Are You Prepared to Begin Opiate Therapy?

Dr. Miles' Anti-Pain Pills, Edmonds Historical Museum, Edmonds, Washington. (Photo credit: Wikipedia)

There are many issues to consider when deciding (with your Pain Management Physician) to begin opiate therapy as part of your chronic pain management plan.

Beginning opiates is not to be taken lightly.

It is not as simple as it all sounds.  You will start a new medication that promises to alleviate some of your ongoing, daily pain.  This class of medications can be fantastic in their ability to relieve pain, and can give a pain patient a glimpse of their 'old' life back.

But you first need to look at the entire picture.

After you have spoken with your physician about trying opiates, and of course you are both in agreement, take just part of an afternoon to think a few things over before running to the pharmacy.

CONSIDERING OPIATE THERAPY IN YOUR LIFE~~~

1. Do you have a history of alchohol or drug abuse?
2. Are you being treated (actively) for a diagnosis of Mental Illness?
3. Are you a compliant person?
4. Are you honest about your pain with your doctor?
5. Are you a very patient patient?
6. Are you willing to research and learn about these medications?
7. Are you willing to take on the side effects of opiate therapy?
8. Are you you wiling to stop opiates at any time if necessary?
9. Are you willing to stop opiates suddenly and abruptly?
10. Are you aware of the term Withdrawal Syndrome & what it means?
11. Are you willing to go through the withdrawal off of opiates?
12. Are you strong enough to deal with misinformation and misinformed comments? (Over and over)
13. Are you willing to fight for whatever helps YOUR pain? (Including non-opiate measures)
14. See #5.

I see a total person, a holistic view, in my patients.  A person who has been addicted to any mind-altering substance that caused harm or distress to any part of his/her life, would not be a good candidate for opiate therapy, and hopefully the physician made that call when getting the patient's history.

An actively depressed patient would not be started on opiate therapy. (Possibly when the depression is  treated, as pain can cause depression, and there are many pain patients with a co-morbidity of depression.)

A person with a history of lying about drug use, diverting medication if in the medical field, or anyone who looks at medication for pain as a commodity or a high only, is not the candidate for treatment with opiates.

Your doctor that treats your pain must be your partner in your pain care.  Be honest and forthright.  Docs appreciate candor, and also the educated patient.  Read up on opiates and their side effects.  Know what you are choosing to put in your body.

You must be prepared to possibly sign some sort of pain contract.  You must be prepared to do what your doctor instructs you to do.  (Compliance).  You must be ready to take on the side effects of opiates, such as  constipation (which can become very severe) nausea, tiredness, appetite changes, and others.

You may be asked to stop taking your pain medication.  This is usually after a surgery, to evaluate how the pain is without any painkillers.  In other words, "Did it work?"

You may decide to stay off of pain medication after the surgery if the outcome of said surgery is positive, the original pain is gone, and physically you can 'do' life, because the main cause of the pain has been 'fixed'.

You must be ready to accept whatever your body is going to do.  For instance, I had a large second Thoracic spine surgery.  After recovering and getting past the post-op pain, I stopped opiate use, and was pain-free for quite awhile.  I went to the gym faithfully, it was like I felt years before.  Nothing was needed for pain.

Then the pain started again.  Slowly, slowly.  But it was back, and new tests showed new pathologies in my spine.  Because that was my 2nd Thoracic spine surgery, I chose (and was advised) not to have any more surgeries.  I needed to treat my pain.

I was back in the ring again.  All the holdups with filling medications is reason enough for some people to go all Micheal Douglas (Falling Down) on everyone.  That is nothing.  Nothing.  You need to fight for your right to proper pain relief, in a reasonable amount of time, and that is not always easy to do.  Seems like the system is against those that do have opiates as part of their therapy.  Hard to see a doctor, hard to fill meds on time, hard to be patient while you are experiencing withdrawals (because you are dependent, not addicted) and still you must remain calm and deal with the situation at hand.

It is common to hear the word addicted used incorrectly with the subject of chronic pain patients and opiates.  I have written extensively abut this subject before.  (Addiction, Dependence and Tolerance Parts One and Two).  You must be strong and ready to stand up for yourself, for who you are, what quality of life you want, and how you have chosen to treat your pain.

Above all, you must be patient.  
 


Gentle Hugs......

Related articles

• California Pain Patients Bill of Rights 

Goodbye to the American Pain Foundation

It was with great sadness that I read my email from the American Pain Foundation, announcing that they were to be no more.  I was shocked and saddened.  I have looked to the APF for information, support, ideas and open networking for many years.

Join me in wishing them all luck in the future, and to thank them for their tireless efforts over the years, all in the name of those who are in pain in America.

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From the American Pain Foundation:

"With deep regret and heavy hearts, we sadly inform you that due to irreparable economic circumstances, APF must cease to exist, effective immediately. On May 3, 2012, the Board of Directors formally voted to dissolve the organization.


The Board and staff have worked tirelessly over many months to address a significant gap between available financial resources and funds needed to remain operational. Unfortunately, the economic situation has not changed in any meaningful way, despite our best efforts.

APF hopes to be able to transfer content from various information, education, and support programs to other organizations so that you may continue to benefit from the value these programs have provided to thousands of individuals and families across the country.

Your personal experiences in living with pain and seeking compassion, empathy and medical care often against the odds -- have driven our efforts over these many years. This includes enactment of key provisions of the National Pain Care Policy Act in the Health Reform Bill that led to a landmark report issued in 2011 by the Institutes of Medicine. This report documents the shocking numbers of US citizens that live with pain and calls for immediate changes to address gaps in care. Despite this, the current climate towards improving the plight of people with pain in the US continues to be precarious and hostile.

As you unfortunately know, the need for public outcry around the needs of Americans struggling with pain conditions is greater today than ever before in light of the multi-front assault occurring daily on our right to dignified care. Misguided state and federal policies are impeding access to appropriate and reasonable medical care for people struggling with pain, and deterring even the most compassionate medical providers from treating anyone with pain conditions.

It is therefore critical that each of you raise your voices singularly and together to demand the care you deserve. It is only by continuing to demand attention to the ever-worsening barriers and unacceptable suffering that change will occur.

Elected officials, policy makers, and the media need to keep hearing from each and every one of you so they are not allowed to walk away from the consequences of this over-looked public health and medical problem.

Please know that although APF will cease to exist, the resolve and commitment among individuals on the Board and staff remain strong."


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Goodbye old friends......

Gentle Hugs.... and Stay strong ~just for today~

A Fix for the Last Post and How's Your Knee?

Alrighty, I feel like a nerd.  Hmmm, if I was a nerd, I would have known this.  Idiot maybe?

The 'Text Enhance' I ranted about was simply a cookie/extension that had to be taken off the computer.  That's all.  Should've  realized it was something like this, when I was seeing IT nearly everywhere, on sites big and small.

For a short time last night (ok, the weeeee hours) I thought this company had taken over and was surreptitiously and randomly placing ads.

*I was very tired.

If anyone ever has this problem, this is where I found the information to remove it, and get things back to normal!!  http://botcrawl.com/how-to-remove-text-enhance/  Thanks to botcrawl.com!! Great information on their site.  The hovering links are gone.  

My knee was looked at by the Orthopedist and he put a shot of Marcaine into it, relieving some of the pain and movement restriction.  The DX was Osteoarthritis.  I kept asking, "What about the piece of bone floating around?"  "Osteoarthritis", doc said.  Bleh.  Where don't I have that?  Return PRN, if it hurts, or any other problem happens, were the parting instructions.  No surgery, floating weird bone piece or not.  That is a very good thing.  Looks like I just need to get some more supplements.

I'm off crutches (yeeeeeah) and walking without much pain. (In the knee)  I will get feelings of it wanting to slip, to do the same thing again, when putting force or pressure on the knee.  I haven't been able to sit with my knee tucked under me or cross legged since knee surgery, but after this injury, there is much less ROM.

All in all, focus on the knee injury is past, and I am grateful after two knee surgeries, and this injury, it has no pain to speak of.  I really put a huge strain on my spine, especially the Thoracic area (where every level is herniated and has bulky Osteophytes) when I had to use crutches.  I had to recover in the spine from the crutch use.  Sure throws things out of balance when one leg is always off the floor.

Thanks for the well-wishes and notes asking how things are.

  

Gentle Hugs.... and Stay strong ~just for today~

Bloggers: Did You Request All These New Text Links?

Who is Text Enhance and why are they suddenly ALL over my blog?

I have already written them demanding they remove the irritating text links in the body of my work, and Cmon, in the friggin header of my blog??  Really??

Now, the words --'Chronic Pain'--are invisible up in the blog header, as they are now highlighted text links, and those two words completely disappear because of the blue tones used in my header/picture at the top.

In making my blog rounds and visiting other's sites, I see they too have many 'enhanced' words.  I know they did not ask for them.

I am very protective of advertising on my blog.  I rarely do any ads, and when I do, I make sure they are related to the content of the blog.

When did we all sign up for some ad company to come in and put a bunch of random text-links ALL over our sites??  We didn't.

Does anyone know how this all occurred?  Did we have a meeting and I missed it???

*rant over



Gentle Hugs.... and Stay strong ~just for today~

Educating the Professionals on Pain

"I totally agree with you that there is an urgent need for education in regards to chronic pain - not just for the community at large, but for the very doctors, specialists, physios and other health care workers who are supposed to be the very ones who should understand our pain, limitations and difficulties better than any others!"

Great comment by one of my longtime readers. Her comment triggered writing on this subject, regarding educating the very ones that should have already been schooled on chronic pain.  The docs, nurses, and other healthcare professionals that are in the profession to help others, to relieve suffering, and to advocate for their patients.

Example:  A new Primary doc visit.  Me: These are the medications I am taking to control my chronic pain.  Doc:  YOU are taking this dose?  Me:  Yes sir, my pain is excellently managed by my pain management physician.  Doc:  YOU are really taking this dose?  Me:  Yes doctor.  Doc:  Would you consent to a urine drug screen?  Me:  Sure, let's do it!  Doc:  I have never seen any patient take this dosage of medications and not be (insert a doctor hanging his arms down at his sides, slumping, eyes at half mast, and kind of limping) like this.  Me:  Well, I have been taking these medications for many years, and I am tolerant to the dose.  Doc:  I have never seen such bright eyes, and even though you are on crutches, you are quite balanced and alert.  Me:  Just give me the cup.

I decided not to have any water.

First time I have been asked for a drug screen, and first time I have been asked for that screen to prove I am really taking what I said I was prescribed, because I 'looked so alert', and 'my eyes were so bright'.

When I related all of this to my Pain management physician of over 8 years, he smiled and said, "I guess he doesn't have many chronic pain patients, eh?"  We giggled about it, and he said how many times he has heard that, always surprised that GP's, Family Practice, or Internists do not seem to either SEE CP patients, or just do not treat them, therefore they stay away from the pain meds and act all bent out of shape when they hear what a specialist has done to help alleviate the pain.

How many times have we chronic pain patients had to visit the ER?  Never a good visit.  Never.  How many times have you been told:  "Oh, we don't prescribe that here, we are not going to give you any pain meds, we will treat your withdrawal symptoms, (even if with a medication I do not want to take), but we can not give you anything for the pain."

I am sure we all have some awesome Emergency Room stories.  It is there that I believe the education has to start regarding patients in chronic pain, who take medications for said pain, who are left without medication for days while the insurance company takes its time with authorizations, etc.  The ER is the first line of defense and I am very aware about the nurses and docs running with the joke about the 'drug seekers'.  I get it.  I have seen both sides.

When a person that lives in pain is seeking help, and truly has prescriptions for a medication(s), WHY do we have to go through so many hoops?  WHY are we made to feel like a flippin druggie?  WHY do some of the staff act like we are the most horrible thing that ever walked into their workplace?  WHERE is the empathy?  But most of all, WHERE is the professionalism?

When did judgement become a course in medical training?

Below is an excerpt from the internet for a Pain management physician who practices in Southern California.  I must give it to him for the kindness and openness with which he states his practice philosophy.

      
Welcome-
We don’t just treat pain. We’re also doing everything we can to change the way people think about pain and wellness, working to dispel the myths, misconceptions (and prejudices) that surround chronic pain. I believe that chronic pain is a serious medical condition and I alway treat my patients with the dignity and respect they deserve. You will never be labeled a “drug addict” in my clinic. 
Dr. K.


I would love to hear about your experiences with this subject!!



Gentle Hugs.... and Stay strong ~just for today~