Pain

How Pain Killers Sometimes Increase Chronic Pain

Becoming addicted to pain medication is a disease. This is because the painkillers (e.g. Vicodin, OxyContin, Norco, Hydrocodone) -- commonly prescribed by physicians to treat pain -- cause a change in your brain chemistry that is not under your control.

Physical impact of pain killers

Doctor Clifford Bernstein, a pain management physician and author on Spine-health.com clearly outlines how these pain medications physically affect the body:

  • The brain responds to the pain medicine by increasing the number of receptors for the drug, and the nerve cells in the brain stop functioning
  • The body stops producing endorphins (the body's natural painkillers) because it is receiving opiates instead
  • The degeneration of the nerve cells in the brain causes a physical dependency on an external supply of opiates, and reducing or not taking the pain killers causes a painful series of physical changes, known as withdrawal.

At this point many people (an estimated 7% who are prescribed narcotic analgesics) continue taking the pain medication to avoid the withdrawal symptoms rather than to treat the original pain. When this occurs the person is dependent on or addicted to the prescription pain medicine.

Pain killers may actually increase pain

Most people do not know that taking painkillers over a long period of time may in fact increase a patient’s sensitivity to pain (hyperalgesia). This happens because long term use of opiate painkillers causes a decrease in your ability to tolerate pain, and an increased sensitivity to pain. When the pain increases, people are often led to believe they need to take higher doses of pain medication than they were on initially.

For those who are addicted to narcotic pain medications, a detoxification program is often needed. Pain killer addiction is a chemical, physical disease, one that requires expert medical treatment in a safe, humane environment.

Posted by: Stephanie

More resources:

Subject: This is an excellent

This is an excellent summation of how pain killers can often times lead to more pain. I think this is true of any drug, for any condition (causing more of what it is intended to treat). I know when I used to take anti-histamines, it used to always seem like I had to keep taking them. What I didn't realize at the time, is that the body would make more histamine in the presence of anti-histamine, which would lead to more of the runny eyes and hay fever symptoms I was taking the medicine for in the first place. There are good uses for medications, but we must be careful not to over do it.

Subject: I can understand what is

I can understand what is being said here, but is it true for every case? I know I've had to increase my narcotic pain killers over 6 yr period cause the pain is always there, unless I limit my movements. If I irritate my facet joints (recently found out that is what has been causing muscle spasms, and in turn LOTS of pain) I'm in severe pain. Then I will lay in bed for a day or 2 and the pain diminishes quite a bit. I am just now starting to cut back on narcotic use as my radiofrequency is helping. Question is: when I was in debilitating pain and was still working, it seemed I had the mental, emotional, and physical endurance to handle the extreme pain. However, as I kept trying to push it and suck up the pain, I got more and more worn out and tired to the point I could not go on any longer no matter how much I wanted to. Besides work I kept our hobby farm going, dealt with an alcoholic spouse. I just kept going like the Duracell bunny. At the time I had not increased my dose of oxycontin and vicodin, it was at the same dose for couple years. Did I just get "burned out" from the constant assault of feeling the pain-it seems that was the case. But don't know for sure cause I am more sensitive to pain now (it's 3 yrs later), can't handle much of it and then I'm in bed groaning. Any advice on this?

Subject: I understand the concern

I understand the concern about everyone becoming addicted to narcotics, but what about people like myself that has been suffering with back pain for 9 years now, and not being able to even get any kind of pain medication from doctors? Certain people always make it bad for others, just the way it goes. I have to get my pain medication from the streets basically, and my doctor knows it, I told him. I suffer with chronic DDD, in my back shoulders and knees. I also have scoliosis, and sciatica. This had progressed over the years after being told I just had a bulding disc 9 years ago. I am so afraid to go to any kind of clinic, went once for my back pain and was told not even 2 minutes after meeting this quack that I have to deal with my addiction first, and walked out on me! I was so shocked and humiliated, I had a few choice words for him as I was leaving! Who is he to judge me until he walks a day in my shoes!! It is just so terrible that people who are sincerely suffering everyday have to be ridiculed and be called addicts when all they want is to not have any pain for even 5 mins! So fustrating. Just to add, I'm only 36, can't work anymore, and feel like my life is over. Oh well, that's life eh?! I just hope that these doctors, or anyone else who wants to pick apart this "narcotic addiction" subject never has to experience mine or anyone else's legitimate pain!

Subject: Life over

Hang in there kid, been living with this since '73. I figure a good day every once in a while is better than none forever. I guess I'm just too damned stubboorn to let that jackass, "Pain" take over my life. I switch back and forth from one brand of 'magic'to another every so often and that keeps my brain confused, and a certain amount of 'damn the pain, full speed ahead' helps too.

If you don't have a sympathetic ear to bend, I'll listen, don't think I have any answers, well, yes I have one, "Turn it over to your Lord", that helps me, I thank the Lord for good days and cry wih my Lord on bad days, I believe that help is there for anyone.

Christ's Love and Blessings

Bill

Subject: "Turn it over to your Lord"

Awesome advise Bill! Can't get any better than that! I totally agree with you, besides God won't let you go thru anything that HE knows you can't handle..If He brought you to "it" HE will bring you thru it!

Blessings to all. Smile

Subject: A new drug will soon be the

A new drug will soon be the wonder drug for chronic pain. It is called Suboxone, a drug now used for addicts trying to get off heavy drugs. While using it, users have found that they have less pain. Now it is being prescribed for chronic pain patients, especially back pain. It is a wonder drug! It does not have the side effects of opiates and can be used for the rest of your life. See your pain management doctor about it!

Subject: re: your msg on Suboxone

Sandy,

Appreciate the info. I have 'managed' my situation since '73. The only thing that has worked for me is switching meds every 6-8 months. Used to take 30 -40 regular aspirin + all the normal 'magic'. VA just switched me to morphine and oxyxcodone from Tramadol and oxy.

Oxy wires me, can't sleep till exhausted, have you found any workable sleep meds to counteract??

Thanks God I can do light work, like remodeling type stuff, that is my 'opiate', when concentrating on project, can bear the pain, put it off to the side at least, till it wins about 12 hours in and then it's magic pills, and alcohol. Know booze is a no no but the only thing short of a IM of demerol that works.
Thanks again for the tip,

May God's blessings flood and fill your life,

Bill

Subject: please just shoot anyone in

please just shoot anyone in chronic pain, would be simpler. certinly cant have them being comfortable, can we?? the heck with them, who cares if they hurt, just buck up and shut up

Subject: Dear Elizabeth

Obviously you have never lived with Chrinic Pain.
It stopped my life at 52. So why don't you restrict your useless and insensitive comments to the TEEN BLOGS.

Subject: Dear Elizabeth reply

Rebecca,

I think if you reread Elizabeth's comment, you'll see she was giving us some tounge in cheek sarcasism.

I know I've sometimes thought the 'least' of those in the medical profession were very dismissive and unsympathetic.

It's tough, I sometimes feel peolple are uncomfortable around me just as if I were in a wheel chair and some do indeed act like perhaps they would rather I would just die so I would not disrupt their life.

TOUGH, I'm staying around, like it or not, I'd like to say but never do, "sorry my pain makes you uncomfortable, I'll try to not wince or anything so you can pretend I'm just like you"

Subject: My son started taking

My son started taking Tylenol 3's for back pain. He was unable to get more from the Dr. and started buying Oxycontin from a friend who worked as a secretary for a cancer Dr. My son became so addicted to Oxycontin. He tried so hard to get off it on his own. We did not have help for him in our community... I was one month away from getting him into a medical detox. Unfortunately, Ben was not able to hold on. He ended his life. He left his health card beside the bottle of Oxycontin. The coroner said he was making a statement that "these pills affected my life". The coroner also said the withdrawal is so severe and unsafe to do alone that many people want to die during this time. Ben was an active outdoorsman and at that moment when he felt he couldn't go through the withdrawal anymore, he had the quick means to end his agony. I want Oxycontin put back on the shelves and only given to people in the end stages of cancer, in which it was intended.

Subject: What a surprise

you won't believe this but I stumbled on this on the net looking for info for Marinus.

Subject: SORRY FOR LOSS

YOUR SON MUST HAVE HAD AN ADDICTION BEFORE HE STARTED THOSE MEDS FOR HIM TO SOUGHT AFTER THEM IN THAT MANNER SO QUICKLY. THEY REALLY HELP PEOPLE WITH CHONIC PAIN NOT JUST CANCER PATIENTS.

Subject: I have a confession to

I have a confession to make...I apologize if this is too long or boring. Only a few close family members know about my addiction problems...here goes: I am 36 yrs old and have been taking narcotic pain killers (for lower back pain) for the better part of 9 years now. The majority of time I've been taking Vicoprofen (which is hydrocodone + ibuprofen). I should also mention that I have a high-stress job and family situation. At first, I took the pills to get rid of the pain. However, once I discovered how much hydrocodone made my life stresses just melt into oblivion, I kept getting refills upon refills throughout the years (from my family doctor) just to feel good. Although they made me feel good mentally, I always noticed that Vicoprofen made my back worse....sometimes to the point where I couldn't walk up a flight of stairs. I was referred to a spine specialist doc two years ago. I've had several MRIs done in the last two years, and they all show that I DO have several herniated discs, but I've been told by a surgeon that back surgery wouldn't do much....and may make my back pain even worse. This surgeon said that my back pain was caused by stress...not stress on the back, but life stressors. Anyway, to make a long story short, the specialist doc and I both agree that I am physically dependent on narcotic painkillers. He has put me on Suboxone 8mg twice-daily. Suboxone has done wonders for my narcotic cravings, but it seems to have made my back pain worse. In my last appt, the doc said that being on pain meds has likely caused the continuation of my back pain. However, that doesn't explain to me why my back hurts MUCH WORSE now that I'm Suboxone. One other thing...he said that if I'm still in pain by my next appt, that he will prescribe Methadone for my pain (as it's apparently less abusable than other narcotics). Now, this scares me to death...reading about people who take Methadone as prescribed and die. I don't know what to do!! Are there other painkillers that might be better? (Demerol, Darvocet, anything..?) Thanks for your time.

Subject: Alternative

Have you tried Tramadol ER? that wih added aspirin or tylenol may do the trick since your 'real' pain level is low to moderate.

Believe it or not, deep breathing and meditaion helps too, not the hokey Harrey Chrisna stuff but just deep focusing with a goal to gain control over your body, just 5 minutes can reset the stress level down a few pegs, try it.

Refocusing your life goals and attention away from yourself to something else meaningful and as valuable as you can help, prayer and service to a church is a wonderful way to get that redirection and a new and exciting focus. If it is not all about ourselves, the pain gets lost in the background, sounds hokey but it really does work.

Christ's Blessings today and always,

Bill

Hope that helps

Subject: Reply to "I have a confession too"

It seems to me that you should be seeing a pain management specialist and not a surgeon. A good pain management specialist will help you to find the treatment that is right for you. And if they want to try methadone they usually start off with lower doses and gradually increase it. Methadone did not work well for me but I know others that it has helped a great deal. Surgeons (and most every other doctor on the planet) have had no training at all in treating chronic pain.

Some drugs such as vicodin, etc. are great for acute and break through pain but not for treating chronic pain. A pain specialist would help you to find a long acting pain medication.

It took a long time to find the right doctors and medication but it can make a big difference in your quality of life.

Best of Luck!

Subject: about your response

My husband has DDD and 3 crushed disc in the lumbar spine and has been on Ultram for a few months and said that he can't get through a work day w\out them. Have you heard of it? His pain doc perscribe them. Also , he's not addicted because he hates taking pills and told him he wanted off and wanted to do everything in his power to try not to be on them. Anyways I was wondering if you heard of them and they work great for him

Subject: Ultram

To set your feers at ease Ultram is non-narcotic but kind of work on the same receptors for mild pain, if the pain gets more severe he will probably need a second med added of one or the other. They do work real well for some people.

Subject: about your response

My husband has DDD and 3 crushed disc in the lumbar spine and has been on Ultram for a few months and said that he can't get through a work day w\out them. Have you heard of it? His pain doc perscribe them. Also , he's not addicted because he hates taking pills and told him he wanted off and wanted to do everything in his power to try not to be on them. Anyways I was wondering if you heard of them and they work great for him

Subject: Aaron W, Considering methadone

Hello Aaron W,
I speak from experience when I tell you this. I have been on Methadone now for my second time and I will probably get kicked out of my pain clinic next week because I am going to refuse to take anymore. To keep this a little short my wait use to always run between 145 and 150 the VA put me on Methadone and I ballooned out to 203 pounds, I had to quit the VA and go to a private pain clinic to get me off the methadone and on to ms-contin. Now a few years later and I have been throu 3 other NEEDLE PUSHERS and I am at my 4th and he took me off the morphine my weight being at 148 and now 7 months later I have severe edema in my lower extremities and have balooned to 206 and get hardly breath and have not change my diet salt, sugar all that stuff from before. Methadone works great for some people titrated slowly and carefully wathed over the first 6 to 8 weeks, watch for any signs of feet and ankle swelling or any weight gain. Sorry this is so long but the plain truth is some Doctors don't listen to a damn word you say when you talk to them because they are to busy formulating in their head what they are going to do to you next. Good Luck and
God Bless

Subject: methadone

Dear Aaron,

I hope your feeling better since the last 60 days.

Please be careful with MethD!! I have recently kicked cold turkey, sixty days of hell!! I need 4 screws, two rods and a bone graft , at L5-S1, because the Vert. keeps slipping 25-50% out of place . I hAVE BEEN LIVING WITH THIS FOR MANY YEARS. I started on on 5 mgs. of Methd. bid , which worked great for awhile, from a pain clinic and over three years they increased my dose to 120 mgs!!!. Needless to say methd blocks the opiate receptors of every other narc, so they don't work and turns your feces to concrete!!! Unless you continue to up all your doses nothing works and eventually your sympathetic nervous system shuts down!!! I couldn't take it so I quit. Not Fun. But Glad I did.

Now I have discovered that nerve blocking drugs work great, such as as Lyrica &Topamax, along with A muscle relaxant, , i.e. tizanidine, with some light narcs, norco and tramadol and maybe a light benzo or sleeper.

Anyway, I still have to have the surgey, bone graft and all, i have had ABOUT 20 DOC'S SECOND OPINIONS!! Please BE WARY OF THE HEAVY NARCS I was on 300 mgs Oxy c. BID LAST FALL AND THE STUFF ABOVE WORKS BETTER!! SUBOXONE WORKS GREAT WITH OPIATE WITHDRAWL SYMPTS., , BUT NOT PAIN, SO I'VE HEARD. THEY ARE A NASTY CYCLE TO GET ON AND WORSE TO GET OFF!! PEACE, HOPE and LOVE, TOM
Buddha Says: "Pain is a paper tiger that hides in the grass of the undisciplined mind".

Subject: pain med tolerance

What goes on in my Chronic Pain Specialist Doctor's head. I have been going to the same Chronic Pain Clinic for @15 years. They basically prescribe me the same amount of pain pills today as I got 10 years ago. I'm prescibed 8 Norco per diem. Now despiste the fact that my DDD is worse, yearly MRIs show that every cervical vertabrae and disc are worse, I am 15 years oler and more arthritic, and the nature of these meds is that you need more and more to get the same relief - my doctor has never upped my dosage. What does he think I'm doing? Of course I have serveral other doctors writing me scripts - not for the same stuff but I don't get it. I shouldn't have to doctor shop but I'm only trying to survive.

Subject: pain med tolerance

You need to either go back to your pain clinic or find a clinic/doctor who will listen to you when you talk about your pain. Stress to them what you are taking and how your relief from this medication has changed over the years. Find someone who will listen to you and work with you.
Doctor shopping for scripts does not treat the problem only dulls it and can cause more problems.
Have you tried physical therapy? I find that it helps me a great deal. I am fortunate that I have a physician who listens to me about my pain and works with me to keep it under control.

Subject: Quit cryin

Dear Woody,
You are the reason doctors are hesitant about what they prescribe.You are a pill junkie, going to several doctors for pills.You need to either have a heart to heart with your doctor or he/she knows more than you think he/she knows.Be for real ,people like myself have cut thier meds in thirds and live with the pain.Stop being a weakling.I physically work hard every day and still cut my pills in a third.I wish I did not need them but Dr Butch ye Shay butched my operation from Alant-- Spine Health or whatever thier name is him and Dr. the shrimp -ester the little dick.all he kept doing was uppin my meds uppin the meds while my disc was still herniated.Mabey you should call the little needle dick you should get along fine,he likes pushing pills.They are located in North NJ. Good luck and toughin up.
P.S. By the way I did like Dr b ye sh-.Good bed side manner,but they are ussally the worst doctors; I found that out the hard way.Thanks for f--ing up my life..Love you..
Its just that they did an MRI saw the herniated disc still post op and said "Its a shadow".Yea sure thing doc..How about some more drugs that I did not need until you butched me....

Subject: GLAD YOUR REALLY NOT IN REAL PAIN

GOOD FOR YOU THAT YOU CAN TOLORATE PAIN SO WELL BUT ALOT OF US CANT AND THERE ARE SO MANY STUPID DOCS OUT HERE WHO JUST DONT GET. WHEN PEOPLE DONT HAVE YOUR PROBLEM THEY DONT CARE. TAKE YOUR ANGER OUT ON THE PEOPLE WHO MESSED YOU UP.

Subject: pain med tolerance

Pill junkie. First, I go to one other doctor because he provides me with non narcotic drugs. Secondly, I sincerly wonder why these doctors are clueless about addiction and tolerance. I have been offered morphine and fentanyl but have stayed away because those are the best and sdtrongest they've got and if I develope a tolerance to those, then I've got nothing else.

I've got 7 herniated discs in my neck, 3 in my lower back, DDD, arthritis so yeah Iam a weakling, a mere shell of my once strong, youthful body.

Subject: Relatively Pain Free

I too have been on a pain management regimen for a long time. Fentanyl patches (150mcg/48 hours, Opana ER (oxymorphone), Roxicodone 30mg 4 x daily, and a few other narcotic nerve pain relievers. (I have Degenerative Disc Disease in my entire lumbar spine which has degraded to the point of a 80 year old, as my doctor told me, Rheumatoid Arthritis and several heart conditions, I'm only 30). Super bowl Sunday I got food poisoning and couldn't keep anything down so I decided to end my pain management regimen cold turkey! HELL on earth is not the word for withdrawls BUT, my pain now without the narcotics is 1/3 as bad as it was when I was on them. I am happy to be non dependant on the narcotics and glad that withdrawl only lasted a month, well the horrible effects of withdrawls. I am stil a little lethargic but life is better! Plus my husband and I can once again try to have children. I guess my point is for those of you reading this is if you can handle the withdrawls it is so worth it.

Subject: Long Term

In 84 I had a car fall off a lift onto me. After surgery and 5 years of recovery I got by till a few years ago with 20 advil and 16 asprin a day. Then the pain came back with a vengence. DDD in all levels and every disk needs replacing. 2 bulging disks pinching nerves in my lower back, one at the T/L level and one in my neck level and and a nerve pinched in my facet joints. Stenosis in all levels and moderate to severe scolosis. My legs are numb and burn, ache and pinch. Constant backache from mid back down and neck & shoulder pain. Oxycodone, vicoden and soma are a way of life because everyone I have seen says there isn't anything surgically they can do. Every few weeks I stop taking everything for a few days to keep from becoming dependant on the meds and I only take meds when pain actually exists and only enough to get by, and even then not on any regular schedule. I also have a good pain doc who keeps a close eye on my progress or is it regress.

Subject: neuro stemulator

Ask your doctor to send you to a pain specialist to check on a neuro stemulator, I had the trial and got a permenant one a month later. it helps with my pain. several levels of my disc are colapsed onto the bottom and pinched the nerves so that I could hardly walk. try it you'll see it will help.

Subject: neuro stemulator

maybe for you but i have one and it has made the pain in my back worse. so it is not for everyone and i would not tell anyone to get it i hate it i have had 5 surgerys because of this thing

Subject: sick of negative comments about pain meds.

I GET THAT ABUSING PAIN MEDS MIGHT MAKE A PERSON FEEL WORSE IF THERE IS NO NEED FOR STRONG MEDS.I HAVE A TERRIBLE NECK AND BACK,SCREWS AND BOLTS ALL OF THAT GOOD STUFF.IF I DID NOT HAVE STRONG MEDS TO TAKE I WOULD PROBALY BE DEAD. I COULD NOT TAKE THE PAIN, ITS SO BAD. I CANT WALK ALOT OF TIMES AND THE LIST GOES ON AND ON. WHEN SURGERY DOESENT HELP OR THE DOC SAYS SURGERY WILL MAKE IT WORSE, WHAT DO YOU DO? WHAT I EXPERIENCE YOU CANT SUCK IT UP. I'VE BEEN ON MEDS FOR 5 YRS. KNOW AND I THANK GOD FOR THE HELP. THE PAIN KEEPS ME CLOSE TO HIM AND HUMBLE AND COMPASSIONATE TO OTHERS. WHO CARES WHAT PEOPLE SAY OR THINK ABOUT US WHO NEED, REALLY NEED THE MEDS TO GET ALONG IN THE WORLD AND FUNCTION. I TOOK SO MUCH CRAP FROM DRS., FAMILY AND SO-CALLED FRIENDS THAT ARE COMPLETELY HEALTHY. HOW DARE ANY ONE WHO DOES NOT SUFFER FROM CHONIC DAILY,NIGHTY AND ALL THE TIME PAIN TELL US HOW WE SHOULD FEEL AND WHAT TO DO. IF I COULD RUN AND WORK OUT AND DRIVE AND HAVE MY LIFE BACK I WOULD TAKE IT IN A SECOND.I GET SO MAD WHEN PEOPLE START DUMPING ON MEDS AND HOW BAD THEY ARE, THEY REALLY HELP PEOPLE THAT NEED THEM.

Subject: Negative Comments

I agree 1000%. I have post operative pain from 3 cancer operations. I have been on pain meds for 3 years. Chronic constant hard core pain. Screw everyone who is on the media band wagon BS against pain killers. I take them when I need them. Sleepness nights, can't even drive a car 10 miles without screaming pain. To everyone who who gives their clinical opinion and I stress the word opinion - stick it. Blah Blah Blah. If you were in my shoes your opinion would change pretty fast. So kiss my ass.

Subject: BRAVO!!! I wish the name

BRAVO!!! I wish the name callers could experience what I do for just five minutes - they would be whimpering for their mamas. I hate it when people say "Oh I have a bad back" or "Oh I have a bad neck" when they are just a little stiff or tight. If you still are able to do most things on most days with little to no pain - you do not have a bad back or a bad neck and No, you do not understand.

Subject: Sick of Negative Comments About Pain Meds.

I also agree with you 100%. I have suffered with chronic pain now for 10 years and many times I have left a consult doctor's appointment in tears, after being told to "just take some Ibuprophen" and when I have asked about something stronger, I have dealt with many responses that were not of any help or very unpleasant. I actually had one Dr. throw me out of his office! I was so discussed with the fact that this man was looking down at me as if I were some type of "junky". I only wish that someone like that would live in my shoes for 1 day or for him 1 lifetime! I have Fibromyalgia, almost every disc in my back is either herniated, bulging, or is degenerative, and at L-3 there is a nodule, also I have severe Lymphedema, DJD both knees, another nodule was recently found on my thryoid gland, which was only identified due to an MRI being done on my neck, Carpal Tunnel Syndrome, Bursitis of right shoulder, and (surprise) Depression. I had discetomy surgery in March, 1999, on L-3,4, & 5, which was horrible, but compared to what I am up against now, that was nothing. I will need three seperate surgery's to do each area, installing a metal rod with bolts, etc. Plus through all of this, I am working full-time, but due to all of my absences, I have been downgraded in my position and denied annual raises due to all of my sick leave being used although I have 2 letters in my personnel file from 2 different specialists that I see that indicates I have multiple chronic illnesses that may require 1-2 days sick per month. I have worked full-time, same place, for 26 years and I only have 3 1/2 yrs. left before I can retire at 30 years, but I do not think I am going to make it. I am not following up on medical tests, appt.'s, etc., due to working, therefore, I am unfortunately, in the process of seeking information on how to apply for disability retirement.
I would love to hear back from someone with their opinion on whether or not I should try to stick it out for another 3 1/2 yrs. or should I go on and apply for disability retirement? I am only 44yrs. old, and I feel guilty retiring at this age, plus I am afraid that if I stop working, that means I will stop moving, and the pain will get worse.

Subject: back pain and medication

to anonymous 03/02/2008. I was reading your comments tonight about pain medication and how we are told we shouldent need it as much as we do. I agree with you, do you think that these people who say its all in the mind, and its mind over matter, have these people ever suufered with chronic pain? i doubt it else they would realize how we depend on our pain medication just to get from day to day. its 2 am and i cant settle. back pain is the worst, you have only one back and if it faILS you, you dont have another. i would take anything i was offered if it gave me some relief, i know increasing the morphine is fround upon, but we try anything to get just a little relief? I cant remeber the last time i felt normal, oh, to just not be in pain, to be able to get into bed, snuggle up and go to sleep would be the biggest gift to me.I hate people who come to my house and say oh yes, i have a bad back, but they played a round of golf! or went shopping, cleaned their house, they dont realize how these normal activities are so desperatley desired by me, they have no idea what a bad back can be. Keep taking the pain medication and sod the consequences, i cant think of anything better at the moment other than a bottle of wine!!

Subject: back pain and meds

I too suffer from cronic back pain. And am also sick of others who are able to participate in sports and physical activities that i only wish i could enjoy again. With three young sons the ppain is not only p[hysical but mental also, not being able to show the correct form for a jump shot etc. I am able to continue work with spinal injections and pain meds, just hydrocodone,my doctor is recommending oxicontin but i am able to function ,albeit painfully with the current meds. I wish you luck in your struggle and pray for a good nights sleep for you soon.

Subject: also sick of negative comments about pain meds

i completey agree with you some people look at you and say well you were walking fine yesterday why cant you get out of bed today you must be faking it or milking the attention you get .if they could just spend one hour in our bodies i think they would change their minds .i also get the people telling me im taking to many pain pills, again if they could only spend an hour in our bodies i think they would change their minds fast.i hope in time something works for you to take care of the pain better.

Subject: Fed up too!!!

I couldn't agree with you more and I have been dealing with this for over 5 years. I am sooo happy to see that I am not alone and know it's not all in my head. I have been on pain meds for some time and don't know how I would go on without them. I have two small children to care for and a full time job which keeps me very busy. I see how people abuse the meds and make it difficult for people like us who really need them just to do the things people take for granted. I don't get high or in a fog from my meds. They take to pain away somewhat so I can do my job or things with my family. It has been VERY frustrating but I also pray a lot and God is on my side. Life is short and I don't understand how people can judge when they have no idea of the pain I am in day to day. This is not a game, just trying to live my life as normally as I can.

Subject: Fed up too!!!

I couldn't agree with you more and I have been dealing with this for over 5 years. Chronic Back Pain, DDD, sciatica and what ever else goes with it. I am sooo happy to see that I am not alone and know it's not all in my head. I have been on pain meds for some time and don't know how I would go on without them. I have two small children to care for and a full time job which keeps me very busy. I see how people abuse the meds and make it difficult for people like us who really need them just to do the things people take for granted. I don't get high or in a fog from my meds. They take to pain away somewhat so I can do my job or things with my family. It has been VERY frustrating but I also pray a lot and God is on my side. Life is short and I don't understand how people can judge when they have no idea of the pain I am in day to day. This is not a game, just trying to live my life as normally as I can.

Subject: Negative comments about pain meds

I couldn't agree with you more and I have been dealing with this for over 5 years. Chronic Back Pain, DDD, sciatica and what ever else goes with it. I started to cry when I found this web site but am sooo happy to see that I am not alone and I know it's not all in my head. I have been on pain meds for some time and don't know how I would go on without them. I have two small children to care for and a full time job which keeps me very busy. I see how people abuse the meds and it angers me because it has made it difficult for people like us who really need them just to do the things people take for granted. I don't get high or in a fog from my meds. They take to pain away somewhat so I can do my job or things with my family. It has been VERY frustrating but I also pray a lot and God is on my side. Life is short and I don't understand how people can judge when they have no idea of the pain I am in day to day. This is not a game, just trying to live my life as normally as I can.

Subject: Negative comments about pain meds

I couldn't agree with you more and I have been dealing with this for over 5 years. Chronic Back Pain, DDD, sciatica and what ever else goes with it. The tears started rolling when I started to read some of the blogs on this site but am sooo happy to see that I am not alone and I know it's not all in my head. I have been on pain meds for some time and don't know how I would go on without them. I have two small children to care for and a full time job which keeps me very busy. I have seen how people abuse meds and it angers me because it has made it difficult for people like us who really need them just to do the things people take for granted. I don't get high or in a fog from my meds. They take to pain away somewhat so I can do my job or things with my family. It has been VERY FRUSTRATING but I also pray a lot and know that God is on my side. Life is short and I don't understand how people can judge when they have no idea of the pain I am in day to day. This is not a game, just trying to live my life as normally as I can.

Subject: to ann- main pain

Hi Ann, First its the energizer bunny dag gum it. other than that I guess my biggest worry is also developing some kind of addiction to the pain killers. I had a level 2 ADCF at the c5-c6, and c6-c7 levels on Jan-19-2008. Now my back of my neck is almost in constant pain. An example would be I haven't been to sleep yet since Saturday night. I think I will see if the Dr. can change me to a different kind of pain pill, but does that keep you from getting addicted if your changing to different meds every so often. or do yu still get addicted after awhile even though you switch around. I hope all ya'll get better and good luck.

Subject: Great, more scare tactics

Bottom line, switching opiates might have some value in a sort of "novelty effect" better masking the pain, but some physical dependence is a reality that's impossible to avoid. So what? Do people on insulin worry about it? You can do far more real damage with tylenol or expensive NSAIDs. Try to find a pain med that works for you and a way to control side effects or sleepiness (a regimen of coffee and metamucil works for me), and try to establish a reasonable but effective dosing schedule with your doc, it can be done, then think about getting your life working instead of spending your time in pain worrying about the meds -- we only have so many years on the meter anyway. I can't believe all the people who writhe and moan instead of taking some pills and getting on with it. A human life goes by pretty fast. Worst of all are the puritans who scare people into suffering so they can earn brownie points in their moral index.

Subject: Intractable Pain is Pain Enough

I am so over being faced with headlines spouting the "horrors" of pain medications and then finding in the meat of the article, the so called horror only effects 7% of the patients in question. 7%... which stands to reason that 53% are helped and have adequate pain control and can be more active, having a semblance of their former life restored to them. I have Adhesive Arachnoiditis, full body Complex Regional Pain Syndrome AND Central Pain Syndrome because after a plane accident, I had a spinal cord injury. No, all of these symptoms were not the IMMEDIATE result of the plane crash. These conditions are the result of the medical system's (specifically the Worker's Compensation system) massive suspicion and opiophobia, even after two surgeries.
Suspicion, because they assume EVERYONE is a faker, they keep real patients waiting until their bodies have turned acute pain into chronic pain. Opiophobia, becuase once the pain was chronic, they try epidural steroid injections, pumps, everything but medication. The treatments made my pain so much worse that with all the syndromes I have (ALL because of the "Non-opiod therpies"), my pain is now classified as INTRACTABLE. Just one of my three syndromes can be seen at the top of the McGill Pain scale: which is for pain - "So severe, it is some of the worst pain in existence."
Before I found an INTRACTABLE Pain Specialist and got on an opioid "cocktail'- type regimen I have now, my pain was too great to even scream. I would cry and wail for a day and then it hurt too much too even moan. How much worse can pain like that get?
Please, If your pain is as bad as mine, get info on "Intractable Pain". One of the best is a booklet on Pain-topics.com. For the other's in the 53% I spoke of at the top? Pay no attention to the haters; be well and know that God won't let you down.
Radene Marie

Subject: Part 2 -Intractable Pain is Pain Enough

---A CORRECTION -- In my response to the above article entitled "Intractable Pain is Pain Enough" I made a mistake that my sloppy proof reading did not catch (probably because I was so very irritated). The percentage of pain patients who are helped by their medications should read 93%, not 53%. 93%. I apologise for not seeing this earlier.
RM-C

Subject: FMS just the life!

I wish I didn't have to take any meds for my Fibro, Chronic Neck Pain/Migraines, Lower back pain. The pain meds is what gets my pain under control, otherwise I would be stuck in bed.
With all the Physical Therapy, Massage Therapy I receive and yet none work unless I have the total combination of pain meds, nerve pain meds, mental health meds and the therapy. I have learned what I works & what doesn't. I don't live off the meds, I live with them. I wish I didn't have to have a pill bottle filled with the several meds I need to take to get through my days & nights as a 34 yr YOUNG married mother of 2.
I can't stand when those few people who have temporary pain, but nothing that is serious like most posted here, that continue to BLAME the pain meds on THEIR ADDICTION & ABUSE on the PILLS!
ITS NOT THE PILLS FAULT!
This is making problems for THOSE OF US who don't abuse these life saving & improving medications. Stop whining about the PILLS causing your life to go to S$%* because you lied to yourself & your doctors about what pains you have or don't have!
Stop ruining it for the rest of us!

Subject: Some REAL research!!!

Addiction and Chronic Pain
By Jennifer P. Schneider, MD, PhD

Chronic pain, especially chronic pain unrelated to cancer, is notoriously under-treated. In 1999, the American Pain Society surveyed 805 people who had chronic pain about the adequacy of treatment they received from their physicians.1 More than 50% of the survey respondents had been in pain for more than five years, and more than 40% of respondents with moderate-to-severe pain could not find adequate relief. For most sufferers, the cause was arthritis or back disorders. Almost half of the 805 patients had changed doctors at least once. The most common reasons for changing doctors were

* too much pain (42%),
* didn�t know a lot about pain management (31%),
* the belief that the doctor didn�t take their pain seriously enough (29%), and
* the doctor�s unwillingness to treat their pain aggressively (27%).

Only 26% of those respondents who had �very severe� pain reported taking opioids (ie, narcotics� the strongest pain relievers available) at the time of the survey.

Opioids are medications derived from morphine or chemically similar drugs created in the laboratory. They are the most effective pain relievers we have. Opioids have been used to treat pain for thousands of years. The most commonly used opioids are morphine, oxycodone, hydrocodone, fentanyl, hydromorphone, and methadone. All except methadone are short-acting medications. If your pain is present around the clock, you are likely to do better with formulations that are released slowly in the body, lasting longer before you need another dose. Morphine, oxycodone and hydromorphone are available in pills that need to be taken only once or twice a day, and in rare cases, three times. Fentanyl is available in a patch that lasts two to three days after it is applied to the skin. Hydrocodone is available only in a short-acting form in combination with aspirin or acetaminophen.

The Myths Surrounding Opioids
Why are some physicians reluctant to treat chronic pain with opioids � the most effective available class of medications for treating pain? It�s for the same reasons that many patients fear strong pain medications � the many myths surrounding the use of opioids. These myths include:

* using opioids means you are a bad or weak person,
* opioids damage the body,
* people who use opioids are likely to become addicted, and
* the body gets used to the opioid dose, which then needs to be increased again and again in order to continue getting pain relief.

Every one of these beliefs is incorrect. Below we�ll go over the facts one by one and see what the reality is.

Myth � Using opioids means you are a bad or weak person
Fact � Opioids are just another drug treatment for pain
Over and over again, when I�ve suggested an opioid to suffering patients, they say, �Morphine! That�s a dangerous drug. My family would think I�m an addict,� or �Methadone? That�s what heroin addicts use. Not me!� Because opioids can be abused, their legitimate use for pain has become stigmatized. As a result, too many people suffer with pain.

Myth � Opioids damage the body
Fact � Opioids are very safe drugs when used as directed
You may be surprised to learn that the American Geriatric Society has determined that opioids are safer for older people than anti-inflammatories (NSAIDS) such as ibuprofen or naproxen. NSAIDs can increase the blood pressure, cause gastrointestinal bleeding, and damage the kidney. Opioids do not � opioids do not damage any organs. They do have some side effects, such as nausea and sedation, but these effects rapidly diminish as you continue using the drugs. Other side effects, such as constipation, don�t lessen with time, but can be prevented or minimized by taking stool softeners and bowel stimulants on a regular basis. Some men on high doses of opioids experience decreased testosterone levels, but this hormone can be replaced by using a testosterone gel or patch.

Myth � People who use opioids are likely to become addicted
Fact � Most people who are treated with opioids do not become addicted
Addiction is a psychological and behavioral disorder. Addiction is characterized by the presence of all three of the following traits:

* loss of control (ie, compulsive use),
* continuation despite adverse consequences, and
* obsession or preoccupation with obtaining and using the substance.

As an addiction advances, the person's life becomes progressively more constricted. The addiction becomes the addict's number one priority, and relationships with family and friends suffer. The addict's inner life becomes filled with preoccupation about the drug. Other activities are given up. Life revolves around obtaining and using the drug. This constriction is an important characteristic that distinguishes use of a drug by an addict from its appropriate use by a patient with chronic pain. Patients who take opioids for chronic pain hopefully expand their life, the opposite of what happens with addicts. Pain patients feel better and are able to increase their activities. They may begin gardening, going to movies, playing with children and grandchildren, and many are able to return to work.

A patient who is addicted to drugs may keep increasing the dose without discussing it with the doctor, might repeatedly use up the medications early, go to several physicians for opioids and lie about seeing other doctors, might inject their oral or topical drugs, or sell drugs to get money with which to buy other drugs. These behaviors are not typical of most pain patients.

Most pain patients taking opioids are not addicted to drugs. What is true of them is that they usually become physically dependent on the drug. Physical dependence has nothing to do with addiction. It simply means that a habituated user will experience certain symptoms if the drug is stopped abruptly. For opioids these withdrawal symptoms can include: anxiety, irritability, goose bumps, drooling, watery eyes, runny nose, sweating, nausea and vomiting, abdominal cramps, and insomnia. Withdrawal from morphine starts six to 12 hours after stopping the medication and peaks at one to three days. Longer-acting opioids, such as methadone, have a slower onset of these symptoms, and they are less severe than with shorter-acting drugs such as morphine and hydromorphone. Withdrawal symptoms can be avoided simply by tapering the drug dose over several days.

Myth � Opioid dosages will have to be increased because the body gets used to the drug
Fact � Significant tolerance to the pain-relieving effects of opioids is unlikely to occur
Tolerance means that a person needs more medication to continue getting the same effect. This is also true of addiction. With time, the addict needs more of the drug to obtain the same mood-altering effect. This is why cigarette smokers tend to increase the number of cigarettes they smoke. When opioids are taken for chronic pain, tolerance develops to some of the opioids� effects (eg, nausea and sedation will lessen) but not to others (eg, constipation and pain relief will continue as long as a patient takes the opioid). Unless the source of your pain progresses, as is true of many cancer patients, you are likely to remain on the same dose that gave you adequate pain relief when you first took the drug.

Tips for Getting the Treatment you Need
The treatment you need depends, first of all, on the diagnosis, so ask your doctor whether he or she is satisfied (s)he has finished working up your problem. For example, the solution to severe ongoing knee pain might be surgery to replace a knee joint damaged by osteoarthritis. You will need to be evaluated by an orthopedic surgeon. If medications are the key to treatment and non-opioids have not given you enough pain relief, ask your doctor what (s)he thinks about a trial of an opioid. Some doctors will be uncomfortable with this approach. You can also ask your doctor for referral to a pain clinic, where various options are available, including injections and medications. If you have been addicted to alcohol and/or drugs in the past, your doctor will be understandably reluctant to prescribe opioids. In that case, it would be worthwhile to get a consultation with a pain specialist who also understands addiction. A pain specialist with training in addiction can figure out a treatment plan that will provide you with pain relief but also addresses safety so as to minimize your chances of relapsing. This plan may or may not include opioids, depending on what substance you were addicted to, how long you�ve been clean and sober, and what you are doing to maintain recovery. If you have an active addiction as well as severe chronic pain, you will need addiction treatment before a physician will even consider treating your pain with opioids.

You can learn more about the various treatments for chronic pain, including medications, physical modalities, surgery, psychological approaches, and alternative treatments, by reading my book, Living with Chronic Pain (2004). The book also addresses the issues relating to pain and addiction.

Jennifer Schneider, MD, PhD, practices pain medicine and addiction medicine in Tucson, Arizona. She is the author of Living with Chronic Pain (2004), available from www.amazon.com or www.bn.com.

References
1. MDs struggle to treat chronic pain. The Quality Indicator Compendium on Pain, Nov. 2002, pp. 9-10.

Subject: Some REAL research!!!

Thank you for some real research. 10 years ago I was diagnosed with untreatable chronic pain conditions. At that time I needed twice as much narcotic pain relief as I use today. I have not needed any increase for more than 5 years. Clearly, chronic pain patients are not being harmed by using medication that make it possible to live their lives.

Subject: neck pain

I have just recently surrendered to chronic neck pain which became sudden and very severe following a jerking motion at work. I filed worker's comp and was given the steroids and the pain killers. The opiates made me feel so good that even with the pain; I actually mowed my lawn the second week. Mind you; before this I was running five miles a day and have been unable to even walk a mile since. Today I went to my occupational medicine and told them I am getting better and needed just 10 more days to work on PT...with the option of doing the injection of steroid if I did not feel my stamina return and the pain level tolerable. I am suviving now only on round the clock advil. Instead of listening to me; they actually tried to put me back to work in two days. They compromised by one week put me on light duty although I told them driving is HELL! They said "how did you get here today?" I had to drive to them in pain but certainly not in rush hour traffic and then certainly not having to be followed by being in a vertical position with arms extended the rest of the day. No one really cares. I am very depressed. I was the most active person...always on the move and I have now been benched. I know I must sound like such a whiner; most of you have dealt with this forever but I am so down...I feel like my life is worthless...I plan on trying the light duty and being honest about my symptoms and asking if maybe they can cross train me. My job involves heavy lifting and I no longer think I am going to be able to do it...
thanks for listening

Subject: pain

I know what you mean I tried to explain to my p.a how I was feeling and he preceede to tell me how he dealt with the exact pain. I looked at this nut and could not beleive he thought we had the same body because that is the only way he knew how I felt and the extentof my pain