Why else would the pain get worse at certain times? I do not believe that the pain pills have caused us to feel pain. I do understand to a certain extent what is being said here. I guess it seems like the author is talking more about a habit than real pain. I think this implies that if we never had of taken pain meds or breakthrough pain meds then the pain would never get worse at certain times of the day. Something causes the pain no matter what kind of pain you have. I believe it has to do with the body having a reason somewhere to hurt. I don't think it is because we crave a pain pill and therefore we hurt.
Now, can pills be habit forming? You bet. They are very much so for some people. But pain is the stimulus for taking the pill; not that the pill is stimulus for causing the pain.
Hmmmm???
The thinking caps are on and we are all thinking about how pain medications are used. Before opening a bottle of pills, any pills, thought should take place. What are the pills for? When should the pills be taken? Are the pills necessary?
Pills have become an automatic reflex to a many of life's problems. This article particularily pertains to short-acting pain pills that are really designed for occasional, episodic pain. I prefer that my patients who have 24/7 pain to take these "breakthrough" pain medications once and a while, not daily and certainly not round-the-clock. I keep my patients ahead of the pain with adequate doses of long acting medications at provide more even pain control without the risk of a pain reflex.
I am very concerned about the routine use of short-acting pain pills that have a hammer-like effect on the pain that only last 4 to 6 hours. The scheduled use of such medications is a problem and can create a dangerous habit. Just like building a house with just a hammer is a potentially dangerous problem.
Dr. Christina Lasich, MD
i appreciate your responce.......... i just sort of feel like i am being talked down to though.............. i mean why would i not know why i take my own pain pills and for what pain? i guess some people may not know why, but i think that is very rare and probably the addicted person, not the majority of us on pain meds....... i think it is this kind of belief by doctors that are the real barrier to many of us getting the relief we deserve to have. i do applaud you for seemingly taking care of your patients with their pain and also giving them breakthrough pain pills, so i give you that. maybe it is just the computer that seems to make it as if you are thinking we have half of our brain gone or something........ i guess im jsut thinking about me, and i know my meds and i also know how hard it is to get very basic pain control anymore, so perhaps your experinece as a doctor is different............... but i still feel talked down to in the first paragraph. but kudos to you for coming on the internet so we may have these discussions even if we disagree.
I totally understand with what you are saying. I have a bottle of break through pain pills in my purse. It has been there for almost two months. I have taken one pill, because I really needed it. It worked quickly, and well. I was on 2400 mg of Ibuprofen a day for a year. Besides tearing up my stomach, the ibuprofen stopped working. A Rheumatologist prescibed this high dose of Ibuprofen for suspected, early RA. That was ten years ago. I don't take any Ibuprofen anymore. I take a medication daily to control joint damage and inflammation and I take pain medication when needed and I take a break through med if/when necessary. I have a friend who is a nurse who has horibble arthritis and has to take break through pain meds sometimes. She said to only take the break thru med when absolutley necessary. It has been her experience that the less the pain meds you take, the more effective they are when you do take them. Do you think she is right about this? It seems to work for me. Thank you for your input.
The least amount of medications that you can get away with is always better because as your tolerance levels increase, the effectivness of your pills will decrease.
Many people do take the breakthrough pain medications appropriately; thus, I continue to prescribe them when appropriate. Unfortunately, some doctors refuse to prescribe anything but a long acting medication. That decision may be too restrictive because activity related breakthrough pain does happen (personally I know all too well about "drop you to your knees" back pain). But, I also see some patients grabbing for the bottle a little too often because it is an easy habit to fall into. I like to see people try other pain relievers first like ice, stretching, resting, and tractioning, before reaching for that bottle of short-acting medications.
We all need to think a little more about the how's, when's, and if's of pain medication use. All I ask is for one to take a second thought before opening the bottle next time.
Dr. Christina Lasich, MD
Thank you, Dr Laisch. I really appreciate your feedback. I am one of those people who hates taking pills. Unfortunately, I now have several prescriptions. Two are for high blood pressure ( I have had that since I was 29...not overweight, I am as active as I can be etc...runs in my family ) I take one med for fibromyalgia, which has been a lifesaver, one med twice a day...Plaquenil...for inflammatory arthritis, Lipitor and a rescue inhaler for asthma. I only take tramdol for pain when I aboslutely have no alternative...after I try the ice pack, tylenol, etc. My motto is that less is more. My orthopedic doctor wants me to take more pain meds, my GP, a very smart lady, says take a little as possible. I agree with her. LOL Thanks again! V
Nah, I really don't need to think everytime I need to take a pain med as yeah, I do know what they are for, my unbearable chronic pain, and yup I do know the dose that is effective for my pain, and I even know to try other things first, providing its not at an already unbearable level right now. I think most chronic pain patients are quite well aware of all this.
Sure, those that follow the "pill for every ill" mindset might need a reminder to think first but not the seasoned chronic pain patient who deals with this day in and day out, all day and all night type of pain that yes, can increase for absolutely no reason some days. Or maybe there is a reason after all.. off the top of my head.. increased stress is tops, inadequate sleep too, even yes the weather has an effect at times.
All I can do is be thankful my doctor is unlike this one. My pain doc treats me as if yes I really do have my own idea of what's working for my chronic pain and gives me credit for being able to understand what my body is telling me each and every individual day. After all, I feel the pain, not the doc.
i just have to say that after 29 yrs of living with pain I have been through it all - taking time to uhhh breaaath thruuu the paaain - tai chi - chiropractors - meditation and so on - quite frankly - i have the right to live as much of my life as possible without having to spend more than half of it breathing, meditation and so forth the "break through" medication allows me to get on with my life - to work - to ski - to white water raft - to study and learn - sure some pain is always there but indeed the medication is a life giver - and saver - when I was able to take even more than the minimal amount I am allowed now - i slept better, ate better, played more, worked more and learned more. I have 22 genetic maladies and I NEED a lot of medication - but thanx to everyone trying to "fix" certain problems - I am now back on the sofa more than I should have to be - now I must pick and choose - will i go sailing next weekend - or will I work on my business plan? Because now I do not have enough relief in order to enjoy both. Your back pain must have either been mild or just that once it brought you to your knees - because when it comes down to it - i believe the patient does know best - they know their body best - and we are not uneducated about how the CNS works or PSNS works or how Primary and Secondary - Yes even people in pain are educated. I am sorry but I too feel the sarcasim. A pill once in a great while? And I thought my doctor was afraid of pain medications. Too many people are suffering for too many aweful reasons. It is just plain sad.
I was 'sucked in' by the email I received and at the top of that page was the title-'Avoiding Conditioned Responses to Medication' I thought cool this will be a good read. I got 2 paragraghs in and thought to myself who wrote this and then saw you name -Lasich. Everytime without fail, why must you talk down to 'us' and then, in other posts anyway, proclaim to understand. I truely do not know why they have you listed as an expert, give me a break. Start actually listening and reading....MAYBE some day you MIGHT understand, and maybe just maybe you MIGHT write something worth reading.
Thinxminx
Personal attacks with "you" statements never lead to constructive, good communication. I am always open to debate when given legitimate points of contention. For example:
A reader of this article might argue: "Hey Dr. Lasich, I am insulted by you comparing me to dogs."
My reply might be: "Really, I am not so sure that that comparison is insulting. I personally have a great deal of respect for dogs because as a species they are one of the most diverse, adaptable, and loyal. In fact, my English Pointer was found starving as a stray (after a human dumped her). She literally ate her own poop fresh from her butt just to survive. Show me a one-year-old human child who would do that to survive. Dogs are extremely adaptable and resilient no matter what we as humans do to them. Besides, much of our scientific advancements come from animal observation and study. Humans are just one species on this great plant, and sometimes we are not that great."
I am listening and I am open to any debate about this or any article I write.
Dr. Christina Lasich, MD
You may be right...
Instead I returned to my office today and my choosen career. I tried to find a little pain relief for a 92 year old as her son looked on with concern. I let a 58 year old meth and oxy addict have a second chance at a better life while her 28 year old daughter (also an addict) has already been taken under my wing and has found the right pathway. I even brought in baked treats (healthy ones of course) to share with my patients.. all in a days work. I have not totally lost faith in humanity, but some days I do prefer dogs.
Before we digress further, getting back to the article at hand, staying ahead of the pain can sometimes get out of control because the pills have the potential to get ahead of you. Be careful out there and think twice before you open that pill bottle.
Dr. Christina Lasich, MD
i have to agree with you, ICpain70
I am also one that never liked to take medicine, but I also have severe Osteo-Arthiritis in my hip, and also in my knee, ankle, lower back, shoulder, and neck. I would never take any med's until I was almost not able to function, and then I would be hurting so bad - I would have to resort to heavy-duty narcotics and/or steroid injections (which are worse for the joints in the long run). My doctor always advised me I would be better off taking something on a regular basis rather than waiting until the pain got uncontrollable and we had to pull out the big guns. And I finally listened. The chronic spells of pain (along with other life difficulties) cause me to be depressed and/or irritable a large part of the time. I finally requested a time-released Fentanyl patch, which provides a steady dose of medication over the course of several days. I think my kids would agree, that it has helped me tremendously. They were the ones that usually were on the short end of my "bad days".
And, no, I still don't beleive in popping a pill every time a little ache and pain comes along, but when it's chronic pain - I have to agree that staying ahead of the pain is always more benefical than trying to play catch up after it's gotten out of control.
.....KRMarti.....
Sounds like the long-acting medication is a great safety net that allowed you to get your life back. How wonderful! Some doctors would stop there with the long-acting medication, but that inadequate and is not enough in cetain situations. When used appropriately, the short-acting pills can give you the right amount of pain control at the right time. A pill once and a while can make a big difference and keep you ahead of the pain. Just be careful and think twice before you reach for the bottle because habitual schedules can form quickly and you do not want to get on that roller coaster.
Dr. Christina Lasich, MD
While I do disagree with most of what was in the article, I think there are some things you are overlooking. My doctor suggested an ER morphine. However, the drug left me feeling like a dingbat, unable to function and certainly not me! It was horrible to feel like that. She also does not prescribe ER meds and breakthrough meds, she doesn't believe in that. I personally chose to take a percosett every 4 to 5 hours which does nothing except get rid of the pain. I can come in to work 10 hours a day, I can drive to work, do what I need to do in life. I have a very busy life, much of which I have already given up because of pain and non-stop scatica, arthritis in my big joints, etc. It flat out sucks, but there really are no options. We want to live somewhat of a decent life! I know personally that I will never, ever, ride my beautiful black stallion again. I raised him from a pup and my favorite thing to do in life was put him in the trailer and take him to the mountains every sunday and we would ride all day long, just the two of us. I know I will NEVER experience that again. It is heartbreaking - it is wrong and it is a BS deal. Did I choose this? Hell no. But my doctor is so touchy about pain meds that if I run out early because I did some ridiculous thing, like ride him in the field for half an hour and hurt worse than ever and had to take an extra couple pills for 2 or 3 days - God what a sin. What a crisis. The whole deal is BS. Doctors need to consider their patients more carefully and realize just what they are giving up. We are big boys and girls - we deal with this crap everyday and we know how we feel and when our pain is too much and we need to take medication. We know what it's like to get behind on our pain too, but nobody cares about that - their only worried about the drugs we are taking. Don't people think we'd gladly give them all up just to feel decent again? Do they think we want this BS life? Not me! I doubt anyone here asked for this crap. I actually took my concealed weapon out of my truck because I have toyed with ending it all from time to time. I get so sick of it, the pressure of work and everything else. One day - I was going and luckily my daughter called me and I changed my mind. She doesn't know it, but had it not been for that call and hearing my grandson laughing in the background - I would not be here anymore - that is pretty serious. What are we gonna be like in another 10 years? We all think about that, if it's this bad now - where is it gonna go from here? No, we need more doctors that are compasionate. My thoughts on the whole mess - who gives a damn if you take an extra pill or two a day to get by. It sure beats the alternative - blowing your GD brains out because your just sick of the pain, the stress of the drug issues, and everything that goes along with it.
WOW.Marion,I read your input.I am with you 100%! I too,am a Chronic Pain sufferer.For 23yrs.Started when I was 13,an operation that changed my life forever.Leaving me in CHRONIC PAIN,24/7...365 days a year for the rest of my life.I am on serious pain medications.Started with Oxycocet,then Hydromorph Contin, then Hydromorphone,then Cesamet..and now a combination of all 4. WOW. Thats enough to probably kill a bunch of people. But that is what I take on a daily basis.Prescribed by my Pain Management Specialist Doctor.I am becoming tolerant of ALL of the medications.Taking medications every 2-3 hours.And the WORST part about it? I am STILL IN PAIN.
My pain will never fully go away permanently.Im stuck living with this.Its NOT FIXABLE.
Diagnosed with a Lung Disease 2008.I live with serious pain.My pain is from my LungDisease,and pain from my legs.(from the waist down).My walk has changed over the past few years.More painful.Both with my legs,and with my LungDisease. Making it difficult to breathe as well.
I have to LIVE with this constant,non-relenting, pain.I hate it.I hate life.It hurts too much.I contemplate SUICIDE on a daily basis.I dont want to have children (I cant anyways),because I want to be able to commit SUICIDE when the time is right.Is that wrong?
Is it wrong to decide to decide when you want to die (as long as you are not leaving any children behind)...we are legally an ADULT at 18.
Marion,I can say,I too can relate to what you are going through in a way.
Life really does SUCK.
I understand how you feel. I have pushed that decision out a few times, always ended up being glad I did because I do have two amazing kids. A daughter 24, who is married and just gave me my first grandson a year and a half ago and a son who is 17 and the best kid in the world. One day, the time will be right. I have already changed up my life insurance so if I decide too - everyone is taken care of. I have things in order. It's sick in some people's minds I guess, but when your this miserable and have already given up almost everything you love, what are you supposed to do. I know here at work, they could make life so much easier for me, but they won't. Everyone thinks the gov takes care of their employees, but they don't. I have begged to work from home for a few hours each morning which would make a tremendous difference, but they won't do it. No reason in the world I can't do my entire job from home, but they won't have any part of that. This is a suck life and that's all there is to it. The only good things are my kids and my animals. If it weren't for them, guaranteed I would not be here anymore! Doctors are jerks too if you ask me. I don't know where all these people are getting enough drugs to kill theirselves on them cuz I can't find a doctor that will give me enough to even be comfortable - it is ridiculous! I feel for you and everyone that deals with this crap!
I understand how the both of you feel. when my mom is gone so am I! 29 yrs and now an other cycle of being waaay under medicated. does it really matter when you get to the point where you are in pain 24/7 when and how much you as the patient feel you need in order to - gosh forbid - enjoy life? docs have waaay too much power. pain cannot be solved. no doctor is going to come up with some brilliant answer - at least not without causing a whole lot of HARM! Oh my gosh - there is just no getting through to some people - doctors just do Not care - as long as they do not have to stand up to the DEA - they are good. maybe some people are able to take a pill once in a while - there was a time i could manage my pain that way - when i was 11 - 15 but that was a long time ago.
I was not insulted by the article and understand the habitual pill taking issue-I have been there. Recently changed to fentanyl patch to avoid the ups and downs of percoset every 4-6 hrs. (It was creating worsened manic depression symptoms). When on percoset (for a year) I really had pain that required continual dosing, even though it was prescribed as every 6 hours "as needed" for pain. But I believe now that the doctors are correct; stopping a narcotic creates a pain response because the body wants more narcotic. Not a psychological addiction but a physical one. My doc explained it very clearly and I don't think he is making it up. Now I can't remember details, Cymbalta has pretty much taken away a lot of my memory function. There are always trade-offs.
I find myself wanting to reach for a percoset (I had some left over) even if my pain is not significantly worse (e.g breakthrough pain). It is a habit-I have caught myself. This developed over many years (tons of ibuprofen then ultram then percoset). It's not for a "high". Watching my own behavior I have to agree with the article at least from the big picture...the actual mechanics of how this narcotic pain response works is beyond me, but I beleive it is there.
The long acting patch combined with the Cymbalta has been working really well. I am also taking Naproxin for an injury. Could I use an emergency breakthrough pain med? Yes. But I don't want to re-develop a habit and will deal with the breakthrough pain - unless it is bad enough to go to the hospital.
Thanks for reading!
Rose
Yes Rose, this is a very tough subject that needed to be discussed because people like you have seen the effects of this slippery slope called opioid pain management. Although opioids can give life back, they can also take away everything precious too.
Thank you for your bravely sharing your truthful comments about what happened to you.
Dr. Christina Lasich, MD
As soon as I read this article I knew it would stir things up.
As a former addict who has arthritis pain I was exceptionally interested in this article and the comments. When I was in a methodone program but no longer addicted; I was subjected to intense pain because of the stigma of addiction and a misdiagnose. I was in pain management but not given any narcotics and went from walking with one cane, to two canes to a walker while being told it was from a compresssed disc. The pain became intolerable and I could not sleep or lay down and feel off my bed from a sitting position because I was exhausted from lack of sleep. I was sent to a Rheumatoid Arthritis Dr. who was very angry at what I was being put through and said I probably needed a hip replacement. He was correct - I had a large hole in my hip, my leg bone was no longer connected and you can imagine. They finally prescribed Vicodin. I have been clean and sober for five years and am no longer on Methadone. I try not to take even Tylenol unless I have to. However, I am really afraid of what will happen to me if my Arthritis pain ever again reaches unmanageble levels. I am very sympathetic to people who must take pain meds to be able to function. I almost wonder what does it matter if they are addicted if it enables them to function. I know the level of pain I was in pre-surgery was a horror I do not want to face again.
I appreciate your comments in this interesting debate. When a former addict comes to me with pain, I really try to find a non-opioid or weak opioid that will provide some relief before risking a relapse by providing opioid medications. In fact, I just started seeing a former addict who relapsed when the PCP placed her on OxyContin and Norco. Now she is back to using meth with the Oxy's that she sells. Finally the PCP got wise to the problem and called me. Now, I am trying to save this patient who has pain from the grips of addiction with a Suboxone program.
It does matter if someone becomes addicted. By definition, addiction is a behavior that interferes with ones ability to function properly. Do not confuse that with chemical dependency. Everyone who takes opioids on a routine basis becomes chemically dependent on the medication. Dependency is not a problem if someone has a functional life and is able to do what needs to be done in life.
Sometimes chemical dependency can slip into conditioned responses and then slip even further still into addiction. That is the slippery slope that must be respected and avoided.
In fact, one of my long-time, chronic back pain patients has fallen down that slope. His wife just informed me that he has been stealing medications and lying to both of us. She is about ready to leave him and his children are noticing a problem. On Monday morning, I need to try to save this husband, father, and man from slipping further into addiction because his life is falling apart, not because of inadequate pain control but because of addiction. Even "seasoned" pain patients can fall.
Dr. Christina Lasich, MD
As a former addict, I am not even supposed to say former but only recovering. I fully understand the pain of trying to deal with addiction. It is a horror. And I appreciate your explaining to me the difference between chemical dependency and addiction as I did not comprehend this previously. I currently refuse to take even non opoid pain medication just because I understand how slippery that slope is. I do take Osteo Biflex and Omega 3's and watch my diet and exercise. I am only worried about what will happen to me if I am in extreme pain some day. But I will have to cross that bridge when I come to it and, hopefully, will have even more years of sobriety under my belt to help me deal.
i have been told by friends who are recovering and who later found themselves in chronic pain that the "effect" they once aimed for was not felt once they found themselves in pain. chronic pain and addiction use the same neuro pathways and this is one reason why LESS than 1% of people who take pain medication for pain actually become chemically "dependant" - it's a fact you may look it up. along with good healthy life "hygine" you can avoid certain behaviors - such as: taking the pain pill when you're feeling depressed and Not when you feel pain (though if you Google: Opiods Past Present and Future, you'll get my take on that) - is one way some can become "addicted/dependant" - going to counseling often enough to shuffle through the am I's? - the Should I's and so forth can also help.
Thank goodness we are indeed much More capeable than dogs at resisting a basic response - if you're worried your addiction will return - than get a notebook - be honest with yourself - what made you use? when, where, who, why? and do what you can to change that behavior. You are human and capeable of so much more than some would have you think you are. It is actually this same basic "reponse" I think I may be talking about - rather than let it use you - You use It! Train yourself : I know if i take this pill when I am not actually physically needing to take it I may slip down that slope - so, I am going to go for a walk and wait ... etc etc. Please do not suffer when there is a means to ease that particular suffering.
Actually, everyone (100%) who takes opioid medications on a regular, routine and daily basis becomes physically dependent. Physical dependency is a natural physiologic response to the continues, exogenous supply of opioids. Thus, if the opioids are abruptly discontinued, the body goes into withdrawls.
Those who become addicted (take the medication despite harm) have fallen down the slippery slop of conditioned behaviors and responses. Although this may be rare among those who have pain, it does happen. That fact should not be ignored.
I like the idea of keeping track of when, where, why of taking a medication as a way to monitor its use. Just like looking in the mirror and being honest.
Dr. Christina Lasich, MD
Thank you for your concern. However, I am not in severe pain at this time nor am I currently worried about relapse. I am no longer interested in getting high and have completely changed my life style. However, as a recovering addict I see benefit in addressing possible situations that could threaten my sobriety in the future, expecially when they come up on Health Central. I do appreciate your advice.
To put it politely, this article is not science, it is misinformed, unsubstantiated, nonsense.
The doctor who wrote it is "conditionally", and constantly, biased against opiate pain medications for chronic pain patients. She does not know what she is talking about. Why she is designated as an "expert" and given space on this forum has always been a mystery to me.
Chronic pain patients who take their meds, as prescribed, every 4-6 hours are not "salivating" like Pavlovian dogs. They are in severe, chronic pain and they are almost always undermedicated.
Pain Central, please get rid of this idiot. Her articles do actual harm to chronic pain patients and perpetuate detrimental myths.
This article has not been harmful at all. Sometimes bringing controversial subjects into the light provides for constructive (although heated) discussions that can provide the basis for thought and growth. Just read the comment from "Rose" (see above) and maybe some truth will come to light.
Harm comes from not saying anything at all. Harm comes from only telling people what the want to hear.
"This is the way the world ends
This is the way the world ends
This is the way the world ends
Not with a bang but a whimper." e.e. cummings
Dr. Christina Lasich, MD
I took my pain meds as prescribed (percoset) every 4-6 hours for about 10 months. Even after changing to a pain med patch I wanted that Percoset. I never tried to steal any though I would crave more as my body wanted more. It is a slippery slope.
Don't kid yourself, the article does point out some good stuff that people should be aware of.
I kept telling myself the percs were enabling me to live a somewhat normal life with less pain. Eventually I figured out they were creating psychological problems. I am not saying people should not take opiods but they really need to understand what they are getting into. When my doc first gave me warnings I brushed them off. Now I know I should have listened better.
Don't shoot the messenger. We all need to protect our rights for proper pain management and that includes the proper use of opiods. Some people have addictive personalities (actually I think they discovered a gene that's connected) and you may not know you are that type. Just be cautious yet demand that your docs are listening. If they are not find a new one. I can't stress enough to be careful and aware.
Rose
Get over yourself, Ms. I don't care MD.
I have lived with relentless chronic pain for 16 years now. I thank God every day for my anesthesiologist pain management specialist who UNDERSTANDS chronic pain. The way I feel 99% of the time, I could only WISH to be one of those dogs used in the experiment---at least I COULD eat then. You have set us back centuries with your article. What you are talking about is ADDICTION----something that chronic pain patients minimally experience. If you would check the studies done you might be amazingly surprised that INDEED, we DO depend on our medications to live any kind of "normal" existence, and yes, we ARE dependent on them to live. We, however, are NOT addicts. If a doctor ever gave me a pain medication with instructions that read "Take one only and then only in an emergency" I would walk out the door and know that ignorance about pain still runs rampant among doctors. With your article you have fed those hungry FDA dogs to introduce even more severe, strict limitations on medications that we need to function in this world. SHAME, SHAME, SHAME on you!
Matt'smom
Actually, there are addicts among you. You just don't see them. I am seeing one tommorrow to save him before he loses his wife, his job and his children.
For some the medication use starts with the pain of a migraine, menstrual cramps, back pain or other pain and then the use can turn ugly and harmful. Chemical dependency can lead to addiction, I see it everyday. Care and vigilancy can keep one from falling down this slippery slope. Treat the pain yes absolutely; just do it carefully.
I care enough to bring this subject to light and help those even if they have fallen.
Dr. Christina Lasich, MD
This negative approach to pain medications causes many to suffer in atrocious pain. So I'd like to share my personal story of how this stigma has negatively affected my entire life. I was injured in a car accident over a year ago. My pain was excruciating yet I w as weary about seeing a dr because I didn't want to be seen as a drug seeker. My pain became so unbearable that I accidently took 6 Tylenol in 1/2 an hour. I still had so much pain and muscle spasms that I looked like I was having a seizer. I was home alone and this awful pain had me crying and shaking but I feared that if I called 911 they would just think I had OD and wouldn't help me. The next morning I went to my doctor who gave me cyclobenzaprine and naproxen and said to take acetaminophen if necessary. A few weeks later my pain was more controlled but I was taking loads of pills. While visiting a friend her mom decided that I was taking too much medicine, so she took my meds away and decided what I got. Eventually my pain and spasms were so bad that they were begging me to go to the ER. They sure gave back my drugs then!
My family dr sent me to physical therapy 3x a week and when he decided that my sprained neck was beyond him he sent me to a specialist. I was then diagnosed with myofascial pain syndrome and fibromyalgia. Before seeing the pain specialist I had a really hard time. I spent most of my life on my heating pad. I had been unable to get sleep because of my pain. School was very unbearable for me and my social life began to dwindle. She gave me lots of trigger point injections that numbed me up so I could stretch them out and gave me meds for pain, depression and insomnia. The specialist also changed around my physical therapy a bit and I have been seeing a message therapist. Today despite that I still have pain; I am leading a much normal life. I am able to do much more now. I've graduated from school, gotten a job and my license. I can actually do my own hair and most importantly to me, I've returned to karate. So now I don't look like I'm in pain so my family says "it's all in my head" and calls me a drug addict. I wish they could just comprehend the struggles I experience every day. Wish they could understand that it's either my current active life or going back to laying on my heating pad 24/7...I've been hurt not only physically but emotionally as well people fail to see the truth. That after heat, ice, herbs, daily exercises 3x's a day and therapy 3 xs a week, messages, rest and more...WE STILL HAVE PAIN!!!
And although it's hard to express my emotion in writing. Typing up my story has caused me to shed many tears because of the hurt and denial I've been through.
Hi, I have an Idea that I think could really stop this narcodic px issue that is widespread. So what if we get a bill pased to where anyone who is prescribed pain pills would have to agree to random testing so that the doctors could monitor everyone and make sure that no one is harming themselves or missusing their meds? This I believe would help people that are really in pain get the care they need as well as slow the missuse of this medication. I also would like for people that are just addicted to it to be able to get a px and be monitored to make sure they are not missusing it while they get tappered off the right way and getting outside help to help them know that they don't need this? Please let me know what you think?
Your idea is well founded and in fact most pain management specialty clinics do have a signed agreement "contract" with patients that includes an agreement to allow random urine drug screening. Random drug testing is a way to help improve safety for opioid use.
Again, I wish I lived in a world where such testing was unneccessary and everyone was completely honest. But, I need to be real and safe because drug use is a very slippery slope.
Dr. Christina Lasich, MD
Pain pills do not help much with severe chronic pain. they just knock the edge off so you do not jump off it!
Pain pills are a miserable placebo for a real life. I do not take any of mine, and I have a big stash of all kinds, unless I need one. Sometimes that sets me up for about 3 hours of unrelenting misery until I can rein it in. During those 3 hours, I feel like cutting my legs off, like a wolf who chews a leg off when it is caught in a trap. There were 521 people who "overdosed" last year in my state using Hydrocodone and Oxycodone. I do not believe that. I believe that their pain was so great and they had been marginalized so much by the medical community that they committed suicide, they did not "overdose". The wonder to me is that the number is not much higher.....how much the body can withstand and keep on going is amazing. We all long for life, but chronic pain is inconsistent with life, period.
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really???????????????? im sorry , but this feels like it was written twenty years ago.............. or by someone who has never experienced unrelenting pain or someone who doesnt quite believe the people who are in unrelenting pain. i dont understand this article............... well, no i guess i do understand this article. what i dont understand is the whole concept of 'stay in agony until it gets worse'.......... it already is worse to the point of where we cant life our lives , that is why we have the pain pills! i am not meaning to sound rude to a doctor, but really?????????
Mahrad... you missed something...
Go back and read the first page again. The doctor's ONLY talking becoming conditioned to using short-acting break-through pain medication, NOT the long-acting meds you take only once or twice a day. Quite honestly, I was feeling much the same as you until I caught the part about INCREASING the long-acting meds so that ideally there should be little or no breakthrough pain to medicate.
I thought it was a well-known medical fact now that what you don't want to happen is for the pain to get ahead of itself such that it's that much harder to get back under control. I do not believe that the pain gets worse because the body wants more medicine. It is possible to develop a physical addiction to certain painkillers, but that's a craving that's separate from the pain. You have the pain because you have the pain, not that the pain spikes as a driver to get you to take more painkillers.
Once again, I find myself questioning the connections and conclusions this author makes in an article. They certainly don't reflect my experience. I realize everyone's different, but she always speaks with such authority, and paints with such broad brushes, I think it's misleading.
Calico
I have to differ, I am now a chronic pain patient and I take fentanyl 75mcg and dilaudid 4, but about 16 years ago, I had a back injury at work, blunt force of pipe at me and I had to squeaze out from behind it, tore all the muscles in my back, shoulder, neck etc... I could not sit, stand, sleep, ride, drive, horrific pain for 2 years, instead of putting me in therapy, the wonderful UNION steelmill workmans comp doctor just kept feeding me pills, and this did cause a conditioned addiction.
When I went through the withdrawals in-patient of course, it was true hell, but funny thing was when it was over my back did not hurt.... the muscles had repaired etc... the pain I was feeling was my body creating a response to get pain meds, it has been well documented that some pain after surgery etc is long gone but the body still tells the brain it hurts to keep receiving the medication when there is no real pain issue. The only way to tell if pain is real is to stop decrease medication completely for approx 7-10 days and once it is completely out of system and conditioning has stopped, (trust me the pain will be over the top in the end trying to get that medicine) but it will subside( if it is addiction and not injury chronic pain). If this happens it was pharmaceutical addiction the one noone talks about, not wanting to get high or taking to many pills etc, the conditioned mind addiction which is probably half of them, I went without pain meds for 14 years had two children, lived free of pain and fearful of pain meds until 2 years ago when I was diagnosed with a spine disorder, leg, hip neuropathy, can't walk or function without pain meds disorder. Even with that, I stopped meds for two weeks, the pain decreased then shot straight up after a 2-3 day period, that is how I know it is truly pain and not by brain wanting medication....most people would argue this because it is confusing but just throwing my story out there. I am now going to be a lifelong chronic pain patient who needs pain medication whether the brain wants it or not, my pain is different though now it isn't impulsive straight up the number pain like when it did before so possibly there is a slight difference in the pain that one could tell whether they need the meds or not who knows.. good luck hope you all have a pain free day...
I guess what we can agree on is there are different types of pain. I know, as you describe, that people who become physically addicted to pain meds suffer horribly when they withdraw from them. I expect all kinds of pain will seem worse during that period, just like even something like a headache will seem worse if we're under stress.
I believe you when you say that your pain was better after you got off the meds, but maybe it would have been better anyway. Maybe there was no causal relationship between your injury healing and getting off the meds. We'll never know.
Do we need to pay close attention to what drugs we're taking, how we're taking them, and try to "ease" off them, in a trial and error way? Absolutely! Do we need to be aware that we can develop a physical dependence on certain painkillers? Of course!
What I don't want to see people do as a result of this article is fear painkillers to the point that they never get a theraputic dose in their system, and so the painkillers are never effective at doing what they are supposed to do, such that the pain feedback loop becomes entrenched.
Calico
thank you for the clarification......... i, however, have regular tylenol #3 and i dont feel like pavlovs dog...... :) i take one in the morning automatically and have been told to take a second if i need it......... i rarely take the second one but sometimes i do........ i dont think my pain happens because i anticipate taking a pill, its preposterous. i guess it can happen to some people but not most, is my feeling. the reason i posted about this is because it is also my believe that this attitude is causing much suffering of people, and my decades use of the same strength medicine prooves that the common attitude of most doctors is wrong. would an extended release help me more? probably, but the prevalent attitude precludes me from getting much help beyond the kind doctor who prescribes this for me......... its always an issue with any specialist i meet, first thing they bring up even tho i only take one a day usually!!!!!! it bugs me that healthy human doctors get to judge chronically pained human patients in a way that can make them have almost no quality of life......... im not picking on the doctor here, im jsut saying it is the prevalent attitude and it is incorrect in most instances. the default should be trust until there is not a reason to trust, but it is guilty until two years of being good prooves you worthy. you know what i mean?????????? thank you for your clarification!
Those were my exact thoughts - you can't be serious! I don't buy it for a minute. I take pain medication (percosett) throughout the day, as needed - period. When the pain becomes intolerable - I take it. This sounds like something my primary doctor would come up with since he's opposed to any pain meds at all. I think a study should be done on the number of suicides by pain patients that cannot get the proper medication and have simply got tired of dealing with the pain, the world, or both.
I completely agree with your assessment of this article, Calico. This author is drawing conclusions from premises that don't even make sense. For example, the whole conditioned response theory in regards to pain spikes. I don't believe anyone's body is "salivating" for another pain pill because their pain level spiked due to anticipation of getting another pain pill. Not at all. Like Calico says, pain is there because pain is there and no way does it rise for a reward pill. I believe you don't even have a thorough understanding of what breakthrough pain is then. In my experience, a person has breakthrough pain happen when they are simply doing whatever activities they are doing or none even, on a long acting med already and then the pain manages to "breakthrough" that long acting med's action. But no one told me that it had to be precipitated by an event. I don't even think it does have to be an event causing it, chronic pain gets worse just because! Because that is the nature of the beast!
"I thought it was a well-known medical fact now that what you don't want to happen is for the pain to get ahead of itself such that it's that much harder to get back under control." Sure is, very well know that it becomes even harder to get rid of that pain when you wait until the bad is already bad. To wait until it is intolerable, I would think there'd be little chance at all of relieving then that already intolerable pain.
This author talks with such certainty but also notice the frequent "may" act this way or "might" be caused by as that gives it all away. That this is a theory. A ridiculous theory at best.
I am with ya 100% !! I was thinking the Exact same thing as I was reading the article. Actually, to me, it doesn't even seem logical. I have been on and off pain meds since I was 11 yrs old - i am now 40. When I did not have medication to take my pain would go up and down. So, if I did Not have a pill to take - where is the conditioned response from my brain? good grief - just seems like there's an all out War on people in pain. Hippocrates said: The best medicine is a result of listening to your patient - or something to that affect. I could write a response to this article the size of a book.
im convinced the emotional pain we feel from decades of not being believed by family and friends because doctors dont take us seriously, is way worse than our physical pain. and it hurts my soul so much to know how many just plain kill themselves over this agony.......... its too much agony to take when they know simple pills are there to take but they are not deemed worthy...........
the medical people like to make it out to be a war on drugs but it really ends up being a war on pain medication or any medication that is regulated. because the drug users know how to get what they want , and we who really need it are too busy trying to get it the legal and medical way but cant because the war on drugs makes most doctors too afraid to push back on behalf of their patients......we are the loosers. only us. and for the most part that is ok with most everyone else. they all know we are too weakened and weary to fight for long. we just go away. which is the point isnt it?
You are correct and much more forgiving of this doctor than I am. See my comment, which I think is #31 if it hasn't been deleted, for my full opinion of this idiot who compares chronic pain patients to Pavlovian dogs. Disgusting and absolutely without
scientific basis.
Helene
you can increase long acting meds as much as ya want but eventually - Flare ups will always happen - it is Not even so much "break through" pain as it is that there are times when every medical condition that causes pain will Flare and a person will need medication above and beyond the long acting. i should know i have had chronic/acute pain for 29 years.
i think what a lot of docs forget it that everyone and every body is different.
I was thinking the same thing when I read this. That the person writing it doesn't suffer from chronic pain and never has. The thing is, once the pain has gotten to intolerable levels, it is too late, and it is extremely difficult to get the pain under control. The article is good to an extent. I have become conditioned to taking my meds for breakthrough pain on a schedule and I do not like that at all. But the answer is not to get on an extended release med, because I take that also.
One thing I have noticed is that when I am doing something that is very distracting, especially something physical (I realize many people can't do much in that area and niether can I - but sometimes I push myself) my brain forgets that it is time to take the med, (and the pain is tolerable also, when usually it would be out of control). When I am not doing anything that is particularly distracting, that is when I am anticipating taking the med on time (and when the pain is very bad). The only thing that I have found to do is to push myself, sometimes beyond my limits, to do more than I feel I can. This can be enormously difficult most times, but it does pay off. For one thing, this is my life and I want to live it in the fullest way possible. If I am always not doing things because I will be in more pain later, then I will never do anything. Sometimes it is worth the pain later, to do something that I will enjoy at the moment. Also, it is extremely difficult to cut back on narcotic pain meds. And if I can put off taking it, and without the extreme uncomfortableness, then that is great, and helps me to feel a tiny bit more in control of my life, (a life full of pain that I have no control over), even if just at that moment.