Shoreline

Hi Sara, Pain management means anything that helps someone learn to live with and reduce their chronic pain. You can spend years trying non opiate methods of pain management like Bio feedback, self hypnosis, guided imagery, electric stim, acupuncture, chiropractic, trigger point injections and release, myofacial release and massage, nerve blocks, epidurals, nerve ablation , use of numbing agents or Botox. Antidepressants and antiseizure meds have a role in PM for some.

I came from a different generation of pain management though. No doc would prescribe opiates, not even PM docs unless you had exhausted all other avenues, Now some docs will write you a script for the most potent meds available on your first apt. Is that a good thing? I don't know. At some point you have to look back and say did I try everything I could before I traded pain relief for dependency on opiates and the doc to keep prescribing.

If you haven't tried anything other than the max number of epidural steroids a doc will give in a year, there are dozens of modalities and treatment methods many docs use alone or in combination with opiates. Even now, not all PM docs use opiates , some people do benefit from counseling and learning relaxation techniques or antidepressants and antiseizure meds provide enough relief. Some people swear by acupuncture or chiropractic.

I pretty much had to try them all before long acting opiates were even invented or used for anything other than cancer pain. I was offered pain meds after I was bed ridden from 3 failed back surgeries and 7 years of pain management without pain meds.. However my medical record is 2 charts about 3 inches thick of every other method of pain management I have tried. My doc doesn't have to worry about being audited and the DEA asking did I try anything else before I was handed a script for morphine or oxyContin. It took 7 years, 3 PM clinics and a dozen PM docs to actually try everything I mentioned and the other couple dozen methods I tried.

Pain management isn't about strictly relieving pain though. Any doc can prescribe opiates. If your pain is severe enough to require these meds then a good doc is going to look at the big picture, What's your mental health status, are you depressed, what other coping skills do you have aside from reaching for a bottle of pain meds?

Having nothing but scripts written for pain would be like someone with a major mental illness receiving only medication and never speaking to a shrink or counselor. Meds alone are no more effective at treating depression than counseling alone. However when you combine the two, the results are more than twice as effective, the same stats apply for chronic pain.. The more tools you have to deal with pain and the more coping skills you have the better off you will be. If you chase total relief with medication, it's no different than an addict hoping to get the same high as their first hit after 5 years of abuse. Along with physical dependence on opiates you also develop tolerance. To sustain complete relief you would have to increase the dose of meds on a pretty regular basis.

Even with implanted morphine pumps, which I have, the best they shoot for is 50% pain relief, and that's about the best I can get without the meds causing too many side effects and leaving me impaired.

BT means break through, short acting meds to be used when a base dose of long acting medication just isn't working. BT meds are used for break through pain. Someone with a patch on may have pain from activity or have greater pain at night. Rather than increasing the long acting dose of meds or the strength of the patch to manage your very worst pain, short acting meds are used sparingly to treat those episodes of BT pain to bring an increased level of pain back down to a tolerable level a long acting med or other treatment may provide.

The goal of pain management is to improve function and quality of life. If narcotic pain meds impair someone more than they restore function, it becomes hard to justify continued use of those meds. You don't have to remove someones pain completely to improve their ability to function or improve their quality of life.

Some PM docs use opiates as a last resort when all other methods fail. Some don't use them at all, Some PM docs are rather loose and reckless with opiates and there are PM docs everywhere in between. Some use BT meds and some only use long acting meds and want you to use a non opiate method for BT pain. If a relaxation technique, stretching, Ice, heat, acupuncture or Yoga or whatever can reduce your pain, why increase your level of tolerance and dependence on opiates.

Dependence just means you will experience withdrawal if you stop using a med abruptly, It will occur with anyone using long acting or short acting pain meds around the clock for a continued period of time. It doesn't mean addiction and all the negative aspects associated with addiction. It's simply a physiological response and a price you pay if the only thing that allows you to function is opiate pain medication.

Good luck and welcome, Dave