• Dr. D

Are Your Meds Making You Sick? (Pain meds)

I’m not an expert in relieving pain. I can help people with some types of discomfort, but for

others, I refer them to pain specialists.


Unfortunately, though, patients with pain end up seeing me because I am an addiction specialist, and a lot of people have become hooked on pain meds in the last twenty years.


Part of the reason for that is that treatment providers didn’t understand pain very well.


And still don’t. I don’t understand as well as I’d like, which is why I said up front that that isn’t my specialty.


But I do understand that not all pain is identical, and not all pain should be treated the same.


“What do you mean what’s it like? IT HURTS!”


I’ve had people yell at me like that, because I ask them what their pain is like. But "it hurts" doesn’t tell me anything.


People are not all alike in how they feel pain, and not all pain is the same. That’s why when I ask about pain I want to know what it’s like for the person in front of me.


There are a lot of things I need to know if I’m going to succeed in helping someone to be more comfortable. Like -

-Is it there all the time?

-Is there anything that makes it better? Makes it worse?

-Is it shooting, stabbing, dull, achy, deep, throbbing?

-Does it burn?

-Does it wake you up at night?


I could keep going. But the point is – different causes of pain result in different kinds of pain.


And the characteristics, that is, what it’s like, tells me a lot about what may be most helpful in relieving it.


Acute vs. Chronic Pain


Sometimes pain is described by how long it’s been around. If it stays for more than three months, we call it chronic pain.


Examples of acute pain are a sudden injury like breaking a leg. Surgery can cause acute

pain. We expect to have pain after someone cuts on us. But this type of pain should go away soon with healing.


Childbirth and the pain it causes is acute. Over a few days or weeks, it will likely be all or mostly gone.


Often we treat acute pain with opiates. They work fast. And if you only take them for a short period of time, don’t cause much trouble


Chronic pain is a different animal entirely. Chronic pain can go on for years.


Probably the best example of this is back pain. There are so many reasons people get back pain that I can’t even begin to name them all.


Chronic pain drags you down. People with strong chronic pain can become depressed and suicidal. But this doesn’t mean that it’s in their heads.


It’s depressing to never feel good, like when pain never lets up. But chronic pain also affects some of the chemicals in the brain that control mood. So on going pain can cause depression.


For chronic pain, no matter why it’s happening, the opioid medications are almost never the most helpful in getting people more comfortable and on their feet.


And complete pain relief isn’t the only reason to use pain killers. Part of the goal is getting people back to being able to enjoy their lives.

I’ll come back to this, but the longer we use opiates, typically the less beneficial they are unless we raise the dose.


And then things can get bad fast.


There is More Than One Kind of Pain Reliever


When we talk about “Pain medications” people immediately think Oycontin® or Vicodin® or something like that.

And we all know what's happened in this country due to the widespread use of these medications: abuse, dependence, addiction, death.


But these are only some of the medications available for pain relief. Other includes some seizure medications, antidepressants, acetaminophen, the so-called Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)and some steroid medications.


Because it’s such a huge topic, I’m dividing my posts on pain into three parts. I can’t get everything down that I want to in just one session. And it’s too important to skip covering in detail.


With this post I’m talking about different kinds of pain. Next I’m going to talk about the non-opiate pain killers.


Finally we’ll hit the Big Guns – the opiates like oxycodone and hydrocodone. So be prepared. The next few weeks will all be a pain. That is – about pain.


Not All Pain Relievers Work the Same


It’s also true that not every kind of pain responds best to the big guns like Oxycontin® and Vicodin®. Pain in only one hip, for example, may do better with something like ibuprofen.


When you have pain in just one hip, it’s possible that it’s osteoarthritis. This is the kind that most of us get just through everyday wear and tear.


And osteoarthritis involves a lot of inflammation. Oxycodone doesn’t reduce inflammation while ibuprofen does, so it’s better for this kind of pain.


While big guns help briefly in making things hurt less, they also slow you down.

This means you do less.


And the less you do, the less you’ll be able to do.


And the less you're able to do, the more you will hurt when you do even small things.


And this, in turn increases pain in the long run.


They can also make you groggy, less attentive to what you’re doing, and increase your risk of hurting yourself more as well. (It is also true that over time opioid medications may actually make people more sensitive to pain. But I’ll talk about that later.)


Different Meds for Different Types of Pain


I’ve had people come to see me who were furious because someone tried to offer them an antidepressant for their pain problems.


More than one person has come in sputtering “They think it’s all in my head! I’m not crazy, I’m in pain.”


But there are some kinds of pain that actually respond better to an antidepressant than to other kinds of pain pills. And some of these medications can prevent further episodes.


And prevention is not something that opiates do.


Likewise, you don’t have to have a seizure problem to benefit from taking a seizure medication. Again, it depends on what type of pain you have.


Pain Relief – Things to Think About


Most of the pain we will talk about is the kind that doesn’t go away. There may be times that it’s better or worse. But it’s there. That is, chronic pain.


Most of us would like to avoid any kind of pain. When we hurt acutely, though, we think things can get better, hopefully fast.


And there’s very good reason to think that. We can temporarily shut down pain pathways fairly quickly to get people the relief they need.


Chronic pain, though, isn’t so easy.


And when we talk about chronic pain, we’re talking about more than just that. We have to talk about what it’s doing to your life.


I often tell people that I can’t take their pain away. I can usually, unless it’s time for the pain specialists, make it better, livable.


So my next question will be – what are the things that your current level of pain keeps you from doing?


If I can help you get to a point where you can do those things, but I can’t completely get rid of the pain, is that an acceptable goal?

Because if all you want to be able to do is sit in a chair and do nothing, you might be able to do that without any medication.


If you want to be able to get up and move without being in agony, then we need to look at what medication can help you without causing problems in other parts of your life. Like, making you too sleepy, sluggish, or in danger because you can’t think straight.


Next time we’ll talk about some different kinds of pain relievers and what they’re good for.


In the meantime, if chronic pain is an issue for you, consider what it’s keeping you from doing. Be prepared to have a discussion with your doctor about how to get those things back in your life.


Image of sick man by:© Can Stock Photo Inc. /Mirage3

Image of broken bones by:© Can Stock Photo Inc. /jannoon028

Image of back pain by:© Can Stock Photo Inc. /ribah2012

Image of pills by:© Can Stock Photo Inc. /HaywireMedia

Image of thinker by:© Can Stock Photo Inc. /Orla