I was reading a recent commentary in the June 2013 issue of Pain Medicine News by the new president of the American Academy of Pain Medicine. In the fairness of disclosure, I must confess that Dr. Lynn R. Webster MD is one my most favorite physicians. I have had the pleasure to meet, collaborate with as well as co-present with him at a national conference. He ranks high in my book as one of the top five pain experts in our nation.
His words to other pain medicine specialists are inspiring and sensible. I urge you to read his recommendations to other clinicians about how to prescribe opioids carefully and safely in order to lessen the risk of unintentional overdose. His eight principles for safer prescribing make sense.
So, if your health care provider recommends an opioid trial or you have been taking opioids for some time now, here is a “patient-friendly” version that you should embrace. After all, you are an important member of your pain care team:
Eight Prescribing Principles: A Guide For Patients
Your Clinician Should:
- Assess you for the risk of taking your pain medication inappropriately (using it for reasons other than pain, taking more than prescribed or with alcohol or other drugs that cause sleepiness) before starting opioid therapy and create an appropriate pain care plan accordingly.
- Watch for and address any mental health disorder that you may have. A referral to mental health specialist may be indicated.
- Use the most current conversion table carefully or consult with a pain trained pharmacist before rotating (switching) from one opioid to another whenever this adjustment is needed.
- Avoid recommending that you take benzodiazepines (Xanax, Valium, Ativan) along with opioids, especially during sleep hours. If this is part of your medication plan, talk about how to limit its use or if you can switch to a different medication (for anxiety, muscle spasms or difficulty sleeping)
- Think differently about methadone. If methadone is to be considered it should not be the first opioid you are started on. When it is started, the lowest possible dose should be the starting dose and increased very slowly, only as it may be required.
- Assess you for sleep apnea if you are taking high daily doses of methadone or other opioids and if you have a family or personal history.
- Remind you (if you have been on long-term opioid therapy) to reduce your opioid dose when you have the common cold, flu or an asthma attack.
- Avoid ordering long-acting opioid formulations for you if you experience acute, postoperative or trauma-related pain.
Mirilax works well for me. My g. I. doc recommended this to me. I have used it for years. My sister uses Linzess, it is a prescription pill for people with opioid constipation ,it works well for her.
I wish that there wasn’t a so called”opiod epidemic.” I have 3 spinal & 2 knee injuries & cannot function without pain meds.About 2 years ago they reduced & then took my medications away.Since then my life has gone down hill.I can hardly work,was even living in my vehicle because of lack of work for about 6 months.I went from having a nice place & nice things to homeless in a matter of a couple months. Here in Montana no one seems to care.Everyone is pro marijauna, they just want to get high.I hope that lobbyist succeed here, I need my life back. I’m over 300 lbs now & can hardly move.It just isn’t to treat us this way…
I am very pro opioid for chronic osteoarthritis pain. Am currently in a rehab that is multi-disciplinary and am trying alternatives. I ‘m on one long acting tramadol with 3 given as needed, ativan, gabba pentin which makes me feel like a prisoner in my own body…..pain is gone….I forgot to mention I’m also on oxytocin which I get in the form of a nasal spray. I get headaches on one side of my face and have been given toradol for that. But only for 5 days…!! Just previous to this endeavor I cold turkeyed off 90 mgs oxy noes a CND alternative to oxycontin. I was weak and sick and too weak to book a flight back to Can right away. I eventually got a family member to organize that for me as I was so incapable though I did have the advantage of mental clarity.
Fast Fwd from 3 weeks of pure hell to coming back to this facility to begin with tramadol. I will be staying on here for quite a while. The reality is–I’m doing this to get my family off my case. And partly to see if I can get by without which the family does not approve. I know I made them sound like the Sopranos….no–just very controlling by threatening me. Long story. I’m not doing this entirely for myself….I need the familiar is all I’m saying……thanks y’all.
and for PTSD I’m on prosaic and dexedrine.
Teri,
Hello, it can be so hard when we have family and/or friends who do not understand how pain affects every aspect of our lives. It is hard to explain to them what they cannot see. I know that many family and friends are concerned for our well being when we must use pain medications. They hear and read all the negative information that is shared in media reports about drug abuse, much of which is untrue and only tells one side of the story. I hope that you will come back to TPC often and allow us to offer our support in every way we can.
They have live hosted chats here every Monday-Wednesday-Friday at 11:00 AM Eastern time. It is a great way to start the day and the folks are so kind, compassionate and they truly do understand a life of pain.
Take care,
Noki4
NOK14, you are generous and your comments are compelling. Having been in chronic severe pain for more than 30 years, I’ve tried everything and kept an open mind. When loved ones do not understand our need to use powerful medications, we try to educate them. In this way, Internet sites like this one can be very useful. But when family and friends fail to accept our education efforts and when they continue to denigrate us because we require powerful pain medications, we must finally break with them. When you explain to them that less than 3% of all patients using such drugs become addicted and they don’t accept it, it’s time to move on and stop caring what they think – even if you love them. It’s frustrating and sad; but when someone we care about refuses to accept facts, then they are no longer helpful. In fact, they are harming us. It’s hard enough to deal with overwhelming pain, let alone also deal with people who criticize us for using the only option that helps us remain useful human beings. Whether by ignorance, stupidity or wilful disregard of empirically proven facts, we must leave those people behind Until they accept us for who we are – people in constant pain who require powerful medications just to sit and stand for a few hours. We must learn to shut them out. Such people are prejudiced. If they criticize you despite the knowledge that these medications help you work, cook, sleep and care for others, then they don’t mush care for us. Once more… less than 3% of all chronic pain patients become addicted. In fact, if you remove from that group people with a prior history of addiction, then the actual rate of addiction among chronic pain patients is less than 1% Want the proof? It’s here: http://www.ncbi.nlm.nih.gov/pubmed/20091598?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=1, here http://updates.pain-topics.org/2011/01/study-finds-low-risk-of-rx-opioid-use.html and here – http://updates.pain-topics.org/2012/08/when-is-rx-opioid-addiction-something.html. I have more research, but all of them reach the same conclusion – almost no one who uses opioid medications becomes addicted. So why are our loved ones criticizing us? Ignorance or prejudice.
Wise counsel, CW. It is so important to surround yourself with others who are supportive and positive–they see and encourage you when your pain care is improving your life and are honest with you should they see signs that your life appears to be deteriorating or your quality of life is diminishing. Caring, loving, positive and honesty are traits which should be sought after and emulated too.
For more on this, please read: https://paincommunity.org/relationships-ones-comfort-chaos/
Cweinbl,
I totally agree with you that one can only try to educate family or friends so many times, after that it is time to limit one’s time around them. Surrounding ourselves with folks that do understand or at least try to understand allows positive energy to surround us and we need lots of that.
My answer to the question you shared would be, prejudice. There are so many negative media articles that only tell one side of the story. On top of that there is a group of substance abuse professionals that calls themselves “experts in all things pain related” who do so much harm each and every time they are interviewed. It is sad, really sad that the substance abuse issues in this country are placed on the backs of the legitimate people living with pain.
Thank you for your post I enjoyed it,
Noki4
Your additional feedback is an added plus. Thank you for those pearls of wisdom.
Everyone on a ‘High Dose Opioids’ program for Intractable Pain {I am one such person}, who has been doing that for more than 5 years, Definitely needs to be taking Stimulant Laxative Tablets! Nothing else will work {reliably}.
And — they don’t have to be, and they should not be, synthetic stimulant Laxatives! There is an Herbal Senna Laxative {as Tablets, available at every Health Food Store} that is Very Reliable {I take them myself} and are less expensive than the ones sold at Drug Stores. Also. when using them, it does not take significant time to work out how many per day You need to take — If you are working with an Expert with many years of experience. I have been taking High Dose Opioids for over 20 consecutive years and am Endorsed by Dr. Forest Tennant. I have designed Laxative programs for scores of Chronic Pain Patients & Intractable Pain Patients for over 15 years.
Excellent post! Thanks. I could only add a few thoughts:
1. For patients with a history of addiction disorder, opioid antagonists such as Naloxone and Suboxone have displayed promise.
2. For chronic pain, research shows that long-acting opioids are more efficacious. This eliminates the ups and downs associated with decreased plasma level and the need to wait for a new dose to reach peak plasma level.
3. If the long-acting opioid is sometimes insufficient, short-acting opioids can be used for breakthrough pain.
4. Medications should represent only one front in the battle to manage chronic pain. Consider promising mind-body techniques, such as biofeedback, systematic relaxation, meditation and Yoga.
5. Finally, virtually everyone using opioids over time will become afflicted with constipation. This is caused by the opioid’s effect slowing or even ending bowel peristalsis. This type of constipation is not easily cured. Taking stool softeners, adding dietary fiber and using ordinary laxatives is a good idea. However, be advised that you might need to use a stimulant laxative to remain regular. Just make sure that it says, “Stimulant” on the box. It might take several months to determine which dosage is appropriate for your unique body function. But I can guarantee that it will work (sometimes a little too well!). Dulcolax and Alophen are examples of potent stimulant laxatives.
Thanks again for the useful post.