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What is chronic pain?
Chronic pain is a progressive disease of
the nervous system, caused by failure of
the body’s internal pain control systems.
The disease is accompanied by changes
in the chemical and anatomical makeup
of the spinal cord. Chronic pain is a
malignancy, in the sense that when it
goes untreated, it increases in intensity
and spreads to areas that weren’t
previously affected, damaging the
sufferer’s health and functioning.
Why treat chronic pain with
opioids?
Opioids are substances naturally
produced within the body to regulate
pain. They are commonly known as
endorphins, and recognized as producing
the state of euphoria known as the
runner’s high. Chronic pain victims, who
can’t produce enough opioids on their
own, often benefit from supplementation
with pharmaceutical opioids.
What are the goals of treatment?
Lowering of pain levels.
Reducing suffering through restoration
of functioning in life activities, as close
to normal as possible.
Arresting and reversing the damage done
by chronic pain to the nervous system
and overall health of the patient.
Are opioids dangerous?
When taken as prescribed by your
doctor, opioids are among the safest
drugs available.
Will I get high, or lose control?
When opioids are taken on a regular
schedule, tolerance quickly develops,
and the psychological “high” goes away,
leaving the user feeling completely
normal. Long-term opioid users, as a
group, have driving records for accidents
and violations that are the same as
everyone else’s.
Will I hurt myself because I
don’t feel any pain?
No. Opioids improve functioning by
reducing pain levels. They don’t remove
all the pain, or the ability to perceive
new pain.
Will I become dependent?
You may. Dependence means that if
opioids are abruptly discontinued you
will have a physical withdrawal reaction,
similar to having the flu. This reaction
can be prevented by gradually tapering
off the medication. Dependence is a
physical phenomenon, not a sign of
addiction.
What if I had a previous
substance abuse problem?
This should not prevent a trial of
opioids. Studies at Harvard Medical
School and the University of
Washington indicate that a past history
of substance abuse has little or no
predictive value for failure of opioid
treatment. If you have current behavioral
or substance abuse problems, you may
appear to have trouble with opioid
treatment.
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What about those “Oxycontin
deaths” reported in the media?
Oxycontin, like other opioids, is safe for
patients who take their medicine as
prescribed. “Oxycontin deaths” occur in
habitual substance abusers, not patients,
and are usually the result of combining
the drug with overdoses of alcohol and
other drugs. These are deaths associated
with Oxycontin, not caused by it, and
they are not occurring in patients.
Will I have to take opioids for
the rest of my life?
Opioids can be discontinued whenever
they are no longer needed. Patients may
recover from chronic pain, and return to
active lives.
Will I get addicted, and how can
I tell if I am?
Addiction is defined by the American
Society of Addiction Medicine as
continued use in spite of harm.
Scientific research indicates that opioid
addiction in pain patients is rare. If
opioids make your life better by
controlling pain, you are a pain patient.
If they make your life worse, and you
continue to use them, you may be an
addict.
Will I have to take larger and
larger doses to control my pain?
For most patients, their dose remains
stable over long periods of time.
Are there any side effects?
Constipation, nausea, itching, insomnia,
and drowsiness commonly occur. All of
these side effects can be successfully
managed.
Will the medicine damage my
liver?
No. Opioids occur naturally in the body,
and are not harmful to any organ system.
They can be taken safely for a lifetime,
if necessary. Anti-inflammatory nonopioid
medications, on the other hand,
kill 16,500 patients each year through
bleeding from the stomach, and are toxic
to the liver and kidneys.
What is the correct dose?
The amount that allows optimal
functioning is the correct dose. There is
no upper limit to the dose of opioids that
can be safely used, when the medicine is
increased gradually.
Why won’t my doctor prescribe
enough medicine to control my
pain?
He is too scared. As part of the War on
Drugs, law enforcement is conducting a
witch-hunt against pain doctors who
prescribe opioids compassionately.
Most physicians won’t risk being
targeted by law enforcement, because
they have families to support. As a
result, chronic pain sufferers have
become non-combatant casualties in the
war on drugs.
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