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I'm a mom, a wife, a best friend. Sick with CFIDS/ME/CFS and Fibromyalgia since 1975 as a result of a nasty flu while still in grad school, it wasn't until the late '80's that I received a diagnosis. Until that flu I'd never really been ill before. With each year I get progressively worse and add to the bucket load of symptoms I'm living with. I've been blessed with an incredible family and best friend who've stayed with me through my struggles as we continue to find a way out of this monstrous illness and its complications. We've tried seemingly every approach to find my way back to health. Often I think our best weapon in this undesirable and unasked-for adventure has been laughter.

Monday, July 1, 2013

Should Opioids Be Considered "Bad"?

Yes, terriers are cute too! 

I've been thinking.  Yes, I do realize that that's a risky proposition and I very well know that no one in my family ever wants to go inside my head, but that's my nature.  It's a hobby, you might say - convenient for a person who spends most of her life in bed.

But I just can't let things go when I don't get a satisfactory answer or explanation.  And I can't seem to let go of the opioid question.  At the moment, I feel much like a terrier which gets something between it's "cute" little teeth and sinks in.  However, if you take into consideration my withdrawal from Cymbalta (going on now for how many weeks?) all my "thinking" may be understandable.  Each time I break out in a sweat or my heart starts pounding and racing - along with a few dozen other "minor goodies" - I have to go back to why it is that the medical community is suddenly so reluctant to prescribe everything but opioids. 

Yes, in the past I've written a few posts regarding the question of the "politically correct medical thinking" that's pervading our society. I've written about the advantages of using opioids (narcotics) for the treatment of chronic painful conditions.  And while my posts concerned patients with CFIDS/ME/CFS and fibromyalgia there are, indeed, other chronic painful conditions that deserve to be mentioned and for which opioids may be ideal.  This is not to say that I'm a huge endorser of opioids.  I just think that we really need to keep our options open and know what it is that we're rejecting before we do so.

Osteoarthritis, for example, afflicts millions of Americans and in many cases patients have limited therapeutic options.  To put a human face on this condition, consider the type of case I discussed with my rheumy last week.  When I asked him if he could give me a good example of someone who would benefit from an opioid over other sorts of medicines or medical interventions, he was able to immediately give me an obvious scenario.

Take the problem of a 76-year old overweight, diabetic, hypertensive woman with a weak heart who happened to have severe osteoarthritis of her knees.  Remember, this is a type of "wear and tear" arthritis that frequently accompanies injuries to the joints, or old age.  In a perfect world, this patient would get knee replacements and be able to function more normally.  

However, she's not a surgical candidate because of the aforementioned hypertension, diabetes and cardiac problems.  My rheumy stressed the fact that she should not take anti-inflammatory medications such as ibuprofen, naproxen or the like because her age puts her into a high-risk group of patients who would likely develop bleeding stomach ulcers or severe gastritis from those medications.  Another option without "resorting" to opioids would be injections of medicines directly into the knee joints.  This could give some relief but it would only be temporary.  The best medication for this patient, given the circumstances, would be a long-acting opioid preparation.

The above scenerio occurs quite commonly according to my rheumy, but many patients fear getting "hooked" on opioids while many doctors fear scrutiny for prescribing opioid medication. I was assured that if a patient with no history of drug abuse takes an opioid for pain then the risk of addiction is extremely small.  And if a doctor keeps good records and documents clearly in the medical charts why opioids are the best option at a particular time he/she should not be intimidated into withholding medications that are likely to safely enhance the quality of life for many patients.  

I've personally witnessed individuals, including some family members, who have suffered needlessly because opioid medications were either not offered or were not administered in sufficient doses to effectively get the pain under control.  I must emphasize that I don't expect doctors to take away all of a patient's pain.  But I insist that they alleviate the pain to the point where patients can regain some quality of life.  


As always, I hope everyone's doing their very best, only better. Ciao and paka.

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  1. I think some doctors are afraid of the DEA, others are afraid of liability and, as a result, too many patients are left suffering in chronic pain. It's a fact that nerve cells have a memory. Pain has to be controlled to prevent a host of other issues (including high blood pressure - caused by being in chronic pain).

    I'm going for Botox treatment this week. The neurologist's office moved so we'll see how well my Garmin does in finding the new address. Wish me luck!

    1. Wishing you huge luck, throwing in a few prayers and crossing everything that can be crossed, Melissa! xx

  2. I know in my case, after 11 years on various opioid medication I was hooked and abusing them. After years of hell, suicide attempt and a stint in a mental institution I finally got sick and tired of it. With the help of my pain management doctor, husband and son, I decided to get off of them. It took 3-4 months for the horrible side effects to pass. And another year for the strong urges to go away.
    It will be 2 years next month, I'm still in horrible daily pain and there are still days that my pain leaves me bedridden.
    Do I think that opioid medication can be helpful for some chronic pain sufferers? That's their question to answer.

    1. Hi, Berry! I'm so sorry to hear that you had such a bad time of it with the opioids. In so many ways, we are "cursed" no matter what we do. It's sad that you fell into that extremely small percentage of patients who do have a problem...though did you find relief with opioids until a certain point? I'm not challenging you in any way, shape of form. (Trust me!) I'm just trying to get a better picture of this whole opioid vs "brain" meds thing.

      Congrats on coming through so much, Berry. I'm sorry that you're still in so much pain. Have your exhausted all other options with medication and/or other medical interventions?

      Trust me, I know how you feel. For many reasons I stopped smoking a couple of years ago. I had smoked when in school, for a couple of years but quit cold turkey. Skip twenty years later and I started smoking again. Skip MANY years later - and now I'm an old bat - and I finally made the choice to quit. Although smoking is messy, expensive and bad for your health, I resent that I stopped. I can't help it. It helped A LOT with my pain. And nicotine patches are a joke - at least for me.

      I actually had a doctor who preferred me smoking than taking so many pain meds - he even said, "I never thought I'd ever tell a patient that, EVER!" but then he was a pretty gutsy guy who looked at every situation individually.

      Pain management is so tricky because, like you say, we're all different. That's why I can't scream (but so much) about what Cymbalta is doing to me as I detox, which is going on MUCH longer than the three weeks I'd taken it!... I know Cymbalta helps many but I also know that I'm not alone with such a strong reaction to this "brain med." The side-effects of Lyrica - not even going there. I had thought THAT was bad. Sheesh!

      Thanks so much for writing about your experience, Berry. I really, really hope you can find a few things - heck, even just ONE thing -that can lead to less pain. Pain is definitely not easy. Sigh. xx