Ineffective Pain Killers and Opioid Addiction

22 01 2011

    In many pain patients experience and now scientific studies prove, pain relief (Analgesic) decreases while pain sensitivity increases from excess use of opioids.  The opposite effect of pain relief is experienced when addiction and/or tolerance of morphine like drugs is established. 

    In other words, if you stub your toe and you’ve been using opioids for long periods of time, greater sensitivity to pain can/does occur.  So you ask yourself, how could this be?  I thought pain killers were supposed to lessen the pain experience.   This is true if you are following the manufacturer’s dose and frequency prescribed by your doctor.  Many do not realize excess opioid use can build the bodies tolerance to a point where pain relief is minimized.  In fact, you get the opposite results, increased pain sensitivity.   And the medical term is referred to as Opioid-Induced Hyperalgesia (OIH). 

      Simply stated, OIH is “pain intolerance,” meaning more sensitive to any pain stimulus.  And for many of you that suffer chronic pain, you’ve probably experienced a pain management program that didn’t go according to plan.  Recall, the doctor prescribes, but it is up to the patient to take the recommended prescriptions.  And unfortunately, all too often, patients that should be pulled off of certain pain medications are not.  And others simply do not use the prescribed dosages and create more pain for themselves than necessary because of misinformation and understanding of a pain management program. 

        First of all, how does analgesic tolerance to pain killers occur?  The best way to describe this characteristic is that, your body produces your own morphine like substance (via spinal cord secretions) known as endorphins to alleviate pain when you stub a toe, or slam your finger in a car door.  This substance lessons the painful stimuli experience.  If a person takes “too much and for too long” morphine like drugs, then the spinal cord no longer secrets the body’s natural pain relief agent.  So when your body hurts really bad (chronic) you no longer have that supplemental “natural” pain killing agent in your body.  Instead, you solely rely on your prescriptions.  The pharmaceutical prescription at this point is not enough to provide adequate pain relief.   Taking “too many” pain killers results in an overall increase in pain sensitivity because the pain patient now blocks the body’s ability to dose/mask pain naturally for lack of the body’s natural morphine like defense.  Hence, taking high dosages of pain relief medication for too long and the spinal cords natural pain relief secretion process shuts down.  This is also when addictions to morphine like prescriptions occur. 

      Last year the FDA (Food and Drug Administration) introduced REMS (Risk Evaluation and Mitigation Strategies) guidelines to help manage the known risks for pain medication use.  This is a program intended to improve upon patient safety, education and compliance to mitigate risk of abuse, addiction and serious side effects through smart physician to patient consults. 

      Once these guidelines became known to the pain patience, there was fear (amongst some) REMS would result in limiting their access to needed prescriptions.  This is simply “not” the goal of the FDA REMS guideline program.  In fact, I see a lot of positives in the right direction that I wished were in place when I began my pain management program many years ago.  For example, I didn’t understand the benefits of pain prescription used correctly.  I was mostly aware of the risks of taking pain medications.  So when I noted a secondary risk, I reduced or quit taking the prescription for fear of another secondary ill-health condition.  The lack of “not” understanding the benefits brought on more pain experiences than needed to occur.  And for others, taking too much created addiction. 

          REMS brought with it, concern that pain patients would now have limited access to needed medications.  Why would they fear such a thing?  Think about it, if your addicted to pain killers and you have a risk evaluation (REMS) by a pain managing specialist, it may be determined the best course of pain alleviation action may be to switch over your pain medication, or reduce the dose, etc.  This would surely cause concern for an addict, or someone with continuous chronic pain.  

      However, to mitigate this concern, by working with specialists and through education on topic can get a pain patient back on track.  For example, to get a pain patient back on target may require decreasing medication (e.g., transdermal fentanyl) by 25%.  After 4 weeks, with reduced dose the patient reports 5/10 pain & overall improved coping ability with pain sensitivity [Fentanyl is a potent synthetic (man-made) narcotic].  A 100g dose of fentanyl is approximately equal to 10 mg of morphine. Fentanyl stimulates receptors on nerves in the brain to increase the threshold to pain. 

      So when a pain patient has been using Fentanyl to alleviate pain, a reduction of dose by 25% will appear odd but necessary to get pain under control.  It takes a bit of education and understanding through good patient to physician consults.  If medications are not managed correctly the opposite result of adequate pain relief and addiction often occur.  REMS help the pain patient to understand and manage pain relief more effectively. 

      Also if pain is not managed effectively, secondary risks can and do occur.  

 Constipation – Increase fiber intake, and/or use stool softeners will help. 

  1. Opioid-Induced Hyperalgesia – Ineffective pain relief. See your physician.
  2.  Respiratory Depression – Slow rate of breathing, loss of urge to breathe.
  3. Central Nervous System complications – Dizziness, euphoria, drowsiness, etc.
  4. Cardiovascular – Decreased blood pressure, edema (swelling), slow heart rate.
  5. Musculoskeletal System – Osteoporosis, muscle rigidity and contractions.
  6. Skin System – Itching, “this may not indicate allergic reaction.” 
  7. Immune System – Data suggests long-term use, indicates immune suppression. 
  8. Pregnancy & Breastfeed-Neonatal depression, avoid opioid use during feeding. 
  9. Ocular System – Constriction of pupil. 
  10. Gastrointestinal System – Constipation, nausea, vomiting, bowel problems, etc.
  11. Genitourinary System – Urinary retention.
  12. Endocrine System – Hormonal and sexual dysfunction.
  13. Withdrawal Syndrome – Runny nose, shivering, diarrhea, gooseflesh, etc. 

 Note:  If you are a pain patient and experience any of these symptoms see your primary health provider, or refer to your pain management specialist. 

    The FDA REMS guidelines are now required within all pain patient to physician consults; providing the patient an excellent opportunity to learn about the benefits and risks of using pain killers.   This program will no doubt reduce prescription addiction problems; reduce OIH cases and increase pain relief benefits.  Also REMS incorporated into consults will reduce secondary ill-health risk factors that will reduce unnecessary deaths and lawsuits. 

     It is important that through physician and patient consults, the understanding of safety, education and compliance in pain management transpires.   Without education on the matter, this could be a scary proposition for the pain patient.  I’ve stated in many of the articles I’ve written within the “Mirror Athlete with Pain Chronicles,” it is very important you advocate for the best health care possible.  Without your voice advocating for the best care, your pain referral experiences to medical pain specialists can be unproductive, untimely, stressful and cause you more pain and suffering than need be. 

     The point is, if you know you have a problem and your pain is getting worse, get yourself in and ask for a referral from your primary care physician to begin consults with a pain management specialist.  Go into the session with an open mind, be willing to listen and ask for reference materials on the matter to become educated on your pain condition(s).  Ask about the REMS guidelines and learn to manage your pain safely and effectively and follow your pain specialist recommendations for the best prescription use to alleviate pain.  Through smart pain management consults, education and timely/applicable self-referrals your pain alleviation program will work.  Taking a self interest in your ill-health chronic pain circumstances is important if you want to continue quality living experiences while managing pain. 

 To read more on pain management, REMS, secondary effects of opioid use, visit Internet links below [simply cut/paste web address, insert into browser]. 

 References, 

  1. Pain Pathways, http://www.painpathways.org
  2. Federal Drug Administration, http://www.FDA.gov
  3. American Chronic Pain Association Consumer Guide, http://www.theacpa.org  

 Marc T. Woodard, MBA, BS Exercise Science, USA Medical Services Officer, CPT, RET.  2011 Copyright, All rights reserved, Mirror Athlete Publishing @: http://www.mirrorathlete.com,  Sign up for your Free eNewsletter. 


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22 01 2011
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