I have had chronic pain since 1984. Today I have too many things to do, but can't move. If my doctor took me off my painkillers I'd be in the E. R. You have to use whatever you can to have a good, productive life and for a doctor to remove your painkillers is the same to me as a doctor harming you. I would consider it torture. I hurt even with the large amount of painkillers I take. Fentanyl, hydro, diazepam, gabapentin, etc. I think doctors are fearful because of the large amount of press painkiller addiction is getting. There is a difference between ourselves and the addicts who overuse, who powder several pills and then "snort" them, who use powdered fentanyl as "the new heroin."
I feel frustrated and unable to respond to the publicity my medications receives in the press and know it means more work for me. For the person who asked about pain clinics. I am grateful to have one to help me. On an average day, unlike today,I live a normal and productive life. I work, think, write, drive, take care of myself and two horses. I live in the mountains. I can have this life because of medications. I don't have to explain myself to anyone. I just take my meds at prescribed times.
And no, they do not last six hours. Even my wonderful doctors at the pain clinic have told me they know this, but by law they can only offer so much...Also some have tylenol in them, which can harm the liver or kidneys.
Just wanted to add this for those who go to pain clinics. Or worry about whether they should go. I first feared they'd be like those of the old days and tell me again to do biofeedback, not take meds, change my lifestyle, etc. But knowledge of pain has changed
Good pain-free days to everyone!! I would love a day like that.
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SecretlyDisabled7
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I don't think I have excessive use of opioids but when it says get a plan? Can they cure our problems NO and I'm all for self help I do try. At the end of the day I need the Butrans patch to function more & Cocodamol for breakthrough pain which isn't many.
So what are they going to do take everybody off those stronger opioids. Well I hope they have a plan because those patients are going to need a hell of a lot of support. Which they won't get!
Pain management have taken me off my opiates and now I'm in severe pain can hardly move so they must have been working but they said they cause more pain and liver damage well I would rather take them than having to deal with this xxxx
Hi chatterbox I've just been to pain clinic introduction to pain management course, I asked about swapping my pain meds as I have been on tramadol over 20 years and was told there is no such thing as breakthrough pain in chronic pain and pain meds are no good for chronic pain anyway, I don't know where this has all come from, most people on here are taking them and some have had really bad problems changing over, I'm going on holiday next Monday so I'm reluctant to do anything till I get back but it really worries me not having anything to take the edge off my pain, I am really with you on this one and feel your pain
I think the issue is that there is insufficient evidence to show that opiates are effective in treating chronic pain.
Once this is coupled with a few choice 'statistics' (and we all know what they say about statistics) such as the oft quoted '20,000' deaths a year in the US it makes politicians and policy makers nervous. The knee jerk response is to start a media war against the 'over prescription' of certain medications. This in turn reduces the number of scripts created and the figures appear to improve. Policy makers pat themselves on the back and chronic pain sufferers are left to (slowly) pick up the pieces of their painful lives.
There is also research that suggests that (IN RATS) opiates actually increase the duration of certain pain responses to some induced conditions (such as having a stitch put in the sciatic nerve).
And there are known issues with sensitisation and hyperalgesia where opiates actually increase the levels of pain in patients, what percentage of long-term chronic pain sufferers this applies to I don't know, and I'm not sure anyone else does.
But it's a very complicated and somewhat muddled picture. There are lots of other things to take into account, such as if in people the limited research shows that long-term, high-dose (defined as > 100mg morphine equivalence for > 10 years) opiate treatment improves mental outlook and reduces overall pain in 100% of participants ( news-medical.net/news/20130... ) and if taking away pain medication in chronic sufferers without giving them the tools required to cope leads to self-medicating with alcohol, illegal opiates, diverted opiates etc, then what are the implications of this for society as a whole and the individuals in question?
I think, but obviously can't prove, that most of us on here that are using opiates as a part of their pain medication regime would say that while they don't remove the pain completely (nothing does), they 'take the edge off' a little and allow us a slightly higher quality of life than we might otherwise enjoy.
Personally I am trying to get off morphine at present, and despite being on a very high dose for a long time (though not 10 years) I can honestly say with my hand on my heart that the 90% reduction I have achieved thus far has been no harder, in fact I would say easier, than reducing from a large, long-term regime of corticosteroids. For me.
Let's not forget the distinction between addiction and physical dependence. True addiction occurs in a very small percentage of chronic pain sufferers, dependence occurs in the vast majority. Dependence means slowly weaning yourself off, addiction means that you will do ANYTHING to get your hands on more, regardless of the cost to yourself. Very different things.
And it is the endocrine suppression that I have found the most worrying factor of long-term use. Our bodies produce their own opiates (endorphins) and our livers etc are equipped to deal with them. They are NOT toxic to us, as mentioned above more genuine pain patients die from NSAID use than opiate use.
You say: "Pain management have taken me off my opiates." This does suggest that the pain management are not partially competent. They should have reduced your dose over a period of time. To allow your body to adjust to the withdrawal side effects.
I have bilateral psoriatic & osteoarthritis, Fibro pustular psoriasis guttate Psoriasis & inverse (going through a calm period with psoriasis) I have DDD L4L5 L5S1 radicular pain & sciatica. SPinal stenosis that affects my bladder causing numerous bathroom visits. Bursitis Tendonitis elbows hips. Arthritis in my facet joints plus narrowing at C3-C7 - falling apart 🙈
Had a few ops & epidural steroid injections. Acupuncture physio etc. Having another MRI in a couple of weeks & then see a surgeon. I do not want to go down the op route if I can help it. I would rather see my consultants in the Autumn who could give me a MILD decompression in my lumber spine.
Getting back to pain I couldn't go without anything the pain is unbearable for me if the drugs are helping people function then why break something that was good?
They should not take you off them just like that rather ease off slowly. I just do not understand where those doctors are coming from. I would require quite a discussion on what they are going to give me and how they are going to help me come off the original drug. Unless your blood sample showed severe liver damage. I cannot understand why they have done it that way.
Yes I still have chronic pain we all have chronic pain. I know the meds that help me & I'm happy with that.
Like you said it's a mild dose compared to some.
I don't do bad considering the overall state of my Skelton etc. They're are many people yes have become addicted through no fault of their own. All I'm saying is yes obviously if they are taking to many meds & at times those meds are in conflict with one another then they should be helped by the doctors to ween themselves off not taken away in one swoop.
Then try to help them and themselves to lead a more comfortable life .
Having all kinds of disabilities is no fun and we all at times think before I'd been given any kind of strong medication (I Am intolerant to many strong medication) I'll do anything just please get me out of this pain.
You come across as quite hard are you an administrator?
My empathy is for anybody that suffers pain whether they manage on nothing strong meds or mild. After all this is what this site is about isn't it giving people advise and a little chat & comfort . Fortunately I have a very caring family but it is nice to chat with people that are in similar situationsand at times are feeling very poorly & down.
I shall forget the conversation now because for me it has completely gone off track and has lost its original momentum I just want people to be cared for in the proper manner. I also get the feeling you do not like me. It's not the sort of wording one would use on a pain management site (& frankly I don't care your words)
Jenny, Everyone's pain interests me. I want to help people, myself, and others who suffer. I realize that for some it is our way of being and it is an unwanted companion. I am also finding wording like "frankly I don't care" to be without empathy and a bit arrogant. It is not why we are on this site. We are here to help and care about one another, not to hurt each other.
Have you a reference for the assertion that opiates reduce life expectancy please? Quite a claim and one for which I can find no supporting evidence.
What is the mechanism for shortening of lifespan, or is this claim an extrapolation of the myth that chronic opiate users die within 20 years?
Of the 20,000 that die in the US from opioid related causes, what proportion are pain patients following a doctors prescribed doses that have been titrated slowly, and what proportion are using illicit / diverted doses taken for reasons of pleasure / avoidance / anxiety etc and usually in conjunction with high volume of alcohol or other CNS depressants?
Doctors are taking patients off opiates because of what latest evidence, link please?
Are doctors in the US being forced into taking patients off opiate treatment because they fear for their careers / jobs / liberty?
Don't think anyone claims they remove all pain, that would be ridiculous.
Saying chronic pain exists therefore opiate pain relief doesn't work is a rather simplistic (and false) statement.
And just for clarity I'm not advocating the sole use of opiate therapy or high-dose opiate therapy for chronic pain conditions, but some of this 'balance' you are adding is skewed even further towards the other extreme.
There is a place for opiate based analgesia, but there are limits to its effectiveness.
For 'balance' more people die from the 'correct' use of NSAIDs (mainly from stomach bleeds) than from the 'correct' use of opiate analgesia.
You ask: "Have you a reference for the assertion that opiates reduce life expectancy please?"
This is actually the wrong question? "Life expectancy" is a statistical quantity. It is meaningless unless you happen to be an insurance company trying to work out an insurance premium to charge.
Opiate overdose is not good. A persons ability to tolerate the side effect of opiate is a variable quantity dependant on a number of factors such as how fine is the opiate powder in the tablet.
A course powder is slower to act than a very fine powder. The very fine powder could give you an over dose while the course powder will not.
Certain foods will cause the opiate to absorb faster leading to possible over dose conditions.
Things are complex. These complexities are never 30 second bullet points.
Different manufacturers produce the same drug in a different way. The different way changes the speed at which the drug will act.
I was more looking for some reference that showed opiates have an impact on life expectancy. However you wish to interpret that phrase.
I answered my own question further down the thread however, and while they do I guess with hindsight it's fairly obvious. Things such as falling over and breaking your hip have a serious effect on people of a certain age, chronic pain patients on long-term opiate therapy are more likely to do this. Apparently. So even this apparently small aspect will shorten the 'life expectancy' of a long term opiate user.
What I didn't fully realise was the extent of other systemic implications.
Well, duh, opiates do Not reduce life span in pain racked victims but because folks in pain, like myself, often have many life threatening diseases/conditions, we often die early... We are dying early not because we coincidentally take opiods. Daniel has the cart before the horse! By his reasoning, one might find that aspirin is causing shortened lives when in fact the reverse may be true. The fact that I take opiods for tremendous pain has indeed LENGTHENED my life-- without them, I would have went to my bed permanently & died decades ago instead of living a perhaps envyed life on my horse farm.
I didn't ask for the links you provided, I asked you to back up the claims you made on a public forum that is supposed to be for people in chronic pain - with credible references. You can't.
Possibly the majority (?) of people reading this site will be on some form of opiate analgesic and you just told them all they were going to die sooner than may otherwise have been the case. If you have information like that to share with people there is a way of communicating it that doesn't upset them quite so much.
But what's worse is it simply isn't true. You are spouting the same falsehoods used in the 'war against drugs' without fully understanding the facts. And doing so in a manner that is bound to upset people.
Whatever your day job (and I certainly didn't mean to offend porters, just found your medical knowledge to be at that level), let's hope you don't use the same abrasive manner. Else I pity your 'patients'.
The next time i see a consultant in pain medicine, I certainly will have a list of questions. I just wish I had researched more before the last one spouted the same nonsense you do.
Thank you for your import. I agree the manner in which Daniel's post was written could make people in chronic pain feel in some way failures or cannot cope with their pain. As I mentioned to him before any pain killing meds had been used. I'm sure like me many people were of the same mind. 'I'll take anything please get me out of this pain' we know there's no cure but in many cases taking the meds makes life more bearable. Thankfully I am of a certain age and his comments did not affect me. I just cannot understand his lack of empathy on a pain site.
Thank you for your import. There is always to sides xx
Wow, quite an argument, I just like to say, I think there is room for everyone to have an opinion, and obviously everyone's experience if pain and treatment is different, I personally am very great full for the Graf stabilisation procedure I had over 20 years ago without it I would of been in constant pain and unable to work have a child etc. Now I have problems with in and above the area but ii think it stops me fron stenosis at those levels so at the moment my bladder is ok (I have some stenosis on the next level up )many are now against spinal surgery but for me for a time it worked, I think that is possibly how the drugs go, at first you get "treated" by pain killers then they either work for a short while or not at all then they increase dosage types etc till you are constantly on a level that probably doesn't make as much difference as it should, then someone says come off them and your body doesn't cope with the withdrawal,. Just because someone is telling you not to take the pain killers doesn't mean your not in pain, I just don't think there are many that effective for chronic pain, like I said I consider myself lucky I in the main get some sleep with amatryptalin and try not to take too much of anything else but I feel that there is so much wrong with the initial approach at the doctors of take thes pills it will all go away, I think we do need a rethink on how people are treated because as it can be seen on here acute pain seems to be allowed to drift into chronic pain without any proper thought or effort or plan as to how to treat the problem not the symptoms,
Sorry if this seem a bit rambley but it's morning and I'm still zombified from amatryptalin 😃
I would like to way in on this discussion by saying that not all pain can be overcome by pschology and whilst I support some of the theories that Lormier Mosely & Co. put forward regarding 're-training your brain' and the context of pain - this cannot apply to all circumstances. I have Trigeminal Neuralgia, nicknamed the 'suicide disease' and often refered to as 'the most painful condition known to mankind'. My condition was caused by trauma to the face (not actually a traumatic event) and my nerve is overactive and hypersensitive. During the early days before I finally recieved a diagnosis, one ignorant GP (mine was on hols) called me an 'addict' and 'drug seeker' and left me screaming in agony with an urgent referral to see a psychiatrist as apparently I desperately needed help. He was right - I did - I needed pain relief! I ended up in the hospital the next day.
During a really bad attack I am given a mixture of morphine, ketamine and lidocaine into the vein in A&E. Toxic and lethal in some doses - it is the only thing that helps.
Stress can aggrevate my condition - which is when pschology is useful but so can a light breeze, yawning, eating, brushing my teeth, talking etc.
Without my pain medications I would be dead because I would not physically be able to cope. If dehydration didnt kill me then eventually I would die of starvation.
Pain medication is essential for the treatment of pain however I accept that it is not the only solution. Pain clinics now often refer to a 'multi-disciplinary approach', trying to balance the hollistic methods with medication. This often works for many people and some even get to a point were they can reduce their meds and still feel relief.
This will not be me. Why? Because my nerve doesnt care or respond to hollistic approaches. It may help me think differently and reduce some stress but the physical triggers will always be there.
Pain medications do get a bad reputation but taken responsibly under the care of a GP or pain clinic they are often a necessity for trying to find a way to live a 'normal' life.
If my GP took my medication away - I'd find another GP. Some are just better at their jobs than others.
In terms of addition - yes these drugs are addictive - your body gets used to them and withdrawal can be fatal if stopped suddenly - this does not mean you are a drug addict!
For instance I take Venlafaxine twice daily - its an antidepressant that can also help with pain - if I forget to take it in the morning I get 'brain zaps', dizziness and feel so ill. When I do then take the tablet these symptoms stop. Am i a drug addict - No. Is my body addicted to or more accuractly reliant on this drug - yes. Big difference.
Pain is subjective - no one feels what you feel therefore no one can tell you that you dont need medication.
As a final point, a cousin of mine who suffered chronic back pain for 20 years died in her late 40s as the morphine weakened her heart and shortened her lifespan. These drugs have a cost long term and morphine based drugs taken regularly will shortern your life, so if you dont need them, dont take them. If you can't have a 'normal' life without them - take them - and enjoy every minute if you can.
Life is short.
Life is hard.
But its even shorter and harder if you live in chronic pain.
Excellent reply - so upsetting when clinicians try and ram cbt down your throat as if it's magic - gah! Anyway, I just wanted to add the example of diabetics type 1 who need insulin from a young age and it is very hard to manage without damage to other organs but they need it to survive. Best wishes 🍀🍀🍀
Been a while! Im setting up a chronic pain organisation and after such horredous treatment this week at A&E Ive contacted the Health Minister for Northern Ireland and I want some serious changes to come out of this. We need the NHS to support chronic pain not brush it under the rug and hope it disappears. If you are interested and are on FB ive a closed forum starting there too. painfullystrong.co.ukfacebook.com/painfullystrong/facebook.com/groups/painful...
Hi Lou, I agree! Many aspects of the health service seem to be in disarray - I joined the 'end our pain group' to help end cannabis prohibition - this endo-cannabinoid system thing seems to offer great promise. Research, funding - the whole thing needs updating - I know many people benefit from pain mmgt but I think it's in the dark ages... no follow up - a hassle to get appointments - gah!
I haven't got much energy at the moment but any support I can offer to anyone I would! big hugs x
You say: "NICE, faculty of pain medicine and the British pain society are all places to look for unbiased information."
Actually a lot of the information can be highly untrustworthy.
Information based on trials may not be accurate when applied to an actual living patient. For the trial information does not tell a person where they are on the population curve. Each patient needs to do their own investigation.
Ok, my final input to this thread, to show balance (and in so doing prove myself wrong on some counts) a comprehensive review of the negative effects of long-term opioid therapy:
And for the record, I am neither in favour or against it, just affected and therefore interested. For some they are essential, and it is all a question of cost vs benefit. IMHO.
I used to have horses, till I had an accident & ended up breaking my back, they fixed me, till I fell over in 2014, now I'm back there again.I've been taking strong painkillers since 2014, gabapentin, nerve numbing cream, zap in, methocarbamol, I know what it's like to suddenly stop , Nov 2014 had noroviris; geez I was sick, kept nothing g in even the pills came back up , 8 says in bed I had sweats, shakes, I ceased up, all coz I couldn't keep pills down..
So no Dr's shouldn't remove u ,it's like giving u a lethal injection!.
Thank you Daniel. The meds do allow me to live a normal life and earn a living, take care of my home, life, animals. Before my pain dr. found the dose for management, I was unable to work and was disabled, so I hope you are not calling me the one with names and so on. I am not arrogant, just a normal older person who happened to have a serious illness and then an accident on top of it. Without the meds, I might not have wanted to survive, let alone live a good life.
Sigh, which if you'd read my post you would see I had already said. I chose to post that link because it was in the public interest, I'm man enough to admit when I made a mistake. Are you?
For a man that went to University to study anything you certainly didn't learn to absorb information very well.
You can now add smug and petulant to arrogant, idiotic and some other insult I can't be bothered to look for as the list of offensive, personal insults you have thrown at me. Were you in the University debating team? Thought not.
You understand irony though?
Finally as I've also said repeatedly I am on less than 1/10 of the maximum dose I was on. 50mg if you really must know. Not addicted then.
And as much as you may wish it I don't plan on being dead in 10 years time, but none of us have a crystal ball, do we?
No go back and read your posts again. See who comes across as smug and petulant. Ask yourself why people react to your posts in the way that they do and then ask yourself if you add anything constructive to the site.
Despite your constant assertions that you are a medical genius I notice you haven't said what you actually do. If not a porter, a cleaner?
The NHS needs cleaners too so don't be overly embarrassed.
I feel very sorry that the discussion has turned to a point where patients feel the need to defend themselves from one unkind comment. Yes, we may do biofeedback, yoga, talk therapy (I have to at my pain clinic) and we may find relief without our medications. As for life expectancy: I want a full and happy life. If it is shorter because of my need to do work important to myself and others, then that is fine with me. I want love and kindness and compassion in my world. I feel terrible that one person's comment has made so many people have to respond to it, feel like they/we need to defend our desire to be free of pain. I think the subject should change to what we want in our lives, how we want to live, what we hope for in the future, how we can make this world and other people better and kinder. I don't think a response is necessary for a person who doesn't care about others. I want to make a difference in this world and have plans for the future that I would like to carry out. I want each day to be peaceful and have beauty of some kind in it, even if my body has its own pains and damages. I am more than just a body in pain. I am also a good spirit, a parent, grandparent, and caretaker. We can still live life while we have it.
As the next post says, you can't see the pain in someone. Unless you have it, you won't know it. If you don't have it, it is easy to dismiss, but sooner or later I think every human will find that there is a form of suffering. Buddhists say that life is about suffering and for some of us, it truly is already. It takes many forms. But the point of that view is to offer what warmth and care you can to each other being, to give.
Been a while since we talked on here. Holiday was lovely and I've had a nerve ablation and two Stellate ganglion blocks since and now unfortunately my pain has come back with a vengeance.
Hi, one little bit that might help someone. My wonderful RheumyCon (Hon Senior Lecturer in RA) said ti find Dr Claws at University of Michigan. Took a few minutes, then found what he was referring to:
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I'm new. Opiate prescribing 
Do you have to accept the generic
coping with constant pain
