Tag Archives: Addiction

Opioid Pain Relievers and Chronic Pain

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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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