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  • Pain management and Addiction

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    Old 09-02-2004, 12:23 PM   #1
    fisherpard
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    Pain management and Addiction

    I am a chronic pain sufferer for about 8 years. I also am addicted and abuse pain medication. I have diabetes, Fibromyalgia, Chronic Diverticulitus and several other spinal issues.

    I am 17 days clean from all opiates. It has been the hardest thing I have ever done. i still crave them.

    Dealing with chronic pain , do any of you worry about addiction and abuse.

    just thinking out loud,
    fisherman

     
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    Old 09-02-2004, 12:29 PM   #2
    vamp36
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    Re: Pain management and Addiction

    Yes, I did in the beginning. I posted a question about it, and Shoreline gave me wonderful advice. He also explained the difference between psychological dependence and physical dependence to me. It releived some of my fears and helped me to understand.

     
    Old 09-02-2004, 01:24 PM   #3
    fisherpard
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    Re: Pain management and Addiction

    I do understand the difference between physical dependence and emotionial dependence. My problem is I developed both. It was a situation lose if you do and you lose if you don't. I began to also use the opiates for emotional pain relief as well as chronic pain. It would lift my spirits and also my depression.

    It is terrible to be in both worlds.

    thanks for listening,
    fisherman

     
    Old 09-02-2004, 02:21 PM   #4
    ladyhope
     
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    you might want to think on this....

    Dear Fisherman,

    You might be surprised to learn that you may not be an addict, after all, but something entirely different if your pain is unmanaged and undermedicated. Let me explain.

    According to the most recent report just released from the Office of DEA Diversion Control they define......


    ABUSE - a term used in the pychiatric to describe maladaptive pattern of substance use, not related to a therapeutic purpose, resulting in recurrent and significant consequences.

    ADDICTION - a chronic neurobiological disease, with genetic, psychosocial, and enviromental factors influencing its development and manifestations. It is characterized by behaviors that include impaired control over drug use, compulsive and continued use despite harm and craving. Addiction is considered distinct from, though sometimes interrelated with tolerance and physical dependence. NEITHER PHYSICAL DEPENDENCE NOR TOLERANCE TO PRESCRIPTION DRUGS IS SUFFICIENT EVIDENCE OF ADDICTION. Unlike tolerance and physical dependence, addiction is not a predictable effect of drug exposure but represents an idiosyncratic adverse reaction in biologically and psychosocially vulnerable individuals, for which drug exposure is only one of the etiologic factors. Simple exposure to opiods does not produce addiction.

    PSEUDOADDICTION - an iatrogenic phenomenon in which a patient with undertreated pain is perceived by health professionals to exhibit behaviors similiar to those seen in addiction, but IS NOT TRUE ADDICTION. Patients become focused on obtaining medications, clock watch, and seem inappropriately "drug seeking". The term has even been used to describe even such behaviors as illicit drug use and deception, if they appear to be primarily driven by the patient's efforts to obtain pain relief. It is believed that pseudoaddiction can be distinguished from true addiction because the behaviors resolve and do not recur when pain is effectively treated.

    PHYSICAL DEPENDENCE - a state of adaptation that is manifested by a specific withdrawal syndrome that can be produced by abrupt cessation of dosing, rapid dose reduction and or administration of an agonist. Most patients on long term opiod therapy develop physical dependence, which is not predictive of addiction.

    TOLERANCE - a state of adaptation in which exposure to a drug induces changes that result in diminution of one or more of the drug's effects over time. Tolerance often occurs in the absence of addiction, as when drugs are used therapeutically over a period of time, and usually requires increased doses of the drug to produce the pharmacologic effects initially resulting from smaller doses.

    Here's the link - click on the PDF doc. to retrieve it in full -
    [URL=http://www.stoppain.org/]Prescription Pain Medications - FAQ[/URL]


    Due to this knowledge I have learned that I have been inadvertently labeled incorrectly as an addict because eight years ago I was suffering from tolerance to very mild pain-killers that had been prescribed and therefore increased my dosage in order to obtain a measure of comfortable pain relief. When my pain was properly and appropriately managed and controlled I had no reason to increase my dosing. I wasn't looking for a high I was looking for pain relief. Now I've got a big mess to clear up with my GP and two former pain specialists that have me listed as an addict.

     
    Old 09-02-2004, 05:50 PM   #5
    twisten
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    Re: Pain management and Addiction

    I think the fear of addiction lurks in most of our minds. I know it does in mine. I never take extra of my base med and I make sure to only use my breakthrough meds when absolutely needed. If I'm having a bad few days I'll talk to my doctor and she will usually increase my meds for a day or two but I never do it on my own.
    __________________
    Crohn's disease, scoliosis, chronic myofascial pain, migraines, Osteoporosis, Trigeminal Neuralgia.

     
    Old 09-02-2004, 10:50 PM   #6
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    Re: Pain management and Addiction

    Great info Ladyhope. This same discussion came up on the back board. Some individuals seemed to believe that anyone who takes medications long term are addicts. This is not the case.

    You can become dependant and you can have tolerance but the real risk of addiction in medical terms is slim, about 3%.

    When you are addicted to the medication, as indicated, it is a desire to abuse medications or take them for anything but pain. Taking medications to control pain as scheduled and prescribed does not mean you addicted.
    Addicts abuse medications, true pain management cases rarely do, I say rarely because of the aveage 3% factor.

    I wasn't as concerned as maybe most with addiction primarly because I have researched and followed Pain Management for years so I was aware of the percentage factor and new studies that had gone on and are continuing to go on.

    Many individuals do percieve themselves as addicts or they are mislabled, primarly because they do not have a full grasp of true pain management and how narcotics or opiods work in our system. It is a sad situation when someone percieves themselves as an addict when in reality it may not be if they truly have a pain problem and are being appropriately treated and do not exhibit the signs of abuse and addiction.

    Some medications are known to give the individual a better mood or a bit of energy, this is nothing new, on the other hand some medications, such as Morphine I found, totally wipe out the energy. It does seem you are in a sticky situation Fisher and I'm not sure what the apprpriate answer would be. We must decide on our own what to believe or what route to take but it is important to educate ourselves first before making that decision.

    here's a snippet of the information my doctor gave me:

    Opioids (narcotics) are medications that work like morphine. There are many drugs in this class. Examples of some include methadone, demerol, percocets, vicodin, oxycodone, and heroin. Opioids bind to a variety of different receptors on nerve cells in the CNS (central nervous system) and elsewhere in the body, leading to pain relief as well as the various side effects. Different opioids have different affinities for the various receptors and their subclasses on different cells, and this gives each opioid a unique blend of various responses (pain relief and side effects). They cause pain relief by decreasing pain impulses and sensations after binding to the nerve cells in the spinal cord and brain. They also can cause many side effects including sedation, respiratory depression, nausea, constipation, and sometimes mental status changes by affecting other nerve cells in the body.

    Unfortunately, over time, nerve cells become accustomed to the effects of the opioids, and therefore, over time, opioids will have less of an effect in decreasing pain impulses and sensations. This is called Tolerance; the body becomes somewhat tolerant to the effects of the opioids. This develops in everybody who takes opioids chronically. A patient may find that the medication will not seem to work as well as it did in the beginning. This is to be expected. Even though they will develop tolerance, it will not be complete, and the medications will always give them some relief. There may be times when they may feel that the medications are not helping them at all. I’m sure that if they were to stop taking them for a day, their pain would worsen. The main point of this is that with the use of opioids, the goal is only partial relief, NOT complete relief, since the latter is unattainable due to the development of tolerance.

    There is no treatment to prevent the development of tolerance. Increasing the dose of opioids to counteract tolerance will only subsequently increase the level of tolerance. The body will re-adjust to the new higher dose of opioid, and the degree of pain relief will ultimately be no better than that previously achieved with the lower dose of that opioid.

    Opioids are the main medications used for the treatment of acute, severe pain, such as experienced following surgery, bone fractures, or any other severe injuries. If a patient already has a high tolerance to opioids, they will not work well or not at all using standard doses, if and when a patient needs them to treat severe, acute pain. Therefore, it is important for a patient to minimize the use of their opioids, to minimize their development of tolerance, so as to preserve the ability of their body to respond to opioids for pain relief should they experience severe, acute pain.

    Addiction is the craving of opioids for reasons other than pain relief, and is different from tolerance. With time, everybody develops some degree of tolerance, but only a small fraction of patients become addicted to or abuse opioid medications.

    Withdrawal occurs when a patient, who is taking a large quantity of opioids, suddenly stops taking them. With taking opioids chronically, the body becomes accustomed to a high level of them, and when this level suddenly drops, various different cells in the body respond, and this results in withdrawal symptoms. Examples of some symptoms include diarrhea, tachycardia, and anxiety. Most patients are only using relatively low doses of opioids, and if they would stop them suddenly, they probably wouldn’t have any withdrawal symptoms at all, or if they did, they would be very mild. Increasing pain would be a greater problem.

     
    Old 09-02-2004, 11:42 PM   #7
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    Re: Pain management and Addiction

    (((((((((((((((Tammy))))))))))))))))

    OMG! Hon, you've been to hell and back. I swear these doctors are damned insane and unbelieveable to let you suffer like that. I'm just glad now that you have someone who is really concerned about your pain issues.

    First - were it me I'd stay on the meds. I hate pain because it rules my life, like it is now. However, if you can tolerate NOT being on them I guess you have to do what is best for you.

    Second - no matter how little of an opiod you take you will have withdrawals of some kind, if you've taken them for a long period of time. In my case, the less withdrawals I had was when I was much younger and when opiods were first introduced into my system. Most likely, to cessate from them you will gradually taper down your doses over a few weeks until they are completely out of your system, thereby avoiding the horrendous withdrawals that are induced when a drug like MS Contin is abruptly removed from your body. It's extremely unpleasant. I know because I just detoxed off methadone abruptly with no help whatsoever. I nearly went insane. But that's another story.

    Long term opiod therapy is not going to make an addict out of you, but it will give you a much better and more stable quality of life that is far better than being consumed by pain 24/7.

    Good luck.

     
    Old 09-03-2004, 07:44 AM   #8
    Kissa
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    Re: Pain management and Addiction

    Hello and welcome. Just a bit of advice, it's so much easier to read posts if you put them in small paragraphs as many of us tend to loose our spot while reading online

    Because a pharmacist said that MSC is worse than Loratab doesn't always mean that it is. Again, there is only a small percentage of individuals who become addicted.
    Yes you do go through horrible withdrawals, I just went through it last week. LA medications are more benficial for pain than those that are short acting.

    The time to worry about addiction is when you find yourself taking medications improperly for recreation, not pain control. It is always good to be aware of your medication routines because this can sometimes indicate a change needed in medications but doesn't mean addiction. If you feel you are becomming truly addicted and are abusing medications then it is wise to talk to your doctor. Until then I wouldn't spend time over worrying about it because you may end up undermedicating which is a problem.

    If you find you can not function in daily life due to pain it is acceptable to seek out PM treatment and not feel guilty about it. We all deserve some sort of quality in our lives and sometimes in order to do that we do require medications and other forms of pain management to do just that.

    Good luck
    Barbie

     
    Old 09-04-2004, 07:19 PM   #9
    lavendermoon
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    Question Re: Pain management and Addiction

    It seems as though we all have this issue in some shape or form. I've seen many posters use the term "breakthrough meds." What does this mean? Sorry I guess I really am outing myself as new. Thanks.

    LavenderMoon

     
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