The Pain Game (for real)

When thinking about writing this post, the title was already in my mind, because of the content.

But I thought, this title is too obvious and catchy.  There must be a book by that title…something S&M related, surely…So I Googled it, and found, not a book, but a stupid reality show.  In Dutch.  There are probably English versions, but this one was in Dutch.

What I want to talk about, is, in effect, sadistic.  It causes a LOT of pain, and down the road it will cause even more.

It seems that from 1999 to the present, there has been a four-fold increase in the number of deaths due to overdose on prescription opioid pain pills.  This includes unintentional and intentional overdose on medicines were either prescribed for the person who died, or were obtained in other ways such as borrowing or stealing from someone else, or buying on the black market, or buying in other countries where some forms of opioids are legal over the counter.

These numbers are certainly shocking, and no one denies that the epidemic of fatalities needs to stop.

Now jump cut to my last visit with my spine doctor, a physiatrist, who, although I have seen her many times, has never laid a hand on me.  She did look at my MRI report, though, so she knows I have spinal stenosis.  I have bony growths in my spine that are squishing the nerves and my spinal cord itself, causing pain and clumsiness.

I did not share my psychiatric diagnosed with her, not wanting to muddy the waters (“somaticizing,” would then be the diagnosis, or perhaps “malingering”).

I went to her with the idea that I might get a new spinal pain control modality, which is a pump device much like an insulin pump for diabetics, only this one uses a tiny catheter that goes into the spinal canal and has an external pump that delivers an eensy-weensy continuous dose of morphine directly into the spinal canal, where it blocks the pain signals without causing any brain symptoms like grogginess, dizziness, addiction, etc.

Oooooh no!  She was adamant that she wasn’t going to prescribe morphine for anybody!  Instead she insisted that I get a steroid injection into my neck, with a not-insignificant risk of ending up a quadriplegic.  When that didn’t work, she prescribed a pill that made me so dizzy and uncoordinated that I fell down a flight of stairs, injuring my back and causing such a jolt to my neck that I literally wanted to cut my head off from the pain.

I had to beg for some Tramadol, which at that time wasn’t even a scheduled drug.  She grudgingly gave me thirty tablets, and warned me not to ask for refills.

Now jump cut to Laura the doctor.

I compulsively haunt the physicians-only version of Medscape.  I learn all kinds of interesting things.  Plus, I do maintain my medical license, in the vain hope that one day I will be healthy enough to return to medical practice (no danger of that), so I keep up on my continuing education hours.

One day an article caught my eye:

“Heroin use up 10,000%!  (OK, only 400%.)  Many users are pain patients cut off from their pain meds based on addiction and overdose fears!  Prescription pain meds gateway drugs to heroin!

Huh?

People with chronic pain are being denied their pain meds because their doctors are:

1.  Afraid of being disciplined by their state medical boards, which have established Macchiavellian standards for how many opioid scripts any one doctor can write;

2.  Afraid of getting sued if someone does die;

3.  Genuinely convinced that treating genuine pain with opioids is dangerous.

So….

It happens that there is a large, cheap, and easily obtained supply of heroin in the United States at this time.  My son tells me it’s all the rage with the high school crowd.  That’s a scary thought.

But people who are in genuine chronic pain, who are either refused or cut off from prescription pain medication, will naturally seek relief where they can.  And if they can buy relief from the neighborhood heroin supplier, well, that is one way to relieve their pain.

Of course heroin has its downsides (irony font here).  I don’t have to list them; you know what they are.

For me, this is insult piled upon injury.  First they take away the pain meds, in knee-jerk fashion.  Then, when people desperate to get out of pain turn to heroin for relief, they shout, See, we told you!  Prescription pain meds are a gateway drug to heroin abuse!

Can someone please tell me how people with minimum eleven years of post-high school education cannot identify flawed logic when it’s biting them in the arse?

I’m grumpy as hell (if you haven’t yet noticed :-D) because my nerve pain is radiating all the way into my hand, and the Crohn’s Disease that was found on biopsy but isn’t “bad enough” to treat is acting up, and I do have a small stash of pain meds, but I’m saving them in case I fall when I’m out in the wilderness and break a bone.  That has happened to me twice already, and I’ve been glad to have the meds since the places I haunt don’t get cell reception, and it’s nice to have a little relief while trekking to the nearest hospital–that is, if it’s something I can’t splint up myself.  A bad habit, I know, but you can’t take the doctor out of the doctor….I can just hear my therapist saying, “What was that you just said about logic?”  Yeah, yeah.  I know.  And these are decisions I make on my own behalf.  I don’t penalize an entire population of people who need relief from pain.

Next edition:  Why are so many people hurting?  And why are so many people hurting so much that they’re dying?

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42 Comments

  1. I had no idea that people are turning to heroin when they are denied their pain meds! For doctors to leave patients in so much pain that they have no alternative but to take a dangerous illegal drug is malpractice, in my opinion. It is similar to doctors who will not prescribe morphine to terminal cancer patients “because they might get addicted.” I understand that some of these doctors sincerely think they are doing the right thing — and others are just trying to cover their a** — but that means they need to be better educated about the reality of what they are causing.
    Is there anything we can do to change this?

    Reply
    • I think the best thing we can do is to make LOTS of noise about it. Educated consumers do not need to be duped into accepting backwards logic. Sure, there are people who get addicted to hydrocodone or whatever, and many of them have legitimate pain. So, to withdraw their medication and then expect them to go without any treatment at all is purely punitive. I think it’s going to take a lot of discussion and a lot of airing in the media for this whole thorny tangled mess to get sorted out.

      Reply
      • I agree, education and media exposure are key. When I googled this issue, I came across an organization called Common Sense for Drug Policy. I’m going to check them out.

        Reply
  2. Laura, that’s scary! Hadn’t heard heroine was replacing pain meds in the US. Know medical marijuana is being used for pain & PTSD. Studies on PTSD in vets going on now. What’s your experience with marijuana for pain? Healing thoughts for you. Chryssa (aka Christine)

    Reply
    • Hi Chryssa! My own experience with mj is that it takes a while to kick in. I suspect that’s because the pain modulating chemicals are the CBDs, not the THC. If this is Greek to you let me know and I’ll explain it better. Since I don’t like the “high” of mj, I look for strains that are very low THC, high CBD. I find that strains of that sort really help alleviate the spasms in my neck, arm, and leg, and also help the spasms from the Crohn’s. My favorite strain for this is Master Kush, which I grow myself, since I can be sure it’s completely organic, and that it listens to pure vibrational music, and of course I talk to it and send it lots of love. I only use a tiny bit before bed, and that way I only wake up in pain 10 times instead of 50! It does help get rid of the nightmares, too. What are your thoughts about it?

      Reply
  3. I have constant spinal pain after breaking my spine twice. The thing is, adequate pain relief doesn’t turn you into an addict; it means that you can function at a level that others do. It is a very necessary thing!

    Reply
  4. I had an odd episode with nasty, debilitating pain in my jaw after my mother passed. It stuck around for 8 months. I saw every specialist available to no avail. The strongest pain killers couldn’t stop the pain. I did have a low dose of tranxene (anxiety med) at the time and (mistake or not) took a stronger dose one day. Pain gone. Got Dr. to prescribe a dose 4x stronger than my regular dose. Cured! I’m no doctor, but I know myself. I am lucky my Dr. is pretty reasonable when I want something.
    I hope she is marijuana friendly. I would ditch my other meds as they wouldn’t be necessary. I think my state is on the way to legalized, the state is so far in the red, they need the tax revenue!

    Reply
    • I really like your comment about knowing yourself. No one can see inside me or feel what I feel, so they should stop pretending that they do. I hate being treated as if the doctor knows more about me than I know about myself!

      Reply
      • I like to ask people, What do YOU think is wrong? Sometimes they get mad and say, Well you’re the doctor, YOU tell ME! In which case I know that this match is not made in Heaven and we should probably find them a different doc who is a better fit. I want people to be partners in healing. Yes, I do have several special skill sets. But you know how you feel, and only you can give me the information and feedback about the ongoing healing process. My job is to take the information you tell me, and that I collect from you in other ways, and together with you, form a plan for working towards wellness. I myself am totally disgusted with the direction that medicine has gone. I’d rather go to the mechanic and get put on a machine that diagnoses everything, then fixes it, than go to ten different specialists, none of whom communicate with each other. I end up feeling like a tin can full of nuts and bolts and screws, all rattling around making noise, and who knows which is which!

        Reply
    • Hmmm. I like to think our pain is trying to tell us something. Like, my spine pain has always flared up when I have no support. That’s what a spine is supposed to do, right? Support you. So what I’m hearing from you (and please correct me if I’m wrong) is that your jaw pain began after your mother passed. So that leads me to wonder–at what point did you have to keep your mouth shut? While she was alive, or after she passed, or anytime in between? Childhood? You don’t have to answer this, just tossing this ball up in the air. I’ve known some people whose entire lives were dedicated to keeping their mouth shut. Then their parent dies, suddenly they don’t have to clamp their jaw anymore…But their jaw doesn’t know what to do with its newfound freedom, so it goes haywire…eventually it adjusts to being able to express itself, and feels much better.

      Reply
      • I have no issue answering…
        I had a wistful childhood and no parent issues.
        I could have been blaming myself and shouldn’t have been… ie could I have gotten there in time to do cpr? Sure. I agree pain is a reaction, maybe not just as specific as you’re getting.
        It was the oddest thing. 9 doctors including a couple of head ones, DDS, couldn’t make anything of it. I can’t possibly be the first one this had happened to. However, is gone now. Hopefully never to return.

        Reply
        • I’m rooting for you, but not root canal…just, let’s say, peony roots. Asparagus roots. Root beer! (silly font) I’d rather have root beer than a root canal, any day. One time some dentist shot me up with the Novocaine and hit an artery instead of the nerve, which caused my jaw muscles to go into spasm, and his finger was in my mouth….needless to say, we both screamed…But my mouth wouldn’t open for a long time…I think he had to get rabies shots after that :-p

          Reply
    • Hi Ilex, somehow my reply to you ended up in the wrong spot in the line. It’s underneath Anita’s reply to my reply.

      Reply
  5. Hi Liebe,
    A doctor friend of mine disclosed that he never met a patient who didn’t know what was wrong with them and how he/she needed to be treated.

    That said, we know that doctor’s work with statistics. It’s just my feeling that he/she makes an assessment whether consciously or unconsciously decides whether the patient sitting in front of him is the average.

    And if that patient asks for pain medication he’ll get it. And keep getting it until he asks for a pump and will not get off it.

    It is the rare case, where a patient with severe neural damage recovers, but there is the 1 or 2% that do attain recovery. I suffered nerve sensitivity-lost feeling in half my face after pressure during dental surgery, but it all came back after four months. I did a lot of inverted Yoga postures on my own that brought blood to my face. It was very uncomfortable loosing sensation to say the least. Admittedly, this was not spinal injury. Pain medication just isn’t in my vocabulary, (with the exception of a brief time after breast cancer and wrist surgery). This must sound to you that I am patting myself on the back.

    I have been in Yoga classes where the instructors have been in auto accidents and have been told that they will never walk again. And then a few years later they are master yoga teachers helping students get their lives back. What do I think? I think you get the idea…..

    I don’t have any answers for chronic pain except to keep moving, swimming if possible. You can perhaps find a public pool. God made hills apart of this earth and man-made built stairs to climb tough terrain, go find one or the other and run up it.

    Over the years I have observed that sugar and salt in my diet precipitate almost instantaneous responses of swelling in the extremities. It’s not severe, but I feel it after one meal containing processed foods. Watch your intake.

    With affection,
    Ida

    Reply
    • First I would like to say congratulations on beating cancer. That is huge.

      Next, I will say that I might be all wrong about this, and in that case I apologize. I feel that for a person who “works in the mental health field” to devalue another person’s pain, and to suggest all kinds of things that you don’t know whether the person already does, is capable of doing, or could cause harm, is inappropriate. If you can’t listen with compassion and abstain from making assumptions and judgements, you should consider another kind of work. Yes, I am offended, and I can tell you that many of my readers, who suffer intractable mental and/or physical pain, will be horrified to read your comment. I would simply delete it, were it not for the fact that it will demonstrate to my readers that they are not simply imagining that there are practitioners who will tell them to, in effect, “just get on with it.” My neurosurgeon once told me coldly to “quit whining, it’s only pain.” Well, he changed his tune when HE developed spinal stenosis, had surgery, and had to leave practice! I hate to admit it, but I still get a chuckle out of that. I certainly don’t wish chronic pain on you, but I do wish you would develop your compassion muscles, however that shakes out. Goodbye!

      Reply
  6. In the meantime psych patients are sent home naked, with bottles of benzodiazepines, a “If Norman Vincent Peal can do it so can you” plaque, a list of AA meetings even if they aren’t addicts and alcoholics and an appointment for useless CBT classes.

    Reply
  7. I was on opiates from 8/2012 until 1/2015. They were absolutely necessary. It was Dillaudid by the end, In January, some of the most painful things went away, and the rest I could deal with. (Like my neuropathy.) Around November of 2014, my stomach hurt too much and I knew those were the cause. It became cost vs. benefit at that point. So in January, I just stopped. My doctors suggested a taper, but I was done. 3 weeks of terrible withdrawals, and that was that. Haven’t wanted any at all. I wish I could testify before Congress to get them to understand how important they were when I needed them, and how regulating an important medication so harshly, based on the actions of some who would find another way to medicate anyway, is an inhumane policy decision.

    Reply
    • Yes, and yes. In a way it’s even more cruel than criminalizing cannabis, which, for anyone who has ever been debilitated with nausea/no appetite, is literally a lifesaver. I have used Dilaudid when I ruptured 5 discs basically at the same time, and was working 120 hours a week during my residency. At that time the pain was so intense that I couldn’t stand up or sit down even with the drug. So I leaned against walls in my full torso plastic body jacket. Without the drug I would have just laid on the floor, in too much pain to dare to scream. That was incredible that you preferred withdrawal over a taper. It must have really been unpleasant. The drug, I mean. We know the withdrawal was unpleasant 😦

      Reply
      • It was pretty awful, and as long as I took it, my stomach just hurt worse, no matter the dose. So when I was done, I was done, knowing I wouldn’t be able to leave the house for 3 weeks.

        Reply
  8. I can sort of understand the concern about doctors just prescribing drugs to patients, as there have been problems here in the UK with patients not understanding that antibotics can’t help if you have a virus, and GPs being over-worked and stressed and eventually just giving in and prescribing antibiotics because it’s easier than having an argument that’s going to make the appointment over-run more than it already has. But we’re also supposed to have annual reviews of what we’re taking, so that things can be assessed for suitability.

    It’s all gone very Big Brother I fear.

    Reply
    • Antibiotic prescribing is out of control and terrifically dangerous because it breeds resistant bacteria, so then when we really need them the antibiotics won’t work. And now science is discovering that the microbiome, the largest organ of the body that consists of the “good” bacteria that coat our skin and populate our large intestine, is responsible for keeping us healthy. In fact, a new study has implicated the microbiome as a protection from certain types of mental illness! Natural medicine has been saying this for years and mainstream medicine was not listening finally there is objective evidence to support this. Antibiotics mess up the microbiome, so we are left with resistant bacteria and no body armor to protect us from disease. Yes, there are times when antibiotics are appropriate and life-saving, but as you say, the common cold and other viral illnesses are not those times. Thank you for this thought-provoking comment! (As always 🙂 )

      Reply
      • You’re welcome. It also doesn’t help that the meat we eat can be full of antibiotics because some farmers use them to try to prevent disease in their herds and flocks. Fortunately we use a local butcher who sources his meat locally too, so I don’t need to go vegetarian yet. We watched a documentary a while ago about TB in Swaziland and how there is now a multi-drug-resistant strain or strains which is causing an epidemic. It was relevant to us as we used to have sisters in Swaziland. I think there needs to be more done to encourage the holistic approach and to not just treat the individual symptoms. There has to be a reason why there is a greater and greater number of people being diagnosed with ME or Fibromyalgia.

        Reply
        • True. Resistant TB has become a worldwide problem, especially where there is poor nutrition. I don’t know what the situation in the UK is, but in the States, supposedly a wealthy nation, hunger is endemic. Shameful. So the most vulnerable populations, notably the aged and homeless, are getting resistant TB. And others who have compromised immune systems, like those with HIV or cancer. I’m afraid humanity is going down when it should be going up. And it’s all our own fault for wanting instant gratification. BTW I have stopped eating meat except for the occasional occasion when my body seems to crave it. That’s been happening about every three months, so I feel O.K. about it. You’re fortunate to have a local butcher!

          Reply
          • I’ve been vaccinated against TB. But we have an increasing number of food banks and the people on job seekers allowance are on a balancing act to not be sanctioned and have their money stopped, and there are many kids who need to have free school meals and therefore food parcels in the school holidays. I’m sure if I wasn’t in community, I’d have needed to use a food bank by now. It’s an appalling situation but the government just thinks that those who claim benefits are scroungers who don’t have any to work, when the reality is that there aren’t any jobs in the UK for people to do!

            Reply
            • So the U.K. is also feeling the economic crunch…We are also struggling with the harsh reality of meth addiction, and that it’s easy money for those who are out of work. But the fallout from that is that meth addicted parents will trade their government food allowance cards for meth, and they even trade their kid’s food packages for meth, so their kids go hungry when school is out. Even the ones whose parents work at McDonald’s or Wal-Mart for minimum wage $7.50 an hour, or about that, for them school lunch costs $3.00 or more. So a week’s worth of lunches for one child is $15.00. Add a couple more children, and the bill really eats into things like rent, car payments, gas…These are the people who don’t qualify for Medicaid, our health benefits program for poor people…So one health disaster can make them homeless. It’s a travesty, in a country where corporate executives get multi million dollar bonuses, and government officials make six figures. No excuse.

              Reply

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