It's a long read but it is very informative
Opioid medications allow us to treat chronic pain as aggressively as we would any pathogen, but we must first overcome ingrained misconceptions about patients' motivations for seeking treatment and about the addictive properties of the drugs. With controlled use, the newer sustained-release formulations give real hope for safe and sustained pain relief.
Pain must be regarded as a disease... and the physician's first duty is action--heroic action--to fight disease.
--Benjamin Rush
Opioid medications were once withheld from suffering cancer patients because of fear of addiction, exaggerated concern about side effects, or, in some cases, doubt about the morality of treatment. Less than 50 years ago, some medical textbooks discussed the need for patients to experience pain and suffering at the end of life so that they would relate to the agony of Christ and prepare for redemption. Although few physicians still hold these views, many continue to imply that pain should be accepted without complaint, telling their patients that "after all, pain is not going to kill you."
There is growing evidence, however, that too much pain can cause damage and even death. When pain is controlled, medications for the underlying disease or disorder tend to work better. Opioid analgesia is one of the most prolife therapies that we have to offer patients with cancer pain, and there is no reason to think that patients with other diseases are any less deserving of relief or that their pain is any less amenable to treatment. Although there is currently no ideal analgesic for chronic pain, medications that act on ยต-opioid receptors are the closest thing that we have.
Lynn492009-01-22 06:10:42Lots of us are so wary about taking pain medication due to the addictive factor .Pain can cause depression especially chronic unrelenting pain , this is where opioid pain relief is needed. If it gives a better quality of life then I am all for itI use Vicodin now to help deal with the pain I have from avascular necrosis of the hip. In the past I have also used the duragesic patches to help control chronic pain due to reconstructive surgery on my leg.
My doctors monitored my pain levels and the amount of meds I used. I never abused the meds or became addicted to them. For me, it is all about being able to function and not have unrelenting, mindbending pain..............
More from the article:
Appropriate Use Versus Abuse
Nothing is intrinsically good or evil, but its manner of usage may make it so
--St. Thomas Aquinas
The fear of drug abuse and drug addiction is the major reason that physicians are reluctant to prescribe opioid medications for patients in severe pain. The inappropriate use of a medication for a nonmedicinal problem is drug abuse. Using a pain medication to get high or euphoric is clearly inappropriate, as is using drugs to escape family or other problems that should be dealt with by other means. If a patient's physical pain has prevented him or her from living life fully, using a medication that allows a return to normal activities cannot be called drug abuse.
The appropriate role of medicine is to prolong and maintain life, promote function, and provide comfort from symptoms of disease. It is up to the physician to determine whether the prescribed medications are being used to participate in life or to escape from it. The patient's mood and activities, and the reports of family members, can be helpful indicators. Health care facilities are beginning to use validated quality-of-life instruments that should make the assessment of appropriate and inappropriate use easier. Appropriate use of pain medications can significantly increase the quality of life; inappropriate use invariably decreases it.
"Opioid medications were once withheld from suffering cancer patients because of fear of addiction, exaggerated concern about side effects, or, in some cases, doubt about the morality of treatment. Less than 50 years ago, some medical textbooks discussed the need for patients to experience pain and suffering at the end of life so that they would relate to the agony of Christ and prepare for redemption. Although few physicians still hold these views, many continue to imply that pain should be accepted without complaint, telling their patients that "after all, pain is not going to kill you."
Oh so that is where they get that attitude. It was taught. You know a lot of people not just physicians feel that way in my experience. They assume you are drug seeking when you go in for pain. Many family members, friends of chronic pain sufferers feel that way too. To not complain, pain is normal just accept it. I avoid people who think like that. there are times this RA is so severe, I am limited on everything, standing, walking, functioning in general. There is just no way to "fake" wellness to keep them from feeling uncomfortable. Better to be around those who understand and will either sit quietly with you or not place unrealistic demands on you.
Shelly632009-01-22 07:14:45Pain is an interesting topic because it is subjective. I agree that no one should ever live in extreme pain. I also believe that other things affect pain, ie: social situations, depression, other medical conditions, etc. Addiction is a very real issue with dealing with narcotic pain medications. I think most dr's must walk a fine line when making sure their patients arent suffering and not making hem addicts, because it does happen, even with the best intentions.
I am lucky to have an orthopedic doc who used to work in pain management. He believes in managing pain. As long as I am careful to keep my narcotic consumption within his guidelines, he continues to prescribe it. (I take maybe 1 or 2 norcos a day, were I to regularly use 4 to 6 I think he might question it) He of course also sees that I am on NSAIDS DMARDS and cortisone injections, along with aprox 18 mos of PT. So he sees my efforts to manage my pain and improve my functioning.
I have to admit that I was initially worried about becoming dependent, but I'm not as concerned any more. I'd much rather feel healthy than high. That being said, there are days when taking my norco is not only the most humane thing I can do for myself, its the most most humane thing I can do for my family. IMO, I think docs need to be less concerned with addiction and more concerned with quality of life. [QUOTE=leila]I am lucky to have an orthopedic doc who used to work in pain management. He believes in managing pain. As long as I am careful to keep my narcotic consumption within his guidelines, he continues to prescribe it. (I take maybe 1 or 2 norcos a day, were I to regularly use 4 to 6 I think he might question it) He of course also sees that I am on NSAIDS DMARDS and cortisone injections, along with aprox 18 mos of PT. So he sees my efforts to manage my pain and improve my functioning.
I have to admit that I was initially worried about becoming dependent, but I'm not as concerned any more. I'd much rather feel healthy than high. That being said, there are days when taking my norco is not only the most humane thing I can do for myself, its the most most humane thing I can do for my family. IMO, I think docs need to be less concerned with addiction and more concerned with quality of life. [/QUOTE]
I'm glad that my RD understands the chronic pain involved with both RA and AVN. I'm also glad that he has no problem managing my pain and prescribing pain meds when needed...........
Having RA/PsA/OA and damage from all 3 has made me very aware of the need to properly control pain. Even with RA clinical remission I have 2 other active diseases that affect the joint and tendons and damage. I can go days without pain but on the days that I have it I want to be able to alleviate the pain and live my life as normally as possible. I lived 10 years with pain and I think that's enough. Lindy
I live on OPANA... recently theres been times, i've run out and been w/o for as long as 2 wks.. WOW.. i never knew how much that helped me..
I like my vicodin and valium.. I try and be careful, but I hate pain and addiction.. honestly lol, thats the least of my worries!!.. if theres anyone still not getting all the relief you need from vicodin (plus the bitchyness, lol) Opana is a really great med.
I see no reason to be a martyr about pain, right now, thankfully, i'm going thru a decent spell.. crossing fingers, it stays this way... but as we all know, ya never know when its going to come and really kick ass. I'm always in pain, its just that after 4 yrs, i have an acceptable level and then the screaming one.. lol.
Meds.. yes! [QUOTE=LinB]Having RA/PsA/OA and damage from all 3 has made me very aware of the need to properly control pain. Even with RA clinical remission I have 2 other active diseases that affect the joint and tendons and damage. I can go days without pain but on the days that I have it I want to be able to alleviate the pain and live my life as normally as possible. I lived 10 years with pain and I think that's enough. Lindy [/QUOTE]
Sorry to hear about your computer Wolf, that sucks... Thanks for the info. Though to be honest, I'll worry about withdrawal when I get there. Baby steps...You know, it wonderful to have this theoretical conversation about narcotic pain killers and what they can do for your quality of life. But I guess the real test is how do you feel late friday afternoon, when your doc hasn't called in your hydrocodone rx, and the mtx isn't yet working for you, and you are facing a weekend of joints that feel like they are being disolved and no pain meds.
Panicky....
[QUOTE=leila]You know, it wonderful to have this theoretical conversation about narcotic pain killers and what they can do for your quality of life. But I guess the real test is how do you feel late friday afternoon, when your doc hasn't called in your hydrocodone rx, and the mtx isn't yet working for you, and you are facing a weekend of joints that feel like they are being disolved and no pain meds.
Panicky....[/QUOTE]
I feel the same way if my metoprolol script didn't get called in
Well, my doctor's office is now closed and my pharmacy auto-refill-checker-thingy says my refill has yet to be processed. Which either means that my doctor did not fax back the refill request or the pharmacy hasn't gotten to it yet. I can't call and check tonight because I've already called 2x and they are going to start thinking I'm a junky. I guess I'll just casually lurch in there tomorrow... and try not to look too desperate.
Serves me right for waiting till I was a the bottom of the jar.
This may be a very looooong weekend.if it is a drug i take all the time sometimes my pharmacy will give me say like 7 pills to tide me over until my prescription is called in. I live with chronic daily pain. I have back problems that led to a spinal fusion a year ago, this led to permament nerve damage in my leg and also failed back surgery syndrome. On top of this I am now being evulated for RA. I hurt all over, I think most of my joints hurt, and have for awhile now. I had xrays done of my hands and wrists at the rhemy office and she said they are not normal and highly suspicious of RA but I have to do MRI's of the wrist and hand. Little did I know that it was 40 mins each test each side! Last week I made it through one side, I was on the table almost an hour and a half. I was in such pain when it was over I was in tears.
I take avinza (morphine sulfate) once daily and roxicodone for breakthrough pain. This regimen seems to be helping. I also have recently been given voltaren and predlisone. I firmly believe if the patient is responsible and needs pain medication they have every right to them. Its the people that don't use the responbily that make it difficult for everyone else. If use correctly the potential for addiction is very slim, there is a difference between addiction and tolerance.
Lori
I am bumping this topic first because of my own experience with incapacity pain and secondly to provide the information for our new members.
Thanks for bumping this Shug, it is a discussion we should continue to discuss and discuss with our physicians. There are many good choices for pain meds that can help in living life to the fullest when dealing with chronic pain.
If a patient's physical pain has
prevented him or her from living life fully, using a medication that
allows a return to normal activities cannot be called drug abuse.
My Ms. Pcp should have a copy of this...
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