was all in Michigan.   Now we moved to Kingman, AZ for a job.  This is a small town in the middle of the mountains. A lot of Meth addicts and drugs.  The PM here is Very a Different  then Michigan.  I have to sign a pain contract and be tested now and then. This is now 7/15/14 and my MRI shows SEVRE arthritis where my back surgery was.  I have a Lot of swelling which is pinching on my sciatic nerve. There is also one Doctor that does the RFA.  I am waiting to have this done. I still have to have the second test injection. Then the RFA.  In the mean time I am only given norco 5/325.  This does not help the pain much at all.  I am thinking about talking with my PM and asking for the 7.5/500 while I awaite the RFA.  I do work out, get Massages.  That all helps.  My Sed rate is so High due to the swelling so my primary doctor put me on steroids also. She says I have polymyoarthralgia. Not fibromyalgia.  And the dumb thing they did was drop my levothyroid down from 88mcg to 25mcg.  Which now has put me back into hypothyroid again!!! Sore muscles, constipation, tired, emotional. The level was redrawn due to me pushing for that and I was increased to 50. Mcg.   Feeling a little better.

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by Cranky_Crani, Nov 10, 2014
I would rather self medicate than leave my pain management in the hands of people that cannot and have not experienced it. And also seem to have already formed preconceived notions that every person in pain is a "drug seeker". I don't need to line the pockets of every new pharmaceutical rep pushing the latest anti-depressant.

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by painisreal, Feb 17, 2016
I am currently on 125 mcg of Duragesic every 48 hours and 4 mg Dilaudid every 4 hours. This sounds like a lot of medication, and it is, but without it I am unable to even get out of bed by myself and have zero quality of life. I exercise in bed for the most part but on warm days (not many of them in Alaska) if I am having a good day I can ride my horse for 5 to 15 minutes at a walk with help. I am able to help my husband prepare for his 15 hour work day by making his  "lunch" , can make his coffee and can do a little bit of weaving at a time. I now have some quality of life. The doctor who put me on these drugs 8 years ago promised he would stay around so that I wouldn't have to play doctor roulette but then he left less than 2 years later. You are asking why I need so many opiates so I will tell you. At age 17 I was thrown from a car and landed on my head , on the pavement, at 65 mph and was given no treatment at the time, I have degenerative disk disease ( all but 3 disks are bad from my neck to my tailbone), I have fibromyalgia, Reynauds, osteo arthritis, migraines that used to last weeks at a time, and a lump under my right rib which causes severe pain and nausea but no one will even look for the cause of. I was a very active person who fostered special needs infants for 25 years, often having 4-6  babies at a time with no outside help. I sewed, knitted, crocheted, did various types of beadwork, helped build the cabin my husband and I live in, and basically was there for friends and family  when needed. At one time I had been on various  new medications which caused severe side effects. I have zero side effects with the meds I am on now, just relief from the various pains. I did try for 4 years to use herbs. bio feedback, acupuncture and acupressure, physical therapy and otc meds and all that did was to tear up my stomach so that I now have issues with digestion. I was unable to even walk thru a grocery store and had to have a parking permit to be close enough to get into  the stores which had electric carts. My dosages have only changed once in all these years, one provider LOWERED my dose of Dilaudid! I have been subjected to random urine tests, signed contracts, get my prescriptions at only one pharmacy and only use 2 providers (one will not give hormone replacement therapy which I use because of total hysterectomy) Right now I am facing the nightmare I was in before these medications, as well as detoxing cold turkey because my new provider (the clinic I go to has a large turnover of caregivers) will not prescribe them! Living in Fairbanks Alaska means that my options for medical care are extremely limited so in one month time I will be living in hell! Even tho marijuana is legal here I do not use it at all, nor do I drink. It takes at least 2 weeks to get an appointment with a new caregiver and since I don't drive and my husband works very long odd hours I might be able to try one or two others but it doesn't look good. Not all chronic pain patients are addicts! I am so tired of being treated like one. Cancer patients are not the only ones with intractable pain!!

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by efbeyer, Apr 02, 2016
I now have to have urine tests to make sure I am taking my meds.  What irritates me is I have to pay for these tests because others abuse opioids.  I have been taking narcotic pain management medication for 12 years and do not abuse it but feel I am being punished for others abuse.  It really *****!  I used to live in Tennessee and had to move out of state to go back to my old doctor as it is nearly impossible to get pain medication for a legitimate reason.  The people suffering from the abuse of drug addicts are the people who need pain meds to function, frequently minimally, daily.  I am so tire of hearing the dangers of taking opioids...many of us do n ot abuse them.  I don't even know what nit feels to get high from opioids and don't even care...the med I take goes directly to the sites of pain.

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by TooLongOn, Jul 25, 2017
Anyone who says non-cancer patients should not have opiates has never dealt with interstitial cystitis.  

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