What’s the difference between being dependent on opioids and being addicted to them?
How can we still respect chronic pain patient’s rights to treatment, but deal with the opioid epidemic?
Aren’t they all just addicts who we should take the opioids away from them for their own good?
Is there really even such a thing as a “chronic pain” patient?
These are just a few of the many questions people have about this complex issue.
I had a giant schwannoma tumor (originates in nerve cells) removed from my spinal cord and sciatic nerves twenty years ago. (The tumor was between the size of a cantaloupe and soccer ball.). They thought I had endometriosis and I was in surgery for a hysterectomy when they found the tumor. They kind of freaked and called in an oncologist instead of a neurologist. I was left a mess inside due to the surgeon trying to scrape it all off key nerves.
When I awoke from the 10 hour surgery, I felt like I was being burned at the stake from the waist down, even with a morphine drip. 24/7 I was told that in all probability it would never get much better. That I’d be on a morphine drip for life; they signed me up for hospice care even though I wasn’t going to die. Oh, and, I’d never walk again.
I was only 39 and facing the rest of my life in this situation. Then, they tried a drug called Tegratol that’s meant for epilepsy, but has a side effect of helping with peripheral nerve pain. It miraculously reduced the pain enough that Oxycontin time release at 20 mg 3x a day … along with epidurals in my spine every other month and steroids in the in between months got the pain down to a level 6-8. In time, I switched gabapentin, but the opioids are still needed on top to get the pain to where I’m not screaming.
With the pain managed to where I didn’t want to die, I told them that I planned to find a way to walk again, and I began the fight to stand and then walk. A year later, I could walk short distances — like around my house and a classroom. (I use a wheel chair for longer distances.) Using PT bars and crutches and canes to support my weight have destroyed my wrists, so I have horrible arthritis in them. And, since I don’t walk like God planned anymore, I’ve developed horrible arthritis in my feet, knees and lower back over the years. All of which add to my pain load and make it more difficult to mentally manage.
When you have acute, chronic pain like I do, the opioids do not make you high or groggy. The medication just goes to pain receptors to reduce the pain.
I’m dependent on opioids, but I’m not addicted to them.
I have been on the same prescription for 15 years and never felt the desire for more. In fact, if I could get by with less, I would! One of the side effects of opioids is constipation, and I would dearly love to live without that issue. My doctor has in fact asked about trying a higher dose to reduce the growing arthritic pain, but so far, I’ve declined since I can still stand the level 6-8 pain and live my life.
Okay, ALL ^^^ of THAT ^^^ was to explain how ACUTE, chronic pain can happen, and that for many Americans it’s REAL. Without my opioid regimen, I’d be considering how to commit suicide within a week. That’s not an exaggeration, and I’m not sharing that for dramatic effect to make a point. I simply could not live with the torture level pain 24/7 that my condition causes. I’d hold out as long as I could to be able to hand off my responsibilities as best I could, say my goodbyes, and then, I’d hope God would understand and forgive me for letting go of a life filled with nothing but pain.
Good pain management has allowed me to not only live, but also:
- NOT be on disability
- Be a Middle School Teacher
- Adopt our son from a Romanian orphanage, be there to raise him and watch him grow into the wonderful young man he is (That’s my son in the picture above.)
- Rescue orphan wildlife — The raccoon in the picture is one of the fur babies we rescued, raised & released, this year. We did so with a number of squirrels and rabbits, too.
- Run a small ministry to care for the unsheltered homeless in our area
- Do GOTV for the Democratic Party
As a result of this good medical care with includes responsible use of opioids, I have a life that I think results in a number of positive contributions to my country, community, friends and family.
I am begging for — my life, all those I help, all those who love me, and all the many others like me — to not allow chronic pain patients’ rights to treatment to become outlawed in our efforts to end the opioid abuse that is indeed going on. The CDC estimates that as many as 20 million have “high-impact chronic pain” -- pain severe enough that it frequently limits life or work activities. Some percentage of those folks have “acute, high-impact, chronic pain” that makes life completely unbearable without pain management interventions that include opioid medications. Whatever the percentage is, I know that unfortunately I am not alone in this situation.
How could you help? Just stay aware. Please, stand up for people like me and remind legislators that there are people like me who responsibly use and need these medications to stay alive and make positive contributions. There are ways to retain the help people like me need while cutting down on irresponsible and predatory practices.
My Pain Specialist uses fairly simple procedures to ensure pain medications are being used properly in his practice like:
- Doing an exhaustive intake history and examination prior to taking patients on.
- Working with their patients to find a wholistic approach to minimize the amount of opiod medication needed.
- Prescribing the time release forms of the medications
- Requiring monthly, paper prescriptions
- Requiring periodic, unannounced urine tests to make sure we have the drugs in our systems and they aren’t being sold to anyone else
- Maintaining long-term, multi-year relationships with their patients, so they can try out new, non-opiod treatments to see if they can work
- Requiring patients to sign contracts to only use one physician for their pain medications, or be at risk for being unable to get any pain med prescriptions filled
These are the kinds of legal requirements already in place in many states.
I don’t understand why it would be difficult to track the kinds of prescribing, shipping and distribution patterns that go along with abuse situations?!? Enforce the laws on the books to detect and prosecute physicians and clinics that are so obviously simply in the business of making money off of dealing drugs. Get the available, effective medications to those who are addicted, so getting clean is not a painful, sickening, horrific deterrent to getting well.
Thank you for listening.
I hope this helped you understand why people like me, an acute, high-impact chronic pain patients, worry so get really terrified when legislators begin considering outlawing all use of opioids altogether as a solution to the opioid epidemic.