What is chronic pain? The word “Chronos” is actually derived from the Greek word, Chronos, which means “time” and “year.”
There are two types of chronic pain. There is malignant chronic pain, which usually is a symptom of cancer, AIDS, and other severe illnesses. In the final stages of a terminal illness, people are often given narcotics, including morphine and methadone, to help make them a little more comfortable. Addiction is not as high a priority at this stage of the game. The key is to put the terminally ill client at ease during a difficult time.
For this article, we will focus on non-malignant chronic pain. Non-malignant chronic pain includes arthritis, fibromyalgia, lupus, migraines, carpal tunnel syndrome, and many other medical conditions. For people who suffer from these conditions, the pain never appears to go away. Treatment can get very tricky, as well.
Chronic pain can be nonstop in its nature, or it can come and go. Sometimes the pain is mild, and other times the person suffering from chronic pain will be in agony. It all depends on the individual and the medical condition causing the pain. What’s worse is that for those with non-malignant chronic pain, there appears to be no light at the end of the tunnel. Often their pain can last for years.
Many times these individuals go to doctors who often prescribe painkillers, which are usually opioids. Often the physicians will give them refills because the doctors are perplexed! They can’t seem to find the root of the problem! So medicating their clients seems to be the way to go.
There are two types of opioids prescribed for those suffering from chronic pain. Some opioids give immediate relief, as well as opioids that take longer to provide relief.
Short-term opioids include hydrocodone (with acetaminophen or Ibuprofen), codeine, and oxycodone (prescribed alone or combined with aspirin, acetaminophen, and/or ibuprofen).
The short-acting opioids make the clients feel as if they are on a rollercoaster ride. One minute they experience an exhilarating sensation of liberation from the pain, and then suddenly, after a few hours, they crash and are trapped back in the clutches of the horrible agony.
This rollercoaster effect causes major anxiety in the person. Also, when a person gets a twinge of relief from chronic pain, it’s almost like the exuberant feeling a starved person experiences when they finally get a plate of food. They don’t want to stop eating, and what would they do if some cruel human being appeared and grabbed their plate just before they took a bite?
They would lose their mind.
Well, that’s probably the same feeling that a person who suffers from chronic pain gets when they receive relief from an opioid. Then suddenly, a short time later, the relief is literally snatched from them, only to be replaced by the hellish pain.
Chronic pain sufferers often end up taking more of a higher dosage than prescribed. Within the time span of two weeks, they will become addicted to the painkiller. Also, their bodies have developed a tolerance for the painkiller and require a higher dosage! And in many instances, the pain gets worse. This is because the painkillers wreck the nerves that are attached to the pain receptors in the brain. The painkillers cause the nerves to become more sensitive to pain.
This condition is known as “opioid-induced hyperalgesia” (OIH).
It’s an ironic condition because, in the end, the painkillers cause more pain!
According to several doctors featured on American Chronic Pain Association videos, long-acting opioids are preferred to short-acting opioids when treating chronic pain. Apparently, these opioids are formulated on a controlled-release basis, and the pain reduction effects last between 8 and 12 hours. Typical medications include morphine-controlled release tablets, oxycodone-controlled release tablets, and buprenorphine and fentanyl transdermal patches, which are actually placed on the person’s body, much like the nicotine patch.
Additionally, methadone, traditionally used as a maintenance drug for heroin addicts, is used as a long-acting painkiller for chronic pain sufferers. Apparently, methadone targets a specific receptor in the brain. However, methadone, like other opioids, has a very dark side. Methadone interacts with certain foods and other medications. Sometimes if one doctor prescribes methadone for the client, and then a psychiatrist prescribes a certain psychotropic medication without being aware that the client is on methadone, the result can cause death.
Other potential negative side effects include arrhythmia, which is an irregular heartbeat. That can cause death, as well, if the person takes more than the prescribed dose of methadone.
And like other opioids, methadone builds tolerance.
Using opioids to treat chronic pain often leads to drug addiction. And what’s a bit frightening is that this is a major treatment protocol for chronic pain. It’s almost as if the doctors give up trying to find a permanent solution for the pain. It’s actually easier for them to prescribe pills or patches and send the client on his or her way. But sometimes, the truth is that the doctors cannot figure out what is going on! Chronic pain clients will often travel from doctor to doctor in the hopes of finding answers but often leave with prescriptions for painkillers in their hands.
And chronic pain clients often abuse alcohol, as well as other drugs.
Once clients develop a drug addiction, it’s challenging for those trying to help them become clean.
According to a roundtable PainEdu discussion on chronic pain and addiction, Dr. Daniel P. Alford said that not only is a cure required for the pain, but also a remedy is necessary for the addiction. The solution includes getting substance abuse and addiction treatment, including therapy, attending 12-step meetings, and finding a primary care provider who will work with the client on finding alternatives besides opioids to deal with the pain. Alford, who works with clients suffering from chronic pain, requires that they bring proof that they are participating in a drug rehab program and are going to 12-step meetings. Alford added, “I also require a release to allow joint communication between me and their substance abuse treatment providers. Ideally, I will call the substance abuse treatment provider during the primary care visit to reinforce to the patient that I take their addiction treatment seriously. This arrangement is best discussed before beginning opioid treatment. When these discussions occur after treatment has been initiated, it likely becomes confrontational; that is, the patient feels that he/she is being accused of something.”
During the roundtable discussion, Dr. Robert N. Jamison, a Doctorate-level psychologist, said that many chronic pain clients are often “unwanted” by clinicians. But the best solution is for them to find a team of health care professionals, including mental health and physical health providers, that will help them. And those health care professionals are out there.
Alternatives to opioid therapy include holistic therapies, cognitive behavioral therapy, and exercise.
It’s not an easy road to take, but chronic pain clients who get addicted to opiates become very depressed. Their lives lose meaning. And often, the depression infects their families because chronic pain clients are obsessed with their suffering. And sometimes, all they do is complain and drive their families insane, as well as themselves.
The best option that chronic pain clients can do is find good drug rehab and a qualified medical facility that will help them find better and healthier solutions to their pain. This will help them lead meaningful and happier lives.