Join Date: Dec 2006
Re: I learned Less Medication is more....
First of all - thank you for your service to your community for all these years. I graduated from college with a BS in Law Enforcement, and I have had friends who were firefighters and I have nothing but the highest regard for you and your fellows.
In 1969 I was in 9th grade and our upstairs burnt. Long story short, the community was only 2,000 people and the fire department consisted of volunteer firefighters. While tackling the fire upstairs, the firemen took off their coats and lined the stairway with them, leading the water out the front door, and holding the water damage to a minimum. WOW. They sacrificed their own safety and comfort to protect our property. I was amazed.
Now, back to your post.
I'm glad your plan works for you, but it's not something I would recommend. You have clearly suffered long from CP and are now retired early as a result. Most of us here have had chronic pain (CP) for many, many years and have been treated with a wide range of therapy, including meds, ranging from nothing to large patches of fentanyl which is a thousand times as strong as morphine. Many of us could not live reasonably with 4 percocets per day, yet some are forced to do so even with pain that should be treated much more aggressively.
What I have learned through research and experience is that Pain Management (PM) is about preventing pain, or about aborting pain spikes fully at the first sign of such a spike. This is the ideal PM therapy, and the one that has shown consistently in studies experience to result in the least amount of medication used. The opposite would be pain that manages the patient, who chases relief day after day. And, as a matter of fact, that sounds more like your theory than does PM. In essence, you are managing your meds in order to manage your pain, as I understand it. Obviously, CP patients are required to manage their use of meds, but that's a matter of compliance and responsible use of medications rather than pain PM.
PM is about quality of life. Lives and lifestyles are ruined by untreated or under-treated pain that is debilitating both physically and emotionally. Under-treated CP is very harmful to the body. It lowers the immune system's ability to fight infection. It prevents mobility that is necessary to offset atrophy and permanent disfigurement. It ruins lives, breaks up families and causes isolation and hopelessness.
Ppain Management means staying ahead of the pain. By having to chase pain relief more meds are required than by preventing or aborting pain fully at the earliest possible opportunity. This is why most chronic pain patients are on long acting (LA) medications. They are able to sustain a consistent blood plasma level of medication that keeps their pain at an acceptable level 24 hours a day. This is PM. By allowing pain to get ahead of you, and then chasing it with low doses, the pain is managing you. This is not what is thought of as PM.
If I understand you correctly, you should be able, once your body has gotten used to half pills, to then cut your pills in thirds, and once again train your body to need less. Then quarters. Then ... I am not trying to be facetious here. By employing your theory, you are believing that you can influence either your pain or your body's response to pain by forcing it to get by with less medication? The only way I believe this could truly work is if one is titrating downward in order to get off of the meds altogether, like when therapy is being discontinued and the doc is weaning one off of the meds. If your theory is used to actually treat CP, then if I understand correctly, the body is being forced to adjust in hopes that by depriving it of a whole dose, it will somehow adjust to and be satisfied with the lower dose and, ultimately, send less pain signals? Requiring less meds. Or that it's a mind over matter thing that the brain can be trained to require less medication? There is evidence that biofeedback can be used to affect minor to moderate pain at times, like with migraine headaches, but I know of no evidence that one's brain or body can be trained through deprivation to adjust to less medication.
For most of us the cause of our pain is disease related, and these diseases are usually progressive. So the PM treatment is called "palliative," meaning that the condition is no longer curable, and the treatment is compassionate care to allow some kind of meaningful quality of life. In palliative care there is no room for deprivation or trying to train the mind to adjust to less meds. That would be cruel. The idea is to prevent the pain from ever reaching ER level treatment. With such conditions there are also pain spikes that go beyond what the LA meds can prevent, and for this kind of pain a stronger, shorter acting (SA) med is used to abort the pain. This is where meds like Percocet are best used. In such a case the idea is to overwhelm the pain, kind of a "shock and awe" type approach, sending the pain running for cover. At least that's how we'd like to think our breakthrough (BT) pain meds work.
I like the notion of trying or needing to use as little medication as possible, but the mindset in PM is to have as little pain as possible, and the goal is quality of life. The meds are only one of many tools employed to manage pain. The meds used for LA pain relief have no ceiling effect. The dose can be raised to whatever level delivers the needed relief without unmanageable side effects. The short acting (SA) meds, like Percocet, are intended for short term pain, either recovery from surgery or incidental pain. Unfortunately they are also used for CP by physicians unschooled in modern PM. Use of SA meds like Percocet to manage CP almost always results in ever escalating doses because they wear off quickly, but the pain does not. By using LA meds, the pain is prevented by sustained blood plasma levels of meds resulting in an overall lower requirement of medication.