Practical Pain Management Community Advice

Opioids and Chronic Pain Management

From: Living well with pain - 1 year 10 weeks ago

I liked this article as it points out many of the pros and cons for using opioids. I am the CEO of People in Pain Network and we establish peer-led (PSMES) Pain Self-management Education and Support groups. We promote good information about all options for managing chronic pain and opioids are one of the options. I have met thousands of people over the 27 years that I have been living with pain and working with others who live with persistent pain.
The following quote is what I want to comment about
"What makes opioids potentially addictive, unlike some of the other medications that we use in pain management (acetaminophen, NSAIDs, antidepressants, anticonvulsants), is that they affect the pleasure centers of the brain and can expose the individual to a sense of well being, euphoria, contentment."
By making these statement, it will be harder for people to have a trial of opioids when appropriate, and more fear around addiction. The latest research states that 1 to 4 % of people taking opioids for pain become addicted to the medication. Way more people are addicted to caffeine and sugar.

I have been taking opioids to help manage my pain for 27 years and talk to many, many members who also have tried opioids or use opioids and NEVER have I experienced, or has anyone I know reported that they experienced a sensation related to pleasure, contentment or euphoria that would contribute to a possible addiction. All that happens is that the pain decreases. Often the unpleasant sensations like heartburn, constipation, and nausea are what people living with pain experience when taking opioids for pain.

With the current opioid concerns, I feel that people living with pain will be further denied a trial of opioid medication to help reduce their pain. Unrelieved pain interferes with a person's ability to think clearly, remember information, concentrate and be able to learn and practice pain self-management skills. Once this happens and people are able to keep their daily pain baseline lower, then the doctor and patient can consider tapering the opioid dose.
For myself, my opioid medication reduced my pain by about 30% and after learning pain self-management skills, I could reduce my pain another 30%. Slowly we tapered my dose and I am taking 60% LESS opioids than before with BETTER pain management and increased activity.
The new guidelines, while protecting both doctor and patient are being used as laws not guidelines.
People have a right to have their pain managed and to an improved quality of life.

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I always appreciate an educated, informed, unemotional article (or reply) relating to this political "knee-jerk" reaction to opoid therapy these days. After 28 years of AA, lowered er dose down 2/3 for 15 yrs, then scolded and denied any medication to keep pain level below an "8", I just keep breathing because I'm too Irish to stop, I suppose. Even with documentation of decades of responsible opioid use, Rx fill/refill printouts, MRI reports/diagnoses...some of us continue to be neatly dismissed and live in tortuous pain 24/7. The is unconscionable! I wonder what % is over 65?

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My doctor has stopped my hydrocodone prescription because when he tested my urine the last time I was there, no hydrocodone was present. I told his assistant it was because I didn't take it when I was going to drive, which is the truth, I usually stop about 3 days before I drive and double up on Tylenol. I can't afford to get another DWI because of it. I asked her to have the Doctor call me, however, he didn't csll. What should I do? I really need this pain medication. The assistant thought it was funny that I was cut off. I am already panicking. Please give me some thoughts on what to do.

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Preaching to the choir.

CDC employees recently acknowledged flaws in the CDC's interpretation of its data that have led to misrepresentations and faulty assumptions for YEARS; important among these flaws is that prescribing rates for opioids has DECLINED over the years while the alleged number of overdose deaths has increased, suggesting that prescribing has nothing to do with the "epidemic." The paper is here for anyone who wants a cool, refreshing blast of honesty:https://ajph.aphapublications.org/doi/10.2105/AJPH.2017.304265

It seems strange that, with addiction considered a disease, our government and healthcare system still labels certain substances as "addictive." If the vast majority of people who are regularly exposed to these substances do NOT become addicted, these substances are NOT addictive. If one is predisposed to addiction to a particular substance, then exposure to that substance may lead to the symptoms and manifestations of addiction, but that substance DID NOT CAUSE the addiction.

Some people are allergic to nuts, but we don't label every bag of Planters with black box warnings about anaphylaxis and death.

Healthcare and the related politics are being guided by a combination of blind opportunism and fear of liability, and patients are being denied care and forced to suffer. We all know fear does not make for good decision-making. Doctors invoke convenient guidelines that are made outside the patient room when they SHOULD be thinking about the person in front of them, but in their defense, they are also boxed in by the increased digitization of medicine and the insurance industry it serves.

There doesn't have to be a malicious motive behind any of this. Everyone involved might be acting with their best intentions and trying to help, but that doesn't mean the result is helpful. Nothing should ever be done in healthcare without at least an indirect benefit to patients (i.e. reducing administrative burden on doctors directly benefits the doctors, and doctors then have more time with patients, which benefits patients). Today's patients are the victims of society's data delusion - we have more data than we can handle AND we make the dangerous and foolish assumption that the data is meaningful (it HAS to be, right?), and this is toxic to common sense. Decisions are made supporting something that MIGHT help out of fear of having one's LACK of support for it being perverted into approval of and desire to see the suffering that the "something" CLAIMS to be able to prevent - and there's NEVER any thought to the suffering that the "something" might CAUSE; throw in politicians insulated from Reality AND the effects of their decisions, and you get the farce we have today; doing SOMETHING may NOT be better than doing NOTHING, and it's WORSE if you DON'T KNOW what you're doing.

The mess is understandable and reprehensible, but can be orders of magnitude less messy if we just stop causing it. Stop trying to help people won't help themselves. Stop making laws for the benefit of people breaking laws. Stop giving greater significance to "what MIGHT happen" than to "what IS happening."

Better yet, just STOP. Every tweak and fix applied to a problem that either doesn't exist or that no one bothered to accurately define (probably for being in such a rush to DO or CHANGE something, helpful or not) MORPHS the problem into a NEW entity that we understand even LESS. Stacking failed efforts only makes the underlying issue HARDER to recognize, and REFUSING to be HONEST about what is NOT working perpetuates error and prolongs needless suffering.

So, it boils down to HONESTY and RESTRAINT. This may not be an EASY, but it is SIMPLE.

How do I know? I know because I'm a patient with chronic pain and these are EXPECTED of me as CONDITIONS for whatever relief I'm allowed, evidenced by every treatment contract I've signed, every pill count I've had, and every cup I've peed in.

How about some reciprocity?

Doctors, we NEED you. Stand up for your profession. You are so much MORE than guidelines and decision trees, but the more you allow Silicon Valley and insurance companies to pressure you to ACT like computers, the more you will be REPLACED by computers.

We all know that computers can't be doctors - but if doctors make it LOOK like they can, that won't matter.

Tomorrow's victims are made today.

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Like You, I have been treated for a long period of time with opiates for chronic pain--over 30 years. Though much discipline had to be employed at first, eventually responsible use became the habit. Up to now I haven't had a problem with Physician's in prescribing and helping manage my pain and treatment. Last few years I have been seen by VA Physicians and Pain Specialist. Then I moved back home to be closer to my children and grandchildren. The bottom falls out. My first appointment at the closest VA clinic was a disaster for someone in my situation and medical history. The doctor told me (basically, felt I was being called a liar) "No one in the VA prescribes this amount of opiates." Over and over the doctor told me that it would be against the law to prescribe the dose I am on. I kept my cool--what choice did I have. My dose was cut by over 80%. As the good sport I always try to be, I tried the new dose. After 4 days the pain became untenable. This is not tapering of a dose, in fact I believe I is done right irresponsible. I plan on filing a complaint at the VA Clinic among other possible remedies. I would welcome any and all suggestions regarding this matter. Thank You for Listening!

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