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A philosophical discussion about using medication as the only form of control of chronic pain.

happyHBmomhhappyHBmom Posts: 2,070
edited 06/11/2012 - 8:45 AM in Pain Medications
I know there are a few out there who would be willing to have a philosophical/scientific discussion about our decisions (*cough* avi and lala *cough*) I hope others will feel free to join in.

This started with an article. I don't think I can link it here but I'm happy to tell you via PM. Here is an excerpt:
When the self-talk is saying, this is horrible, awful, terrible, the brain then amplifies the pain signal. When this occurs, the level of distress increases and people suffer thereby remaining a victim to their pain. This further increases the drive to use medications as the only solution for their pain problem.
By: Dr. Stephen F. Grinstead, LMFT, ACRPS, CADC-II

I did not like the article, because to me the implication was that anybody who went on pain medication without therapy would enter a cycle with the only possible outcome being addiction. I was in chronic pain treatment without therapy for 2 years without the addiction cycle being started. And, no, that's not denial.

I discussed that with my therapist (I've been seeing her a little over a month) and she said she thinks that the actual difference is a certain level of self-awareness. I call it (educational psychology background) metacognition. Thinking about your thoughts, whatever you want to call it. It is simply the ability to step back from the emotional and look at what's going on in your brain. It's a skill I learned early.

So, for example, when the pain gets intolerable, yes I can feel that sense of feeling out of control. But when the pain then decreases I can step back and say OK, that's better, I'm OK now.

Do you feel you are able to do that on your own? Or is that difficult for you, to self direct, or be inside your own brain in that way? If you can, do you feel it helps you manage your pain so that medication does not become your only outlet?


  • Sometimes it's overwhelming and nothing helps the pain so I look to distraction. Playing music videos especially fond of the 80's music and seem to feel better. Maybe still have pain but I feel more like forgetting about it by doing something else. I even resort to relaxation and quietening my thoughts and muscles and sometimes get a nap after. So yes when I get a lot of 'flooding' emotions triggered by pain I need to say stop and redirect as above. Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
  • happyHBmom said:

    So, for example, when the pain gets intolerable, yes I can feel that sense of feeling out of control. But when the pain then decreases I can step back and say OK, that's better, I'm OK now.

    Do you feel you are able to do that on your own? Or is that difficult for you, to self direct, or be inside your own brain in that way? If you can, do you feel it helps you manage your pain so that medication does not become your only outlet?
    I can honestly say I have to do this. I don't care for the meds. Have never tolerated meds well and so I use the least amount I have to to get by. I'm always second guessing whether the benefits outweigh the risk. There are more times than I care to admit that I have let the pain get out of control.

    I do what I have to do to get the control back. Sometimes thats mind games filled with distraction, sometimes it's exercise, rest, heat, or ice, and sometimes it's meds. Most times it's a combination of all of the above. But then I can step back and say, "I'm back in control again." I think I use the meds as my last resort and end up suffering through more pain than I need to.

    I'm not real crazy about that quote you found there either. Of course I'm not real crazy about doctors who tell people the pain is all in their head either.
  • Well, that's part of his theoretical schema. He believes that pain starts as something of our bodies, but becomes something of our brains when it gets very severe. And he believes most (he doesn't say most, he says all, but I'll say most for the sake of discussion) people need help to deal with it when the pain resides in our heads.

    And I think it's really a good point- he said something like... when we stop saying "ow that hurts" and start saying "oh my gosh, I can't take this anymore" that's when it becomes something of our mind, not of our body. Or a combination of the two. And at that point, medication alone isn't going to cure it.

    Does that make sense? I think that's one reason that I've been getting so much from the guided imagery, because it has been approaching the pain at that level.
  • Ooooh, so interesting. Hehe, you know I've been pondering the philosophical side of pain meds here lately :)

    I think I agree with the theory of the quote, but not necessarily the implication that it has for the use of pain medication.

    Like you, I've been working with a pain psychologist which has been a great experience- one thing I have really had to work hard on is teasing apart the emotional response I have to pain from the pain itself. We all do it, and just because there is an emotional/mental response to the pain does not make the pain any less real. For me it is helpful to sometimes just step back and say "ok, my back hurts, but it's *just* pain." My natural inclination is to panic with things like "oh my god my back hurts and now I can't go out and maybe I'll never be able to go out and have fun again..." I think our emotions give meaning to pain, and with chronic pain what I've learned is that sometimes pain is just pain- it doesn't have to mean anything. So, I agree with the theory that our brains naturally attach negative meanings to pain, and those negative meanings certainly increase the level of suffering. Like you, I've also done well with guided imagery because it really makes me sit with the physical sensation of the pain which ironically makes me feel more in control of it and less afraid and panicky about it.

    Where I disagree is with the implication that this negative emotional suffering necessarily leads to inappropriate medication usage. It certainly can, but for me I have found that taking medication is an important part of self care. I once heard something like "there is no reward for suffering." While limiting medication usage is certainly a great goal, I think it is also important for us to accept that we have chronic pain and that it is *ok* to need medicine to help us manage. That has been a big struggle of mine recently- giving myself permission to take medication when I need it. But, taking the medicine is about decreasing physical pain and functioning better, not numbing out the emotional pain. It's a skill to have enough self awareness to differentiate the physical from the emotional, and with or without psychological counseling I do believe that most of us recognize the difference in taking medication from a place of "my back hurts and I need to take this so I can function today" versus "my back hurts and I just can't stand it anymore."

    I also think it's important to recognize that pain medicine makes most of us feel pretty bad emotionally- That fact is rarely recognized, but I think it is important. Physically I feel better on pain medicine, but emotionally I feel much worse, so the idea of taking medication to help with the emotional suffering doesn't really ring true, at least for me.

    A very interesting topic, which I think comes down to recognizing the difference in the physical and emotional aspects of chronic pain and developing separate tools to cope with each. I think this is an area where pain medicine is getting better because there is wide recognition that on a biological level chronic pain has psychological implications. Addressing these is a somewhat prickly area, though. We, as patients, sometimes take offense when doctors bring up the mind component of our pain because it can feel like they are saying "it's all in your head." I think it is important to recognize that at least part of it *is* in our heads- chronic pain affects many areas of the brain including the limbic system which affects emotions. For me, seeking help for and developing coping skills for the emotional aspects of chronic pain has been just as helpful as the treatments for the physical source of the pain. The pain is real, the emotional response to the pain is real, and both need to be addressed.
  • Lala, I think that depends on the medication. Being able to exist inside your mind (metacognition again) is part of being able to see the difference- and I was messed up there enough to have lost the ability for a while. Anyway, I recognized that I felt much worse emotionally on Fentanyl than I do on MS-contin, although I felt better physically, and that was also something that started this whole episode of philosophising- that the physical and emotional do somewhat go together, but not in an exact way. Being in a lot of pain makes me feel worse, but I can definitely be in a bit of pain and still feel better if the overall fit of the medication is right.

    But the only times I have been close to pain free since my accident were when I had the fentanyl patch, and I didn't really feel good. So, I agree with what you were saying- mood does not perfectly correlate with pain level. I would much rather be under medicated to a certain amount than be over medicated.
  • I have seriously been contemplating the pains psychology route. Mainly because of my inability to take most of the drugs. How many times have I said, "What I wouldn't give for a good anti-depressant or nerve drug." The side-effects get me every single time and the only thing keeping me from the shrink is the thought of tryng more drugs. Honestly I am not making it up. I've tried so so many. (This is a gal that could never even handle birth control. No gas from the dentist fro me. You can forget your average antibiotic.)

    I am on the low dose of 25 mcg Fentanyl and I worked up very slowly from the 12s. I know I could use more and get better relief but I don't dare. This is the most I can handle and still function semi human and even this I hate. The BT meds I try to avoid at all cost. Just fix me is what i dream. So know I wonder I'm getting some pain relief but I feel lousy. Emotionally and physically. There has to be sometihing out there for someone out there like me that can't take all these crazy drug.

    I can't compete yet in the whole mind game catagory but I'm working on it and doing my homework. I know I'm not there yet. I have some serious work to do and this thread is helping motivate. I do kmow for me I would much rather be under medicated and not deal with the side effects than be over medicated have less pain and fight those awful side effects. Maybe I'm just wacky! All I know is the more I type here the less I am feeling like I am making sense. Thanks for listening to me ramble anyway.
  • I did some research on this doctor, and it's amazing the amount of articles he has written. Bookmarked it for later digestion. Okay with that said....

    We all know HB from our own daily living, mood, emotion does affect pain. If we are happy doing something, lots of the pain gets moved away, conversely if we are tired or depressed, the pain (at least for me) tends to be more in the front of our realizations. Medication...Part of the reason I am real thin on when I use Darvocet or any of the cets for that matter, is like others in here, the pain decreases sure, but I get tired, foggy etc., so then I just get nothing done.

    One of the problems I have with this doctor you used for reference, is if you go to the site all his papers are on, he is all over the place! He goes from moods and pain, to medications, to spiritual being the all and healing, to addiction. A lot of interesting reading for sure! From what I've read over the years, addiction is where the brain is pleasured (chemical change), and thereby the person too enjoys said drug and want more. With pain and the same meds, our "pleasure" isn't what the addict has, but the pleasure hopefully of a bit of a break from pain. I think I said that right.

    To me, just like medical journals show the 'balance of a healthy life' - you know the human form with the food triangle, health, exercise, love (mental) balance is all good. Well for us it is a balance of good food, exercise if we can do it, pain management and a support network of some sort. Notice they don't show that 'new normals' profile? Okay, I will read more on this doctors submissions for future nibbles. Off I go for now... :)

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • You guys are very deep thinkers which is great it's nice to look at things from different perspectives. I hate the fact that I have to take pain medication, it drives me crazy so to speak. I have tried not to take them but then I end up being a complete mess and quite honestly I probably wouldn't want to live. I know that is awful to say but I wouldn't be able to get out of bed or play with my kids or interact with my husband. It has been a hard decision to take meds to be able to at least a living part of my family. I of course can't do what I "want" to do but I can at least live my life. I definately find that the more active I am I can tune out the pain sometimes. Then the down time comes in the evening and holy cow all hell breaks loose. I wouldn't wish this to happen to anyone but maybe if he walked in my shoes for a few days he would change his mind....Thanks guys for this discussion.
  • If "deep" is the word you wish to use. "convoluted" has been used before, as well, LOL! Anyway, it's always fun when I can get people to have these conversations with me. I do not tend to look at things quite the same as *most* others do, for sure!

    I have also been called "OMGSOANNOYING"

    Anyway, I have to get ready for an epidural, but I'd like to remind people that pain has side effects as well. Our body is more used to them, and we're less likely to feel them, but they are still there. So seeing drugs as a foreign invader is fine, but seeing pain as being benign is not quite accurate.

  • These conversations are great because they make us think. HB I'm guessing your daughter is one of the people who call you "omgsoannoying" If not that will come one of these days.

    My feeling is that the brain as an emotional organ is a huge part of pain generation. We know that the brain processes the signals that it gets and sends out orders to the body to react. But can your concious brain control the reactions?

    You slam the door on your finger and the brain knows something happened. It sends out signals to provide care and comfort to the finger. But the question is can you consiously control how much pain your brain thinks there is? Is the pain different for the person who stands there and holds the finger and the person who "shakes" it off and goes back to what they were doing?

    Can one person stay calm which keeps their pulse/blood pressure down which would reduce the pressure on the wounded tissue. Can they actually "convince" their body that it's not too bad and it therefore gets better faster?

    The person who obsesses about the injury has increased blood pressure which makes the finger hurt more. They spend more time staring at the finger which sets off all kinds of chemical responses. And they will still be complaining days later.

    THis is just a small analogy. My belief is that we can apply this to spine problems. Yogis and other mystics believe and have shown that they can control the body's responses to stimuli. While many conditions can only be eased by medication alot of us have pain meds for breakthrough or as needed use. I will admit that there are times I take something before bed because I feel that I will have a bad night. Am I setting myself up for pain by thinking this? Maybe. But that just goes back to proving the idea that the concious brain can be a partner in pain management.
  • No, she isn't. It may be coming, but maybe not- she has always marched to the beat of her own drummer. Unfortunately she's placed herself in the role of caretaker, somewhere I very much do NOT want her!

    So, if medications were your only option, and you, as an emotional, living, breathing human who has as a basic need to be without pain finally found yourself without them, and you had no tools to help yourself in their absence- then what? Those of us who have tried relaxation therapy- Lala I know has been doing it- Avi and Kris have you ever given it a try? I would say a really good guided imagery session works easily as well as a pain reliever, if not as long.

    I figure each of us could find other things that could also help us with our pain. I read recently that for children with chronic pain, video games help. So I went out and got a game I used to play, and you know what? It does make me forget a bit! Not complete, but a little. If I ran out of meds, I'd be bringing out all of the tools I had.

    (playing my video game, on my heating pad, in bed, with my puppy, while my kids are nearby, and so on... distractions that make me happy). What would you do? (Oh, and then I would make them all go away and I'd put a guided imagery tape on the ipod).

    But since we all know that pain killers don't relieve all of our pain, we can also used these to relieve the pain that meds don't quite get to!
  • Howdy HB,

    No, not doing it in any formal way. I have found (like you have) that computer, PSII, Wii games take a lot of the edge off. Basically it is taking our brain power from focusing on 'pain' or discomfort, and letting it focus on pleasure - i.e., the game! :) Tell ya what too, even this right now - posting. That also takes my brain to a distraction from pain, as I think what I write, and as I type I actually mentally verbalize the words as I type them. Make sense?

    Philosophically speaking, while the brain is GREAT at multi-tasking, we *can* 'trick' it sometimes by doing other things.

    Singing in the shower is fun, my jungle cat loves my lap, and that is nice. A ball of fur purring - can't get better than that! I also at times listen to my favorite music videos - loudly too as I live out in the boonies! Yes!!!

    PCTF C4 - T2, Laminectomies C5, C6 & C7. Severe Palsy left arm/hand.
  • Very interesting discussion! I kind of stumbled across some techniques by accident in my quest for pain relief.

    I can totally relate to the fentanyl/pain/feeling out of touch issue. I always felt much better physically while on it, but mentally and emotionally it just drained me. I started having side effects that eventually caused me to get off and that ended up being a blessing in disguise. After I was off completely, I felt like I found my mind again. I'd lost it! :) My pain returned, full force plus some, but my thinking was clearer.

    One night I couldn't get comfortable, my pain was out of control despite taking pain meds, and every other meds you'd think would work. Out of frustration I put on the iPod, cranked it up, and tuned it to something I normally don't ever listen to but my kids are very fond of, RAP! Yes, rap music. At first it wasn't too loud and didn't have an effect so I turned it up until I almost "felt" that exact moment that my mind switched over and I was all consumed with the music. Amazing. I use it now probably 5 of 7 days a week. Still rap as I've found that nothing else seems to turn down off the pain switch, or at least turn it down.

    Another interesting thing that I've found, again by accident, is a coloring book of mandalas. It's a spiritual guided coloring book that I found online one night while looking for paint brushes. Go figure! I paint and draw, but find myself doing less and less of that as I'm unable to stand in one position too long and get frustrated easily. Hoping and praying that will change with this surgery. Anyway...this mandala coloring book not only diverts my attention away from the pain some, it opens up my mind spiritually in some way that I still haven't figured out. I've let my daughters color along with me and they've enjoyed it just as much as I have. I'm about to place an order for another one before we run out of pages in this one. I find coloring in general very relaxing too. And I agree also with the video game theory (and definetly the cats! :) )
  • Years ago when my mother was dying of cancer I was experiencing severe panic attacks.I went to a therapist who gave me anti-anxiety meds and sent me on my way. I learned on my own to talk myself out of the panic attack.I use this now to deal with my chronic pain.


    When the pain level is at let say a 8, I take the med and talk to myself saying "you'll be ok, the med will kick in in 20 min, 10 min and so on."

    I always try to redirect my thoughts onto something else because If I dont I get consumed and think of nothing else but the pain. I use this technique with all of my pain levels. I would never use it alone(been there done that ER trip) nor would I use the meds alone, its a great combo for me in dealing with my chronic pain.


    My 5 kids are the best distraction from the pain. We all pile up on my queen size bed and watch funny movies, play games or just talk about old times. My 15yr. old daughter is very witty so Im usually laughing before to long. You can see the concern in her eyes but she always asks me " did I make you feel better mom?" They're the best medicine!!!
  • That's so sweet! I only have 2 daughters (only!, that's plenty), but they too are constantly trying to cheer me up. Not saying I'm always down, but they're always up for some comic relief. My youngest NEVER ever ever has her mouth closed. NEVER. She sings from the time she opens her eyes until she goes down for the night. And she talks in her sleep lol. She had a friend over the day after I got home from the hospital and she got her to sing along to a couple of songs with her. I overheard her friend saying "isn't that going to bother your moma?", and my daughter told her "nah, that's just what I do! That's what makes her feel better". I couldn't imagine going through these times without them.

    Pain is...well, pain. We all have our means and methods of dealing. I'm thankful that those around me have found there own ways of dealing also :) because sometimes I know that I am not the most pleasant of people (now that's the understatement of the year!)
  • Yep, my son is such a talker- he has this mind that goes different directions every 5 seconds. He is 10 1/2 but will still come cuddle with me and let me snuffle his head and such.

    My daughter is brilliant and beautiful. No, I am not partial, she really is! Seriously! :P

  • I know I am late to the party but would like to contribute my experience..

    Ill try to keep it short...

    I injured my neck wrestling/martial arts about 6 years ago. Disc between C6-C7 was ruptured 4-5mil protrusion into the nerve area. All the classic symptoms of the injury. Since then I have had 4 MRIs with no change. After about 6 months the numbness went away and strength came back in my arm... but I have had pain in my neck and back out to my shoulder ever since. Doc said that the protrusion is barely touching the nerve. Enough to cause pain but not enough to render my arm useless.

    Anyway, i have been on meds since. Tried many "nerve" meds with no luck. The best combo seems to be opiates with something like Robaxin or skelaxin. Started small with Norco and now I am Perc 10/325 thre times a day. I break them in half and spread them out since they don't last long.

    I have been to three Pain docs in the 5 1/2 years. Only changed due to changes in my health insurance.

    All of my docs have told me that Surgery is an option but not guarantee it will be fix the problem, since they think I have nerve damage. And since I am only 37 I have ruled out surgery for now. Not worth the risk.

    Now it seems all the PM docs I have been to never really just settle with meds as an only option. They are always suggesting Epidurals, facet injections or whatever is the new treatment on the block. I have really good insurance and I think they abuse it.

    Personally I think they like to keep people doing higher dollar options. Meds just dont keep the lights on.

  • Also late to this discussion.

    I believe that it being in our minds is total BS! Any time you have something like a disc being pressed against nerves, crushing nerves, rubbing nerves etc... This is going to cause a very real physical reaction. Pain is a way for our bodies to tell us: "Hey, something isn't right here."

    To say it is in our minds is baseless and quite possibly the most insulting thing a medical professional could say.

    I have a friend that is a buddhist. He really subscribed to and believed that the mind controls everything we do. We can will ourselves not to feel pain. We can will ourselves to feel pleasure without the assistance of alcohol and stimulants.

    This is a man that abandoned his job, his life to go and live free without the constraints of responsibility.

    He would say to me when he rolled back into town: "C'mon, man. You can overcome this without Dr's." Then he through his back out. It is amazing how one little event can change a persons perspective on this thing we suffer from every day.

    It is amazing that once he experienced it, he realized that his mind over matter philosophy was not always the answer to things.

    If the man quoted could experience a back injury like mine, or anyone elses for that matter for a day, he would recant everything he wrote there.
  • But of course it is in our minds. Something is pressing on a nerve, which then transmits a signal to our brain that says "there is an injury." Our brain says "There is an injury! You're injured!"

    So our minds think we're injured, but we are not. The pain signals an injury that is not there. We act as if we are injured, and we are not- the pain is neurological, not indicative of any sort of broken bone or strained muscle.

    Pain is a way for our bodies to say something isn't right, but in this case it is a false signal.

    So how much time do we spend acting injured when we are not actually injured? Rest does not heal what ails us.

    The pain is real, don't get me wrong. But it exists solely in our minds. The injury it indicates is not there. The gaping hole it signals does not exist. It's a false alarm. Our bodies efforts to "fix" the issue are more often than not dysfunctional, as the issue does not exist.

    Our bodies develop a lot of stress and tension in response to these mixed signals. Relaxation therapies help a great deal. Don't knock it until you've tried it.
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