Our pain matters

This week in British Columbia  and Nova Scotia, the colleges of physicians of surgeons adopted new guidelines on prescribing opioids, based on those from the U.S. Centers for Disease Control and Prevention.  
Juurlink welcomes the CDC's recommendations, because they discourage using opioids liberally and give suggestions on limiting doses. He remains reluctant to prescribe fentanyl to his non-terminal patients.
"The goal is not to put a patient on a drug that is self-perpetuating and difficult to stop," Juurlink said. "I think until doctors and patients start to appreciate that phenomenon and confront it, we are going to continue to mismanage patients with chronic pain by putting them on opioids for years at a time at high doses in the absence of medical evidence that that's a good thing to do."
There are specific situations where it might be appropriate to prescribe for chronic pain, he said. For example, if someone has debilitating osteoarthritis and other drugs are inadvisable because of kidney or stomach problems, Juurlink said he will occasionally turn to low-dose opioid prescriptions. When he does, he ensures the patient understands the risks and plans an exit strategy.
"It's a very difficult conversation that doctors face every day with these chronic pain patients."
When putting a new patient on an opioid, it's impossible to know who will benefit, suffer side-effects or spiral into addiction.  
Stopping the drugs is also fraught. Many patients are convinced they need the drugs because of the physical dependency and sickness that occurs when trying to cut back.
"There are so many people around the country on high-dose opioids, it's very difficult to craft a cogent argument they're being helped by these drugs," Juurlink said. "Many of them I think would be much better off, from a depression perspective and a pain perspective, if we could gradually work them down to more sensible doses." CBC News
I worry that Canada, where I live, two provinces have adopted the American CDC recommendations on opiates. First, we are not the same. Second, they are in a stirred up frenzy from the skewed media and I thought we would deal with the situation with a little common sense.

I actually think we have less of a opiate addiction problem within the chronic pain community as an actual pain management problem. Pain management is really quite sadly lacking. That is never addressed. And now, will every be less addressed. It is really quite disturbing to be honest.

Opiates are part of some treatment plans. And there are the last resort as it is. They are very necessary in other treatment plans. Because as we all know well pain killers are not that effective at treating pain. They are just the best at what we have currently to manage it for some patients. But they don't actually do that well of a job and you have to deal with tolerance and dependence issues. They just dull the pain a little really. They are meant to help with functionality and quality of life. Remember that. Quality of Life. Take away opiates in those where it is Necessary and you are lowering their quality of life.

Chronic pain research really has yet to come up with viable alternatives. Research is just so new. And new studies are coming out every day, but I don't see anything actually out there to help any of us. Right now it is all how about you exercise and mediate and don't think negatively. Well, I don't know about you but when you are in a crapton of pain that only gets you so far. Actually, doing those things it helps when your pain is being managed, otherwise it is rather... difficult. All those suicidal thoughts get in the way. Or they did for me when my pain wasn't at all managed. Meditate... on the pain. Think about... how much pain you are going to have for the rest of your existence. Don't even think about exercising. Don't even think about working. Don't think about leaving the house. Socializing. Doing anything. Pain, pain, pain. Don't think about having a life. Think about ending it though. So what if opiates are part of your pain management? Shouldn't a pain doctor have that tool at his disposal? I was on Lyrica, Cymbalta and more and they did nothing for me. Cymbalta Caused suicidal ideation and intent, which I hardly needed. Yes, those options needed to be explored, but don't think they don't come without a lot of side effects and risks of their own. And if there is not actual effect going on what then?

At a certain point if you lower that quality of life and increase that pain enough, you will get patients with suicidal ideation and intent. Pain is a suicide risk factor all on its own. Doctors should know this. Suicide happens when pain exceeds the capacity to cope with it. With pain management you can teach all the coping skills you want... but it the pain gets extreme, they have no quality of life, then they are going to have issues coping with it... those strategies that helped them manage before will fail. It happened to me. I coped well and then the pain increased and I could no longer cope the way I did, the pain exceeded all those strategies. Medications tried didn't work. Pain got the best of me. Sometimes it still does to be honest because it still is barely managed even with the coping strategies I have. It is difficult to manage.

I have never in my life had a doctor hand out opiates irresponsibly. Never been on any strong opiates long term at all. Primary doctors tend to do what they ought to do and try alternatives first. All those off-label medications. Maybe for far too long. In my case, quite a long time. Too long it turned out. And I am currently on a slow release tramadol for FM, daily chronic migraines and hypermobility syndrome from the pain clinic. Personally I think it is very mild painkiller and I say that because my pain quite exceeds it. Just maybe that is why I am on it. Just imagine the pain without it. But you can't. Just maybe I wouldn't be on it if anything else worked. Certainly I wouldn't care then would I? If anything else worked I wouldn't have been sent to the pain clinic. And I would have managed pain. And I would still be working full time and have a career. Maybes are all nice and snazzy if life were perfect and pain was easy to manage. But sometimes, it is complex. Sometimes there are no easy answers. My neuro(s) told me I simply do not respond to medications and that there is nothing for me. Maybe they are right and maybe research will catch up to my brain someday soon. Maybe pain complicates pain.

I have this preference for not wanting to die. Isn't my life worth more than dying by suicide? Isn't every ones? I wonder how many people will be left in that place I was not too long ago. How many people are now. That raw desperate place so full of pain. That existence by inches. We already have a pain management problem. How worse do you want to make it? I'd like to believe they will treat the pain that matters. But from experience I know they won't and opiate hysteria will not help. Shaming the patient will not help.

Our lives matter. Our pain matters. Who gives us a voice in this? That we deserve to have a quality of life?
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