Criminal Pain

As I understand it, the consensus among physicians and researchers regarding treatment for chronic pain seems to be this: try mild, non-narcotic pain-relieving drugs and various methods of alternative pain relief before prescribing narcotic pain-relievers to your patients. Be sure to allow an abundance of time to assess the effectiveness of each individual alternative method. And if your patients ask specifically for narcotic pain relief, do everything you can to make them feel like criminals.

While the know-it-alls are patting themselves on the back for their sharp eye on patient care and safety, I’d like to point out something they’ve missed.

Pain doesn’t wait.

I’ll use myself as an example. As a chronic pain patient with rheumatoid disease (arthritis), my pain is occurring right now. It fills my mind, stops my body from moving efficiently (and sometimes, completely), and it makes me fearful in spite of myself. My pain affects everything in my life, from waking up and finding the courage to face the day to going to bed at night aware that it will probably ruin the sleep I need so badly. The pain caused by my RD makes me want my mama–and I’m 58 years old!

Here’s the thing: I need relief from my pain now, not in some amorphous future. Mild, over-the-counter, anti-inflammatory analgesics don’t relieve this pain. They only chew up my liver and eat holes in my stomach. Believe me, I’d be OK with those nasty side-effects if the drugs actually worked on my pain.

And hey, I’m all for alternative methods for pain relief. I really do believe they can be effective, given time and patience. The trouble is that meditation, exercise, mindfulness, biofeedback, and the like can take weeks or months to be even mildly effective. Some of these techniques, such as exercise, require me to endure extra pain on top of what I’m already dealing with. Others, like meditation, require serious focus and concentration. My pain often makes that extremely difficult. I have a hard enough time focusing on mundane, every-day things, like making a shopping list. And I’m supposed to focus all my attention on my belly-button while it feels like someone’s wrenching my shoulder–slowly and with relish–right out of its socket?

Puh-leese.

My pain is disabling me today. It’s depressing me today. It’s making me fearful for my future today. Sometimes it makes me wonder if I can cope with it for the rest of my life. How am I going to do that?

And if over-the-counter pain relievers and alternative pain-relief techniques could adequately control the pain of my fellow 1.5 million American rheumatoid disease patients and myself, would we really bother asking our doctors for narcotics? We are not addicts. The vast majority of us don’t abuse drugs. We are not criminals. We’re responsible human beings coping with real, intractable, often-overwhelming and all-consuming pain caused by an incurable disease that we did nothing to deserve and are doing everything we can to treat.

We know that when we ask for the real pain-relievers, the ones based on opium, our doctors (and now, our pharmacists) are going to give us the side-eye–and maybe even the stink-eye. I’d like to challenge them to put themselves in our shoes for a moment: faced with such sharp suspicion and obvious, dripping disgust, would they really ask for those drugs if they weren’t in excruciating pain?

Not unless they really were addicts intending to get those narcotic drugs illegally by malingering.

So here’s my final point: I know our doctors have strict controls in place–mandated by our government–to identify patients who abuse narcotic pain-relievers. Those controls are the reason that I can only get my month’s supply of serious pain relief if I beg my doctor for them–in person–every 30 days. He’d know in an instant if I was abusing my drugs, because I’d have to beg for a new prescription sooner.

I’m tired of begging. I’m tired of being treated not only like a child, but like a criminal. Somehow, we must change this paradigm so those of us who cope with legitimate chronic pain can get the help we need with respect, dignity, and compassion.

 

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Comments

View Comments (4)
  • Kathy P.
    3 years ago

    Boy, do I understand the frustration! I’ve had my RA for about 40 years, and it has affected dozens of joints in my body, not to mention the contractures, nodules, eyes, skin, tendons and muscle tetany.

    The RA meds don’t always work, or I have bad reactions to them. I’m allergic to some of them, and severely allergic to some of them. My options are limited much of the time. I can only take limited amounts of NSAIDs because I bleed so badly from the other meds, I can just brush a wall or door and be dripping blood all over the place. It’s embarrassing when you’re out in public.

    It got to the point I could no longer drive because my hands were too lumpy and sore, and my hip wouldn’t allow me to sit upright very well. I couldn’t walk very far because of the swellings in the balls of my feet, toes and heel spurs, had to creep up and down our half flight of stairs, couldn’t sleep more than a few hours.

    Very strong opioid painkillers would only take the pain down a notch or two, and I don’t like them. I’m always afraid of becoming addicted, can’t use them while working, and they always leave me with a headache. I also use a disability placard, a cane, TENS unit, splints, braces, acupuncture, ROM exercises, self-hypnosis, strengthening exercises, have tried various diets galore, dietary supplements–and there are still times when I took the painkillers for what little relief they provide.

    In the state where we currently reside, the law enforcement entities are absolute Nazis when it comes to doctors prescribing opioids. Can’t prescribe more than 30 days worth (even for hospice), must actually go for an appointment to get them, must present photo ID, answer a bunch of questions and fill out paperwork at the pharmacy.

    My husband was very concerned because I was becoming so debilitated, and he started doing research. He felt it might be worthwhile to try marijuana, so off we went to a different state because even medical marijuana is illegal in our state. And BTW, at these dispensaries, there were a lot of cotton tops like us, and there’s always at least a couple or three vehicles from our state in the parking lots that we see while we’re there. In fact, we sometimes know some of them.

    The first time we went there, I hobbled in on my cane. Three days later, I didn’t need my cane. My pain was significantly reduced and actually absent in some joints.

    Skip forward 8 months. We’ve been there several times per month, and we’ve learned a lot about the various strains. I’ve found several that are low in the THC compounds (the euphoric part), but high in the CBD compounds (the healing part), but necessary to have the THC in order for the CBDs to work. These strains do not make me “high” (much less foggy headed than painkillers), and they last for 4-5 days after I quit. The high I get is about the same as drinking a glass of wine, but I’m a cheap date when it comes to alcohol.

    I’m now walking again, driving, grocery shopping, cooking, doing dishes by hand, able to sleep without pain and get a good night’s sleep (which helps immensely with the emotional and psychological aspects), comb my hair, hook my bra, pull up my own pants, and many other things that normal people take for granted.

    My regular physician is astonished at the difference in my joints. He’s known me for 25+ years, and has seen me for all kinds of things. Where most people would be grimacing or crying in pain, I say, “Oh, it’s not so bad. I just need a couple of stitches to hold things together,” or “Yeah, the dog got a little over enthusiastic playing ball and punctured me in a couple of places, but I came in for my arthritis.” So, he knows I’m not a wuss.

    So, I don’t know if everyone will have the same degree of relief that I get, but it might be worthwhile to try. It might take some experimentation too, to find what really works well for your body. If it doesn’t help, well you’re not out anymore than what you already are. Go to an actual dispensary–and not street drugs. There are many ways to get the marijuana into your system, so you don’t have to smoke it either. I just know how much it helps me, and how much better I can function. Both my regular doctor and my rheumatologist are fine with me taking the marijuana.

    In fact, we are now in the process of giving up our ranch and everything that we’ve worked for years, in order to move to the state where I can have the marijuana when I need it.

    This part makes me sad to have to give up our way of life and our home. It’s so sad we have to go to this extreme in order for me to be able to manage my disease and perhaps one day be healthy again. Perhaps someday the “war on drugs” will be not be allowed to dictate how we manage our disease.

  • Anita
    3 years ago

    It’s so frustrating, isn’t it? I remember a doctor refusing to give me a prescription for cough medicine with codeine when a had a bout of bronchitis a few years ago. I used to get bronchitis every year since I was a baby and know quite well what works and what doesn’t, but the doctor just said in a patronising tone that “Robitussin is good enough.”

    I hoard my pain meds when I’ve had surgery, so I’ll at least have something on hand when a bad flare hits. I’ve found that flares actually hurt worse than the surgeries I’ve had, so it’s not a hardship to save a few pills for future pain. It’s just sad that we have to do such things, though.

  • Sneed
    3 years ago

    It seems to depend on the particular doc. I’ve never had any trouble getting a scrip for oxycodone renewed by my rheumatologist or filling it for 180 or so at a time. I worked out my own routine for not getting addicted or dependent, it has worked for 16 years and my doc accepted that that was the case and would renew annually on request. If I’d gone back and asked for more or done it more frequently it might have been a different story – but I doubt it. Those who are fighting with their docs over this should consider a new doc, and I fully realize easier said than done but not all are so resistant to fulfilling their patients’s needs.

  • janlorraine
    3 years ago

    I couldn’t agree more. My rheumatologist recently refused to prescribe hydrocodone 5 for me even though I was only taking one and a half pills a day and barely functioning. He recommended pain management. After going a month with nothing to see if I could endure the pain, I succumbed and made an appointment with a large pain clinic. So far my new doctor has been very accommodating, but I wish that I didn’t have to be monitored and submit to urine tests, but that seems to be the price I must pay in order to get out of bed.

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