I wrote this last year but it is still so relevant and I hope helpful! Part 2 tomorrow…
Pain, pain go away…..if only it were so easy. A new facebook friend is suffering terribly at the moment, whilst trying to do what the hospital requires for a spinal cord stimulator trial. Trying to offer some words of advice and encouragement has got me thinking and I thought I’d have a stab at talking about opiate use in chronic pain.
I don’t know what the policies of other pain centres are, but the consultants at St Thomas’ recognise that opiate substances – control drugs such as morphine, pethidine, tramadol, oxycodone etc – are not necessarily the right fit for every type of pain. The majority of what I am going to write is from personal experience – both in my other life as a palliative care nurse, and from now living with chronic pain. I’ll try not to become too medical and I may spread this over several posts as I really don’t want to bore you! I have done a little medical reading to ensure that I am giving you the latest thinking and for those with medical minds I will list some of the articles that I’ve read – although I wouldn’t necessarily recommend them, bedtime reading they ain’t!!
In cancer care and particularly palliative care, opiates have long been the gold standard for pain relief. Diamorphine, pure “medical” heroin, was the drug of choice when I started working in cancer care, but even then nerve or neuropathic pain was a nightmare for us to control. Try to visualise your nervous system as a circuit board whose main branch is the spinal cord, which is supplied with its impulses to & from a source that is your brain. The channels of the circuit are made up of building blocks, cells called neurons, which transmit the messages to & from the brain. The unknown quantity is: in the circuit that processes and transmits pain, which neurons are those providing the output that drives the pain network within the brain where chronic pain is present. Still with me? In chronic pain the firing activity of the neurons is changed, but it is still unknown quite how it is altered.
I have sat in some very complicated pain management sessions in my time when the descriptions of the different pain receptors almost went over my head. All you need to know is that the building blocks contain different receptors which convey different sensations and so respond to different drugs. Think of a lock and a key – a particular key (the drug) is needed to open a lock (the pain receptor). When opiate drugs are used for pain control, the receptor that responds to morphine etc is Mu, but there is now known to be an optimum time period for use of these drugs – probably about 3 months. After a while the opiates cause the down regulation of the Mu receptors, which means that fewer receptors need more opiate molecules to get the same feeling of relief. Eventually the loss of these receptors means that our bodies cannot regulate the feeling of pain so well – and produces what the medics call “hyperalgesia”. When your consultant tells you that the opiates may be increasing your pain rather than reducing it, this is what he is talking about!
But where does this leave me, the person with the chronic pain? To be continued….
“Personalised Medicine & Opioid Analgesic Prescribing for Chronic Pain: Opportunities and challenges” Stephen Bruehl et al, The Journal of Pain, Feb 2013, Vol 14
“Increased Pain Sensitivityin Chronic Pain Subjects on Opioid therapy….” Yi Zhang et al, American Academy of Pain Medicine, 2015, Oxford University Press
“Narcotic Drugs for treatment of Chronic Pain: a double edged sword” Peter Ullrich, Spine-health.com, 2012
“How Pain killers sometimes increase Chronic Pain” Stepahnie Burke, Spine-health.com, 2013
Think this is enough……I apologise if this is too medical, the next part won’t be!
PainPalsBlog 
Thanks for reposting this and I hope you will continue writing. I’ve had chronic pain for 5 years now and I just stopped using opiates to control it in September of last year. I’m very glad that I did. I still have pain and I use cannabis and kratom for pain control. Neither of these eliminate my pain as opiates once did but they do offer some relief. While I was taking the opiates, for about 3-4 years daily, as prescribed, I felt that I needed them to function. There were many times when this was true, especially in the beginning of my illness when I would get severe migraines where I could not move, speak or do anything else because it felt as if my brain was on fire. There isn’t anyway to use opiates on a chronic basis and not get addicted. Not addicted like a junkie in the streets needs their next fix. It’s much more subtle. I had to make sure I always had a doctor who would fill my prescription ( not always easy). I suffered shame and humiliation at doctors offices and pharmacies related to my prescriptions. Even though I took them as prescribed, I knew they owned me. And I wanted as little to do with the Western medical system as possible as I had not been helped by it with my illness, and in many ways I was further harmed with surgeries and medications that made me worse instead of better. One of the problems with chronic use of opiates is that they mask pain. When your pain is masked you can push your body into doing more than what is healthy. I’ve found that chronic pain by its very nature must be accepted and worked with before it can be released. Opiates mask the pain and other symptoms as well leaving a person disconnected from their bodies. It’s like cutting your head off of your body, the opposite of what needs to happen for healing to occur. Thanks again for your post.
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Thank you and will reply in full later today C x
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Very well done. I totally understand the opioid issues. During my five year long addiction, I totally became a different person. I am actually going to be doing an episode on my Addictions podcast about how these types of drugs change people. Thanks again for this. I will be following you.
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Thank you for reading and commenting! I have just posted the second part and think that more is probably needed! Great to connect and follow each other – I will definitely spread your podcasts C x
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I am so wary of the over prescribing of opiates. I have a very high pain threshold but after the birth of my fifth child I had herniated discs that caused me such severe pain and would not allow me to sit. I had to stand or lay on my side. The pain was worse than anything. If I sat down in a car or at a restaurant I could not straighten up. I could not get on the floor and play with my kids. I was nursing my son. the docs kept writing me scripts for percocet which I refused. I can look back at my despair in my FB posts from that time and they are painful to even read. I did take them a few times when nothing else worked and I was lucky because at the same time I purchases a back therapy machine that helped immensely and I only took the meds a handful of times. I have seen the dark side, I have seen the docs pushing these meds and people getting hooked after surgeries, accidents and injuries. I have seen how they wreck lives, I have seen how quickly they change the brain chemistry and make people think they need them for life and that was never the intent. I have seem friends of mine lose their children and it all started with a doctor’s script. They are a slippery slope and we have to come up with other ways rather than reaching for a prescription pad. The links between meds like Benzos and alzheimer’s is scary and we are seeing more and more cases of early onset alzheimer’s. Big pharma is not about cures it is about creating customers. We need to find a better way.
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Hi Carolyn – I agree 100 percent. On the bad days it can be so tough and it feels like there is no other way, and as you say often the doctors start them when a patient arrives in acute pain. But then it might become chronic and it is so hard to feel or understand if the drug is really helping or actually might be making things worse. I know that I would struggle to cope now without the spinal cor stimulator implant, and on some days I do have to take extras for the EDS pain…..but as you say there must be a better and more consistent way to treat chronic pain, physically & mentally. Great to connect, Claire x
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Opiates were originally created for acute pain. They were never meant for long term use. Unfortunately the understanding, training, and etiology of chronic pain is complex. When it comes to women and chronic pain, health professionals are even more confused. Although men are more likely to be addicted women have a higher escalation of use of opioids (sets them up for accidents overdose). I could talk about it forever since it was my dissertation topic. Excellent work keeping a relevant topic open.
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Thanks for reading and for your great comment. Too many don’t understand that opiates may actually be exacerbating their pain – but with no medical knowledge patients have to trust professionals don’t they?! And as you say, there is confusion and sometimes I feel fear amongst fellow professionals – we certainly saw a difference in the prescribing of diamorphine here in the UK after Dr Shipman was exposed, impacting massively on the terminal patients I was caring for. Thanks again for connecting.
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