Popular Painkillers That Can Cause Killer Pain - Page 2

By Jeff Forester 06/15/11
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Prescription opiates can make your pain wiring go haywire.

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With Dr. Tallman’s help, Shawn has begun tapering down and looking for other solutions. “It’s not easy because the pain gets worse in the short-term,” Tallman says. With 15 years of sobriety, Shawn now wears a fentanyl patch (fentanyl, and opiate agonist, is 100 times more powerful than morphine). “There is no silver bullet,” Tallman says, but so far so good. “My pain, the chronic pain, has not changed much, but day to day, with the little things, it is better,” Shawn says. He is also a regular at pain-management support groups. “Everyone that I know that this [opioid-induced hyperalgesia] has happened to are ex-addicts.”

Ironically, Penny only began abusing her pain medication after she got sober and her pain began to spiral ever higher. “At the end I was taking two pills at a time,” she says. “The drugs were not working.” Upping the dose fueled her undiagnosed hyperalgesia, creating a vicious cycle; her behavior became increasingly erratic as she chased relief. “I was an addict. Even being in recovery eight years, I was unable to admit I was hooked on painkillers,” she says. “I had it justified in my mind that it was a doctor’s prescription.”

“People who are coming in with both pain and addiction and which came first is a chicken and the egg,” Hall-Flavin says. “In the end it doesn’t matter—treat one and the other will often improve.” That’s the way it’s supposed to work—unless hyperalgesia turns treatment on its head.

As a result, some pain specialists choose to steer clear of the entire opiate category of painkillers. Dr. Matthew Monsein, a pain expert at the Courage Center and Abbot Northwestern in Minneapolis, has 30 years’ experience with pain-wracked addicts like Penny and Shawn. “There are clearly patients who do better on opioids, but I believe it is a small percentage. Mostly the pain spirals up,” he says. In fact, some studies show that prescription opiates have, at best, only a modest and short-lived effect on pain and even less on functionality, while their risks—physical dependence, addiction and hyperalgesia—are daunting.

Shawn has had four support-group friends take their own lives when they could find no treatment to control the opiate-induced pain. “As a group, we have the highest rate of suicide,” he says.

The Pain Rehabilitation Center at the Mayo Clinic boasts impressive results for the analgesic effects of not taking narcotics. At Mayo, doctors work to taper patients off narcotics and give them other tools. “Seventy percent of patients who complete the three-week program note a decrease in pain severity despite discontinuing pain medications during treatment,” Hooten says. The program focuses on so-called functional rehabilitation: managing the entire cluster of symptoms at the same time: depression and anxiety, addiction and pain. “The goal is resolving and improving management of the pain, not the pain itself,” Hooten says.

For addicts cursed with hyperalgesia, the stakes involved in finding a solution could not be higher. Shawn has had four support-group friends take their own lives when they could find no treatment to control the opiate-induced pain. “As a group, we have the highest rate of suicide,” says Shawn. “It’s like running through a marked minefield blindfolded. I’m going to try everything else, but suicide is my last option.”

Penny also traveled down that road. “My insurance company finally cut me off,” she says. “I wanted to die. Every single nerve ending in my body hurt.” She spent four days in the hospital, four months in recovery. “I was scared shitless,” she says. “I had no idea how I was going to get through the day.”

But with the support of her family and her community of fellow recovery folks, she was able to begin to turn the tables on her hyperalgesia. Now a 56-year-old grandmother, Penny says, “I decided I needed to do something different to be able to live again.” The drugs, she realized, “allowed me to be a crazed maniac—to push and not slow down.” So Penny changed her entire approach to living with pain: she meditates, eats healthy, does yoga, walks. Today she takes no narcotics and experiences less pain.

For the ex-addict in chronic pain, the onset of opioid-induced hyperalgesia can seem like the last turn of the screw. After wrestling your sobriety free from the stranglehold of addiction and leaving the junkie lifestyle behind, the medication prescribed by your doctor brings not relief from pain but a fresh new hell. Yet as both Shawn and Penny show by example, a separate peace can be made. There are many non-narcotic remedies for pain management, ranging from medications to meditation and mindfulness therapy to lifestyle improvements.

“For the person willing to make changes in their life, there absolutely is hope,” says Dr. Hooten. Dr. Hall-Flavin agrees. “Find a physician to work with who understands both addiction and pain,” he says. “Don’t give up hope. Believe in yourself.” Fortunately, ex-addicts have been schooled by the many challenges of recovery in believing in themselves and holding onto hope, even if only for today.

Jeff Forester is a writer in Minnesota. His book, Forest for the Trees, an ecological history of his state's famed Boundary Waters, came out in paperback in 2009. This is his first piece for The Fix.

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Jeff Forester is a writer in Minnesota. His book, Forest for the Trees: How Humans Shaped the North Woods, an ecological history of his state's famed Boundary Waters, came out in paperback in 2009. Jeff is the Executive Director of MN Lakes and Rivers Advocates MLR and you can follow him on Twitter.