Opioid Pain Relievers and Chronic Pain


English: Poppies.

So I’ve been having such great days since I increased my Lyrica dosage that I decided it was time to taper off of the slow-release opioid in my daily regime, and my doctor was happy to agree. The advantages to this are that the body develops tolerance to opioids pretty quickly, while at the same time developing physical dependence on having the opioids in the system. Getting rid of the constant level of opioids means that when I need medication for breakthrough pain, it will be much more effective. In addition, opioids can actually cause increased pain sensitivity over time, and I don’t want to have that problem. Please note that there is a HUGE difference between dependence on a medication and addiction to it. It’s amazing how many doctors themselves don’t have this straight, so lets talk about this for a second.

English: 2D structure of anticonvulsive drug p...

English: 2D structure of anticonvulsive drug pregabalin (Lyrica) (Photo credit: Wikipedia)

Dependence is a biochemical phenomenon. The body gets so used to having a certain level of a compound that it reacts adversely when the level of compound is reduced. This is called withdrawal, and for opioids, involves a lot of extra pain and flulike symptoms among other things. In the case of opioids, this is because once they’ve been in the body messing with the nerve function for a while, the body actually increases the pain neurotransmitters so that the nerves still function how they used to despite the opioids being there getting in the way (tolerance). Take away the opioids, and all those extra pain signals start to get through–the body eventually readjusts, but there’s lots of extra pain in the meantime. That’s withdrawal.

Addiction, on the other hand, is something else. Addiction is a psychological disease–but that still makes it a medical condition, so the current trend of making addicts into criminals and Bad People instead of people in need of help for their disease isn’t going to solve the problem. Addiction to a substance involves taking the substance for the psychological feelings (the high) one gets from it. Addiction almost always requires increasing amounts of whatever the sufferer is addicted to. And addiction, as a psychological dysfunction, outranks the rest of a person’s life–the sufferer will put the substance or activity before friends, family, employment, and their own health and survival. This is where the vilifying of those with the disease of addiction comes in–sufferers will do bad things–lying, stealing,etc–to their loved ones, themselves, and anyone else who stands between them and what they are addicted to. Addiction hurts everyone around the sufferer, and, as with many psychological diseases, if the subject refuses to get the help they need to treat their disease, there is nothing anyone else can do to make them stop their harmful behaviours.

Pain patients are in a lot of trouble right now because people don’t understand the difference between dependence and addiction. Dependence isn’t ideal, but it is a medically acceptable side affect of a necessary medication. When doctors don’t understand this, pain patients are denied treatment for their conditions because the doctor doesn’t want to help a patient’s addiction. When voters don’t understand this, we end up with stricter and stricter regulations for doctors and legitimate pain patients making it difficult or impossible for us to get our needed medications, while people who are addicted ignore the regulations and obtain drugs illegally, however they can get them.

I’ve had an entire clinic refuse take me as a regular patient because I take opioids regularly. They didn’t want to risk the scrutiny involved in prescribing these medications long-term. I’ve had to substitute one medication for another on no notice when every pharmacy ran out of the medication I usually take at the same time. I have to be seen in an appointment by my doctor to pick up my written prescription, drop it off, and pick up the medication from the pharmacy in person every single month. If I don’t want to miss a dose, I have to be there the exact day I run out, because I’m not allowed to fill the prescription even one day early. If I’m sick or having a pain flare or having surgery that day (that happened once), it doesn’t matter–if I want my medication I can’t miss an appointment or send someone else to the pharmacy. For patients in severe pain, the kinds of patients who need these medications, this needing to be somewhere at the exact right time can be extremely challenging if not impossible. While I don’t want to help people suffering from addiction to have easier access to their substances any more than the next person, I hate that the law and many physicians treat me like an addict when I’m not, and I feel that there ought to be a better way to deal with the problem of addiction than the way we’re going right now.

Politics aside, and back to the original topic, I’m tapering off of my slow-release opioid. I’m not enjoying it. I’ve barely dropped the dose (I’m taking one sixth less than I was a week ago) but this is the second day in a row I’m having a full-body pain flare. And it feels counterproductive to take my breakthrough pain medications, which are opioids, to help me in reducing my opioid level in my body–but when the pain gets too bad, I’m risking all kinds of other health problems by having untreated pain–adrenals, cardiac, and brain are all negatively affected by untreated pain. So I’m trying to strike a balance, and in the meanwhile, I’m stuck lying down for the second day in a row. This is going to be a long six weeks, but it will be worth it if I can get to just taking the opioids for breakthrough pain instead of every day. There’s a possibility that the non-withdrawal pain will return below a certain dosage, but even then less is better than more. Wish me luck, everyone!

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9 responses »

  1. Good luck with this!! I always have problems getting of meds – even the NEruiontin/Lyrica meds. Narcotics are tough – but I think 6 weeks is the golden time. The Gaba drugs are longer… Keep us posted – go REALLY SLOW. Can you get liquid dosages to taper super super slow… be really kind to yourself during this time too… I’m keeping you in heart/prayer — xxoo Much Love ~R

    • Thanks Robin! I think I could get liquids in the mainland, but I have a new doctor now and I’m afraid of asking because I need to make sure he never sees me as a drug-seeker, and because of the quick delivery, the liquids and lollipops are even more tightly controlled. My plan is to take one step down a week for 6 weeks, as suggested by my doctor. If that doesn’t work better than it has been, I’ll have to ask for some smaller pills than I have now to taper more gradually. Luckily, i’ve done this before so I know it is possible and it does eventually stop hurting quite so much! =-) I just keep telling myself how nice it will be to just be able to take a pain reliever and have it work well for breakthrough pain!

      • sounds like a good strategy. I agree with you in that when I was able to take narcotics (cannot any longer)… and I would stop – or even just be at the 4 hour point for say percocet… I had amplified pain. So keep reminding yourself it’s artificial. As for the taper… you can often even water down the tablets if needed. When I got off Lyrica I did this with the capsule contents… since their lowest dose was still to high for me to jump off of. Hoping this is smooth transition for you!! x

  2. Wow, thank you so much for sharing. I SO relate to what you’ve written here! I’ve been struggling with terrible chronic pain for going on three years now, and the only pain med that has any effect that anyone has been willing to give me until very recently are opioids. Yes, the body’s tolerance to them grows VERY quickly, and it doesn’t take long before a dependence happens. I have had doctors treat me SO very cruelly while I was in terrible pain.. they didn’t want to help me with my “addiction” and treated me like a low life drug seeking junkie. This happened one night when I went to the ER in desperation.. they left me laying in there moaning and whimpering for two whole hours before some guy came in brusquely and rudely stuck and pain shot in my hip and then told me to go home. When I asked about any kind of follow up, he just quipped “Not our area!” and rushed off. It was humiliating, and the bill I received for this shoddy and insensitive treatment was through the roof. I learned that the ER is not an option for me, no matter how bad it gets.

    When my pain first began, it seemed like it must be related to my female organs, as that’s right where the pain was. The doctors thought that had to be it too. I went that route for a long time with no relief. The gyn route ended with a hysterectomy, and the pain did not falter a bit after the surgery. Also, the gyn that did it was especially insensitive about pain, and sent me home from major surgery with nothing for pain but a tiny bottle of ibuprofen (which did nothing for me.) Needless to say, the recovery period was HORRIBLE.

    Anyway, a PA went ahead and supplied some pain meds, but he wasn’t very nice about it either. During this time, before surgery, I found out that I have lyme disease, but I was told that it wouldn’t affect my pelvic area. I now beg to differ on that, but I’m still not entirely sure what’s going on.

    Most recently, I was referred to a pain clinic. The doctor there is very no nonsense and very anti-opioid. He finally gave me a straight answer regarding these pills, as every other dr. I’d asked said that they don’t cause increased pain to keep you taking them. I suspected that they did, but kept second guessing myself because of these doctors. So, the plan now is to get me an MRI to see if there is anything going on in there that’s causing the pain. If the MRI doesn’t show anything, he wants to get me onto a strict regimen to get off of the opioids. I really DO want off of them, but it IS rather scary, as I don’t know what I’ll do if the pain persists. I did get on a different, non-narcotic drug recently (through my current gen. practitioner) to help me get through with fewer opioids. It does seem to help, so I’m hopeful. I’m trying really hard on my own to taper my usage of opioids down, so that it hopefully won’t be a complete nightmare if I start the program to get me off completely. I have gotten it down quite a bit from the exorbitant doses I’d been taking, but it’s still too much.

    My uncle has had chronic pain for decades and is on EXTREMELY high doses of narcotic medication.. the one dr. that gives it to him is now retiring, and my uncle is really scared, as he may be hard pressed to find anyone willing to supply him with enough to control his pain.. I wish he could get off, but that would be REALLY tough. I do suspect that his pain is probably worse than it has to be because of the opioid dependence.

    Anyhow, I’ve written a book, lol. Thanks for commenting on my blog! I had to click over to see what your blog is about and couldn’t believe my eyes when I saw that you’re talking about the very thing I’ve been going through! Good luck to you!

    • Wow, what an amazing story. Thanks for sharing it with me! I’m so sorry you’ve had such a tough time with doctors, at least I’ve had a couple decent ones in there that were willing to help me no matter what meds I needed! Check out the link at the bottom of my blog to the Survival Handbook for Intractable Pain; he talks a lot about how to find a “good” pain doctor. The big money is all in the nerve block injections and procedures, so many are uninterested in a patient who needs long-term management–and we all do!

      Best of luck with the opiod taper. There are meds that can help, such as clonidine and promethazine. I’m already taking them, unfortunately, but if you’re not you might consider those. But most important is to have your pain controlled, so if the alternate med doesn’t work, don’t let him take what does work away!

      I’ve also had a lot of luck with meditation and TENS for drug-free pain help. If you haven’t already, you might give those a shot too.

      Sending you healing thoughts, and very glad you followed me back to my blog!!

  3. btw, I’ve tried lyrica, but didn’t notice a difference. Would you mind sharing your dosage with me? I just quit taking it because it didn’t seem to a thing for me 😦

    • My current dose is 75mg, 3x/day. I think that’s about half the max dose so I still have room to increase, which is good. I am getting some weird skin burning flushes that go from scalp to toe over about 90 minutes or so about once a week because of the lyrica, however, so I might be at my personal max. Did you try gabapentin too? Some people have better luck with one or the other.

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