I've been doing research on the internet, and I was surprised to see a number of studies and articles that suggest that patients don't actually develop tolerance to the pain relieving effects of opioids/opiates. It seems that a lot the time, people confuse the progression of the underlying disease with tolerance to the pain medication.
A lot of recent studies, it seem, seem to support this viewpoint, but it doesn't, anecdotally, at least, seem right to me.
Also, I wonder what effect periodically not taking meds has on tolerance. Every now and then, if I don't plan on doing anything and I think I can get by, I'll skip a dose of my long acting medication and avoid breakthrough medication for a couple of days. I've always thought that doing so would help reduce tolerance. But another article (can't find it now) seems to actually suggest the opposite (mice who periodically were subject to withdrawal of medication built up tolerance more quickly than other mice who consistently took the opiate). Anyone have insights into this?
Last edited by moderator2; 05-11-2008 at 06:51 AM.
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I really can't speak to the tolerance question, because I've always believed that you do build a tolerance and apparently, so does my doc. I'd have to research it further.
As to whether you can stave off tolerance, by skipping doses of your meds? With BT meds, maybe, to a point. With LA meds, it would be counterproductive to skip them, because from what I've learned, you have to have a consistant BPL (blood plasma level) for them to work effectively.
Sorry I couldn't add more to the idea of tolerance vs. worsening of a condition. I'll do some research if I get a chance.
It's always been my understanding that the only real way to reduce tolerance is to take as little chemical as possible....This is applicable to any chemical....Pain meds, aspirin, caffeine, alcohol, & etc. The less you take, and the longer in between doses, the less your tolerance will be. For example, those people who rarely drink will often get wiped out on one or two alcoholic beverages.
Tolerance just isn't an issue for PM patients. For example, allergy sufferers know all to well how their allergy meds lose effectiveness over time. My ENT says that when that happens, if you switch allergy meds (antihistimines for example) for around six months, and then return to the original med, it will "re-set" your base point....It's almost like starting over. Not quite, but close.
In terms of skipping your LA med dose periodically.....I don't think that does much, if anything re: lowering your tolerance. There just isn't enough of a "gap" or reduction to do any measurable good. Additionally, by skipping your LA med, you are lowering your BPL (blood plasma level) that builds over time....Keeping it elevated is key to fighting the pain.
I do think, however, that limiting your BT meds will stabilize (not reduce) your tolerance....And just the opposite is true....The more BT you need, the more you will need in the future @ some point. In order to "reduce", you need a prolonged cut back....Depending on how long you've been taking pain meds, it could be as long as several months.
Lastly, there is an inevitable trade off in PM between tolerance and pain control. In fact, tolerance and physical dependance are the two made trade offs for adequate pain control and quality of life.....However, I strongly believe that the "pros" far outweigh the "cons." Everyone just has to manage as best they can, given their respective set of circumstances.
I do believe tolerance is too often assumed to be the culprit when pain relief decreases. And I think patients and docs are equally guilty. Disease progression should always be investigated if warranted. Changes in other meds and supplements should also be considered. Finally, I believe that all too often the eventual loss of the 'feeling' of the drug 'kicking in' is misunderstood to be tolerance. It is, in fact, tolerance to euphoria but not analgesia.
It is true, however, that tolerance to the analgesic effects of opioids can develop. For those who always take their meds as prescribed, tolerance develops much more slowly than for those who go beyond prescribed amounts.
I can easily see why intermittently failing to take LA or SA doses actually causes tolerance to develop more quickly. The goal of PM is to prevent pain. But this requires the patient to take meds on schedule. When doses are missed, the pain gets ahead of the meds and it takes more meds to get relief. Make a practice of missing doses and tolerance can skyrocket.
In PM, you always have to leave room for "somewhere to go" in the future, otherwise, your pain may not be treatable.
Really good point Ex, I have been offered increases in my meds, several times over the years, and I am usually inclined to refuse them when first offered. Because I started my journey with CP at the age of 38, and I had been told by more than one physician, that I would have pain for the rest of my life, I never wanted to be in the position of having nowhere left to go.
As crazy as it may sound to some, I am willing to live with my pain levels averaging 7 or 8 for a period of time, so that I am not in that position. My PM understands this, but still offers from time to time, so that I know I still have the option. I am about to accept a recommendation from my PM, to increase my LA meds, in order to decrease my BT meds. To me, it is preferable to take fewer pills each day and still have my pain covered to a degree that for me, is a manageable level. cmpgirl