An article on narcotic pain medication

[raggedyann1]

Hello all,

We have had several threads lately on Pain Medication which includes Narcotic or Opioid meds. Sometimes it is our doctors who are un-informed, or our family and friends, and quite often we the patient. I certainly fell in that group till a good friend here that knows more about pain meds than most, convinced me to take my pain meds at the start of the pain and not to worry so much about addiction.

Since my most disabling symptom/problem is horrendous pain I have spent quite a bit of time these past few months researching and finding good sites to help me understand what is and what is not true in pain management.


http://www.ampainsoc.org/pub/bulletin/mar99/president.htm

[Anisah]

Thanks Karen,

I found the article very interesting, especially since its not that long ago that I started taking morphine and using a pain patch. Thanks for sharing.

take care,
Anisah
:flowers:

[alobreto]

Thank you, Karen, for this link. Very informative.
Angela :)

[Clare.T]

That's extremely useful Karen, thank you. I have pinned it.

Clare

[raggedyann1]

Here is another article that specifically lists lupus as being in the chronic pain catergory.

Chronic Pain Fact Sheet
by Marcia E. Bedard, PhD

In past months, a growing amount of media attention has been given to the unspeakable suffering of millions of Americans with incurable conditions causing severe chronic pain. In addition to articles in the popular press and segments on network television, the Internet is an increasingly rich source of information on this topic. Yet the agonizing pain of millions of chronic pain patients remains untreated. This is largely because the nation's War on Drugs has created a climate of fear among patients and health professionals alike ? fear of using strong opioid medications which are often the only way to relieve severe pain when all other treatments have failed.

This fact sheet is intended to debunk some of the myths that fuel this unreasonable fear, and is being sent to legislators, patients, and health professionals throughout the nation. It will also enable members of the press to have quick access to credible facts about chronic pain. Although this fact sheet shows the devastating effects on physical and mental health when severe pain goes untreated, as well as the profound impact on the economy, there is no way to measure the "bankruptcies of the heart" that invariably accompany this condition. Yet the steady erosion of the quality of life for millions of pain patients and their families ? as they struggle with divorce, poverty, homelessness, despair, and often suicide ? is the real tragedy here.


FACT SHEET ON
CHRONIC NONMALIGNANT PAIN (CNP)

? CNP, pain that lasts six months or more and does not respond well to conventional medical treatment, affects more people than any other type of pain. Thirty-four million Americans suffer from chronic pain, and most are significantly disabled by it, sometimes permanently. (1, 2, 15)

? The economic impact of CNP is staggering. Back pain, migraines, and arthritis alone account for medical costs of $40 billion annually, and pain is the cause of 25% of all sick days taken yearly. The annual total cost of pain from all causes is estimated to be more than $100 billion. (2, 4, 15)

? Despite the magnitude of suffering, CNP remains grossly undertreated in most patients. The reasons for this are: the low priority of pain relief in our health care system; lack of knowledge among both health professionals and consumers about pain management; exaggerated fears of opioid side effects and addiction; and health professionals' fear of medical board and DEA scrutiny, even when controlled substances are used appropriately for pain relief. (2, 13, 14, 15)

? Contrary to common fears, numerous studies have shown addiction is extremely rare in pain patients taking opioid drugs, even in patients with histories of drug abuse and/or addiction. CNP patients will develop a physical dependence on opioid drugs, but this is not the same thing as addiction, which is an aberrant psychological state. (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 13, 14)

? Unrelieved pain has many negative health consequences including, but not limited to: increased stress, metabolic rate, blood clotting and water retention; delayed healing; hormonal imbalances; impaired immune system and gastrointestinal functioning; decreased mobility; problems with appetite and sleep, and needless suffering. CNP also causes many psychological problems, such as feelings of low self-esteem, powerlessness, hopelessness, and depression. (12, 15, 16, 18, 19)

? Undertreatment of CNP often results in suicide. In a recent survey, 50% of CNP patients had inadequate pain relief and had considered suicide to escape the unrelenting agony of their pain. Unrelieved pain also leads to requests for physician-assisted suicide, another indicator of pain's harsh impact on the quality of life of many patients and their families. (7, 8, 13, 14, 15, 16)
? Discrimination against CNP patients is pervasive in the American health care system. Women, racial/ethnic minorities, children, the elderly, worker's compensation patients, and previously disabled patients (e.g., those with cerebral palsy, or who are deaf, blind, amputees, survivors of childhood polio, etc.) are at great risk for undertreatment of their pain, even though patients belonging to one or more of these groups are the vast majority of all CNP patients. (2, 13, 17)

? CNP patients with severe, unrelenting pain from permanent structural damage to the neurologic or musculo-skeletal systems are often subjected to expensive and unnecessary surgeries and other painful invasive procedures. Arachnoiditis and reflex sympathetic dystrophy are the most common causes of severe CNP. Other common causes include: post-trauma, adhesions, systemic lupus, headaches, degenerative arthritis, fibromyalgia, and neuropathies. (8, 15, 18, 19)


Source documents:

1. American Chronic Pain Association. "Coping with Chronic Pain." 1995.
2. Brownlee, Shannon, and Joannie M. Schrof. "The Quality of Mercy." U.S. News and World Report, March 17, 1997: 55-57, 60-62, 65, 67.
3. Pasero, Christine L., R.N., B.S.N., and Margo McCaffery, R.N., M.S., F.A.A.N. "Pain Control." American Journal of Nursing. Vol. 97, No. 6., June, 1997: 20-21.
4. American Academy of Pain Medicine and American Pain Society. "The Use of Opioids for the Treatment of Chronic Pain." Clinical Journal of Pain, Vol. 13, March, 1997: 6-8.
5. Medina J.L., M.D., and S. Diamond, M.D. "Drug Dependency in Patients with Chronic Headache." Headache, 1977, Vol. 17: 12-14.
6. Porter J., M.D. and H. Jick, M.D. "Addiction Rare in Patients Treated with Narcotics." New England Journal of Medicine 1980, Vol. 302: 123.
7. Hitchcock, Laura S., Ph.D., et al. "The Experience of Chronic Nonmalignant Pain." Journal of Pain and Symptom Management, Vol. 9, No. 5, July 1994: 312-318.
8. Tennant, Forest, M.D., Dr. P.H., and Harvey Rose, M.D. "Guidelines for Opioid Treatment of Stage III Intractable Pain." California Task Force on Opined Treatment of Stage III Intractable Pain. January 1, 1997. Research Center for Dependency Disorders and Chronic Pain Community Health Projects Medical Group, West Covina, CA
9. Zenz, Michael M.D., et al. "Long-Term Oral Opioid Therapy in Patients With Chronic Nonmalignant Pain," Journal of Pain and Symptom Management, Vol. 7, No. 2, February 1992: 69-77.
10. Friedman, David P., Ph.D. "Perspectives on the Medical Use of Drugs of Abuse." Journal of Pain and Symptom Management, Vol. 5, No. 1 (Suppl.) February 1990: S2-S5.
11. Portenoy, Russell K., M.D. "Chronic Opioid Therapy in Nonmalignant Pain." Journal of Pain and Symptom Management, Vol. 5, No. 1 (Suppl) February 1990: S46-S62.
12. Dellasega and Keiser. "Pharmacologic Approaches to Chronic Pain in the Adult." Nurse Practitioner. Vol. 22, No. 5, May 1997: 20-25.
13. Medical Board of California. "Prescribing for Pain Management." May 6, 1996.
14. California Board of Pharmacy. "Health Notes: Pain Management." 1996.
15. Canine, Craig. "Pain, Profit, and Sweet Relief." Worth. March, 1997: 79-82, 151-157.
16. Liebeskind, J.C. "Pain Can Kill." Pain, Vol. 44, No. 1, January 1991: 3-4.
17. Morse, T.B. "America's War on the Disabled." Albuquerque, NM: 60's Press.
18. National Institute of Arthritis and Musculoskeletal and Skin Diseases. "Scientific Workshop Summary: The Neuroscience and Endocrinology of Fibromyalgia." July 1996. Bethesda, MD.
19. Davis, Nadyne, et al. (eds.). "Third Annual Fibromyalgia Research Conference." February 1994. Inland Northwest Fibromyalgia Association. Spokane, WA 99206


Marcia E. Bedard, PhD, is a professor emeritus for California State University, Fresno, CA. Printed with permission of the author.

[confused1]

Dear Karen,

Thank you,

Sunny

[alobreto]

Thank you, again, Karen! ;)

You find some great things for us to read and pass along!
Angela :flowers:

[halfpintfl]

style_emoticons/<#EMO_DIR#>/wavey.gif Hi Raggedy, Thanks for the info, it will be very useful, since I have been taking

methadone, with not too great of results.

Very interesting. style_emoticons/<#EMO_DIR#>/cool.gif

[paulie]

style_emoticons/<#EMO_DIR#>/Thanx.gif Karen for sharing the great links.
Very informative. This forum / lupus site/
chat has done a lot for me because of it's
well informed members,I find what I need
to read, but not the time to research for myself.

paulie style_emoticons/<#EMO_DIR#>/biggrin.gif style_emoticons/<#EMO_DIR#>/flowers.gif

[goats]

Thankyou Karen for reffering me back to this thread. it is very important information and helped me to make my decission,and after taking the meds .I feel much less pain
and had a very productive day and good sleep

[frilly6]

<span style="font-size:14pt;line-height:100%"><span style="color:#CC33CC">

Thank You Karen, it is good that this is confirmed. I have had so any Drs trying to take my morphine away and some lovely nurses who keep telling me that you do ot have to suffer pain and it does not make Heroes

hugs

frilly</span></span>

[lilikeke]

style_emoticons/<#EMO_DIR#>/Thanx.gif Both of those articles were very helpful especially since I take Vicodin and every couple months I have to switch to a stronger dose. I wont be afraid of getting addicted to it any more because I am using it for a very good reason. Chronic pain. I used to think it was in my head but now I know I am justified in taking pain meds. style_emoticons/<#EMO_DIR#>/smile.gif

[Clare.T]

I thought it was worth bumping this because there have been a number of posts recently mentioning addiction concerns either people's own or their doctors' being reluctant to deal adequately with pain.

Pain relief is of major importance in lupus treatment these days because it can ruin quality of life. It also has bad physical effects such as raising blood pressure.

Clare

[Firdous7]

I was wondering if anyone has had any luck with pain killers while on steroids. You know for the side effects.

[Firdous7]

I thought it was worth bumping this because there have been a number of posts recently mentioning addiction concerns either people's own or their doctors' being reluctant to deal adequately with pain.

Pain relief is of major importance in lupus treatment these days because it can ruin quality of life. It also has bad physical effects such as raising blood pressure.

Clare

Sometimes the cure is worse than the disease.

[Lily]

Hi Firdous7 and welcome,

You might get more answers if you post this question in a new thread, if you want I can move it for you so you can start your own thread.

Do you mean that Prednisone is giving you side effects of pain? Sorry I'm not sure I understood your question.

Prednisone should not be resulting in pain unless you are weaning down off it? Do you have Fibromyalgia as well, changes in Prednisone doses dont sit well with people with Fibro, they get a LOT of problems with pain when doses are changed.

I'm not sure I understand your second comment either?

Let me know if I can help.

love
Lily

[MichelleAnn]

I am not sure how I would survivie without my percocet....When I need them it is usually later in the day or evening....my legs throb in pain, my knees, etc...nothing I do can take it away and advil does not touch it....I cry, or I go into a panting mode...my blood pressure goes shy high....I try to block it out with breathing like when in labor....the percocet takes the edge off....makes it capable for me to be human again...not bite heads off, able to perform simple tasks....and be more myself....if that is addiction, then yes I am addicted....but without it, I would probably be in the mental hospital, no way could I tolerate that severe pain all the time....I dont need the percocet daily....but when I do, I NEED THEM....I only take one at a time if it is not better I take another in an hour....I tried oxycontin, that made me too zoned out....I hated the effects and it lasted for 12 hours so I could not shake the fatigue if I wanted too....at least the percocet is out of my system in about 4 hours and if I have to be a mom, go to a soccer game, I can plan my day around the meds some...Neurontin did not help me either....but I know it helps many people....I fear the day the doctor takes my percocet away....and I am sure sooner or later, some rules will apply, they do for all the other meds anymore.....Percocet is my best friend when I am in pain...but I never take more than one at a time and more than 2 in 6-8 hours...I take advil with the percocet when pain is severe....I am addicted I guess, becuase it seems that is the only think that helps my pain.

[dawa_lister]

thanks alot for the info,i myself have been fighting for pain control,my doc like so many others are scared i think to pricribe narcotic pain medacin, he wants to control my pain he has been giving me loratab but that is it:rotfl:. If I had a dollar every time i heard from a doc that lupus isn't painful,i'd be a rich woman.:rotfl:

[MichelleAnn]

I go to Pain Clinic....a trained doctor usually an anesthesiaoligist (sorry for spelling) is the type of doctor then he has extra training that deals with pain....I do not just take pain meds from my regular doctor. He expained to me about addiction also becuase I asked him, I was worried....The doctor said a person in pain who takes the medicines and needs the medicines is never addicted....they are dependant on the meds to control the pain...an addict is one who takes the meds and does not need them and abuses them....He said it is ok to be dependant on pain meds if it gives you better quality of life or can give you "life" all together....it is no different than needing heart pills or other meds...you depend on them to give you quality of life whether it helps the pain or the organ, whatever.....there will always be abusers of all medicines, basically everything in life, some abuse it...I get 100 percocet a month, and many times the prescription will last me 2+ months.
Ask to see a Pain Specialist.....they usually start out with Neurontin, it seems to help most people with nerve pain alot with MS take it. Some doctors do nerve steroid shots, epidutrals, I had a few of them done, the first one is the worst, after that, it is nothing if your doctor is good. I always got slightly sedated for it so I did not move......PAIN~ makes me whiney, and bite my kids heads off, depressed, sad, angry, numb.......makes me want to give up on myself.

[ALWIN]

Thank you for your post.

I am going to fight hard for a change of analgesia today. Have waited 6.5 months for my appointment & am terrifed I won't be able to assert myself. Feel galvanised as a result of reading these postings.

Am prescribed Brufen and Co-codamol. Still in pain and becoming a bit aggressive. Hope to goodness I am listened to.

Thanks again

ALWIN:wink2:

[Clare.T]

Good for you Alwin

I am glad you feel empowered. We often have to be very determined and very assertive especially in health care systems like the NHS.

I didn't mention in my reponse to your Intro post that you are entitled to the maximum possible pain relief, but it would be wise not to expect total relief.
People who live in chronic pain also develop various strategies for dealing with what can't be eliminated.

It is also important to have a good idea what's causing the pain so as to have the best way of relieving it.

I had a major interruption while writing this so maybe you won't see it before your appointment

I hope it goes well
Cheers
Clare

[belladonna]

Good to know that these things are being looked at seriously by the medical community at last. It's a crying shame that being pain free is just a dream for so many.
:worried:

[KarolH]

I am new here, stumbled on this article and want to say Thank You.

I am in pretty bad chronic pain every day of my life so this is a great article for me, and others.

Thank you for posting this.;););)