Chronic Pain and Opioids - Debunking the Myths
by Frank Fisher, M.D., Senior Consultant, Pain Relief Network

"What is chronic pain?

Chronic pain is a progressive disease of the nervous system, caused by failure of the body??s internal pain control systems. The disease is accompanied by changes in the chemical and anatomical makeup of the spinal cord. Chronic pain is a malignancy, in the sense that when it goes untreated, it increases in intensity and spreads to areas that weren't previously affected, damaging the sufferer's health and functioning.

Why treat chronic pain with opioids?

Opioids are substances naturally produced within the body to regulate pain. They are commonly known as endorphins, and recognized as producing the state of euphoria known as the runner's high. Chronic pain victims, who cana't produce enough opioids on their own, often benefit from supplementation with pharmaceutical opioids.

What are the goals of treatment?

-- Lowering of pain levels,
-- Reducing suffering through restoration of functioning in life activities, as close to normal as possible.
-- Arresting and reversing the damage done by chronic pain to the nervous system and overall health of the patient.

Are opioids dangerous?

When taken as prescribed by your doctor, opioids are among the safest drugs available.

What about those Oxycontin deaths?? reported in the media?

Oxycontin, like other opioids, is safe for patients who take their medicine as prescribed. Oxycontin deaths occur in habitual substance abusers, not patients, and are usually the result of combining the drug with overdoses of alcohol and other drugs. These are deaths associated with Oxycontin, not caused by it, and they are not occurring in patients.

Will I have to take opioids for the rest of my life?

Opioids can be discontinued whenever they are no longer needed. Patients may recover from chronic pain, and return to active lives.

Will I get addicted, and how can I tell if I am?

Addiction is defined by the American Society of Addiction Medicine as continued use in spite of harm. Scientific research indicates that opioid addiction in pain patients is rare. If opioids make your life better by controlling pain, you are a pain patient. If they make your life worse, and you continue to use them, you may be an addict.

Will I have to take larger and larger doses to control my pain?

For most patients, their dose remains stable over long periods of time.

Will I get high, or lose control?

When opioids are taken on a regular schedule, tolerance quickly develops, and the psychological high goes away, leaving the user feeling completely normal. Long-term opioid users, as a group, have driving records for accidents and violations that are the same as everyone else??s.

Will I hurt myself because I don't feel any pain?

No. Opioids improve functioning by reducing pain levels. They don't remove all the pain, or the ability to perceive new pain.

Will I become dependent?

You may. Dependence means that if opioids are abruptly discontinued you will have a physical withdrawal reaction, similar to having the flu. This reaction can be prevented by gradually tapering off the medication. Dependence is a physical phenomenon, not a sign of addiction.

What if I had a previous substance abuse problem?

This should not prevent a trial of opioids. Studies at Harvard Medical School and the University of Washington indicate that a past history of substance abuse has little or no predictive value for failure of opioid treatment. If you have current behavioral or substance abuse problems, you may appear to have trouble with opioid treatment.

Are there any side effects?

Constipation, nausea, itching, insomnia, and drowsiness commonly occur. All of these side effects can be successfully managed.

Will the medicine damage my liver?

No. Opioids occur naturally in the body, and are not harmful to any organ system. They can be taken safely for a lifetime, if necessary. Anti-inflammatory non-opioid medications such as Motrin, Naprosyn, and Vioxx, on the other hand, kill 16,500 patients each year through bleeding from the stomach, and are toxic to the liver and kidneys.

What is the correct dose?

The amount that allows optimal functioning is the correct dose. There is no upper limit to the dose of opioids that can be safely used, when the medicine is increased gradually.

Why won't my doctor prescribe enough medicine to control my pain?

He is too scared. As part of the War on Drugs, law enforcement is conducting a witch-hunt against pain doctors who prescribe opioids compassionately. Most physicians won't risk being targeted by law enforcement, because they have families to support. As a result, chronic pain sufferers have become non-combatant casualties in the war on drugs.

-- Frank Fisher, M.D., a consultant with the Pain Relief Network
http://www.doctordeluca.com/Librar...

Tami PRN
I hope this information was beneficial to someone. Thanks for reading.
http://www.painreliefnetwork.org/prn/category/mainpage

I think that quality outweighs quanity I finally have a job and meds where I can live a fulfilled life except limitations that I have but God has blessed me and thats a big thing in my life now.I think that pain damages you more than medicine tylenol and otc pain meds are just as bad or worse on the liver. God Bless You All!!!!!!!!!

yes i have heard that.
People in chronic pain arent expected to live 20 years after the injury.
I have being going 12 years with pain now, so i have left 7 and a bit years.

Its amazing what BS they tell people.
No it doesnt SHORTEN your life span.

No it doesnt ruin your organs... it the TYLENOL that they should be most worried about - but they arent going to tell you that.

You dont get "immune" to your meds... you get tolerant... your may need to go up on your dosage but they are now finding that isnt always true IF>>> they are on a appropriate dose to begin with. A good Dr. will know this and work with you.

You will only stop breathing in your sleep IF you take an overdose- you should be taking ONLY what the Dr. prescribes. He wont give you too much- he will go slowly with your increases.

Opioids have NO "ceiling effect" meaning you can always raise your dose as far as you need... Drs will tell you "what happens if you are taking this now and then NOTHING works for you later if you need it." NOT TRUE> you can go up... as you need. IF you need the pain control now- you deserve it now. This is so ridiculous. They try and scare people. If only the were in the patients shoes...
What IS of concern are any side effects that one might experience and thats when its up to you and your dr. to work around those so you can have pain control -balanced- with the most minimal side effects possible.

What power a Dr. has... when he/she holds the possibility of a patient having some sort of life in the palm of their hand.

I dont understand why it is up to someone else how I live my life... are they paying the bills? Going to work for me? NO.

Folks here are correct for sure.

Tylenol can ruin your liver. 30,000 people die a year of Tylenol related liver failure. Motrin and other NSAIDs can hurt the stomach. And with some NSAIDS there is a risk of heart attack. So long as you are taking the correct doses - in a safe way - then it definitely shouldn't be an issue.

And regular opiates can cause osteoporosis and damage to teeth because of causing hypogonadism with long term use and drying out the mouth (which promotes cavities).

You NEED to make sure your calcium and D are where they should be, especially because Vitamin D deficiencies can cause more pain. You can also try and do some form of weight bearing exercise, which helps prevent osteoporosis.

Celtic -agreed.
My Dr. checks my Vit D levels every other month- when I first had it checked it was VERY low.

Also low was my IRON/ Ferritin- level
My Thyroid
Low Cortisol

Many things that we are still working on. So also ~along with~ the Pain meds she Rxs me... I would say I am about... well ... 60% better.

Also have been able to exercise now too - which I could not do before.

every so often when i go to the doctor he says, you cant this cause it causes this and you cant take that cause it causes this.
Prexegie was on the market for a couple of years then they found it causes liver faailure.
Panadol destorys your liver.
Gabapention is the only drug that you sallow that doesnt go into the liver, it goes to the intestine.

Most MD.s receive 4 hours of pain training (your vet receives 12 for your pet). While an immensely complex topic, there are some relatively simple considerations. Pain can kill-via depression, increased adrenaline levels from stress, loss of sleep, etc. Demand pain relief medications or find another Dr. There is no appreciable shortening of life expectancy from taking opiate/opioid medications when taken responsibly. They have been around for thousands of years.

FYI....this post is from 2008