Painkiller Addiction Versus Chronic Pain Management
It’s an ongoing debate in the medical community and among those who suffer from chronic pain: is it worse to suffer from pain or deal with addiction to the opiate painkillers prescribed to alleviate that pain? According to Medical News Today, the debate continues and neither side of the argument shows signs of giving way.
No one thinks that opioid-based medications should be done away with completely. Obviously. Chronic pain is an issue of quality of life and we live in a scientific age that allows us to live free from pain. Doctors struggle with the legal implications of possibly affording someone a prescription for illicit purposes as well as the ethics of treating their patients to the best of their ability.
What the Professionals Have to Say
Srinivasa Raja, MD is a professor of anesthesiology at Johns Hopkins University Medical School. He says:
“Physicians today face a dilemma in trying to balance the needs of their patients with demands from society for better control of opioid medications. We also are dealing with unfounded accusations in the media that increased prescribing of opioids for severe chronic pain is responsible in large part for reported upswings in the abuse of pain medications.
“We do need stronger evidence about which patients will benefit most from these medications to help make better prescribing decisions.But for most chronic pain patients, drugs are not the sole solution. More and more studies are showing that multi-faceted treatment involving physical and cognitive-behavioral therapies and appropriate interventional strategies lead to the most favorable outcomes.”
The American Pain Society
The American Pain Society is “a multidisciplinary community that brings together a diverse group of scientists, clinicians and other professionals to increase the knowledge of pain and transform public policy and clinical practice to reduce pain-related suffering.” They believe that the best way to deal with the problem of prescription drug abuse is through the collaboration of the medical and legal communities as well as the pharmaceutical industry.
Says Raja, “First, I believe physicians should be diligent is communicating with their patients about the benefits and risks of opioids and also screen them for drug-seeking behavior and other warning signs of potential abuse. Also, we must monitor patients carefully to determine when doses can be lowered over time as they improve their pain control and overall functioning.”
What do you think?
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May 18th, 2008 at 10:30 am
I do agree that we can not do away with pain killers because people do need them.I think there should be more info available regarding addiction when a person is perscribed an opiate. I had chronic pain and was perscribed an opiate for pain and after a while my body needed more and more of it. I had no idea this was a sign of being addicted. It really did sneak up on me. And now I need help of making a switch from methadone to suboxone but I have been told by a doctor first you have to get back on an opiate and quit taking the methadone for seven days while taking the opiate like oxycodine for those 7 days and then stop taking that and start the suboxone.Of coarse there was a place that wuold help you do this but they wanted $5000 to do this. I dont have that kind of money so I am hoping and praying that a doctor in my area will help me do this. Iwant off of the methadone more than anything.
People should have more knowledge of this before they start taking an opiate.
Sincerely,
Tanya
May 20th, 2008 at 1:45 am
What is the easiest way of getting of Subutex/suboxone? I am absolutely terrified and tried several times. Can methadone be used? I was on Subutex for chronic pain, although it did not help.
May 20th, 2008 at 3:47 pm
I agree that it is addicting (opiates) but why make them to begin with if u are going to restrict people from taking it? smoking can kill you but thats legal!!! howcome?>>>>> well lets see beacuse they can tax u on that therfore its legal! u see how that works now? the same thing with alcohol! we are just puppets that have to follow someone elses rules until we make our own!!! i am a cronic pain patient and i didnt know how addicting opites were either until i relized iam taking 20 vicodin a day! its not our fault but the pharm companys the goverment and the doctors! its just another way for them to make money off of someones misery! i hope they all have a cronic pain problem in the future to understand the actions of a few!!!!!!
May 22nd, 2008 at 10:51 am
Hi, Tanya. I was thinking about what you said, and I wanted to know what you think: if someone had sat down with you and gone through all the pros and cons of opiate painkillers, do you think you would have chosen another method of chronic pain management? Now that you’re trying to get off opiates, is your doctor helping you to come up with other way to deal with pain?
Hi, Zelda. I’m surprised they had you on Subutex for chronic pain. My understanding is that that’s pretty uncommon. What does your doctor say when you ask him or her about what to do next?
Hi, Nija. 20 Vicodin a day! That must be so frustrating for you, not to mention expensive. Has your doctor talked to you about other pain meds or helping you find other ways to lessen your pain?
May 23rd, 2008 at 7:36 am
i am on methadone for cronic back pain, i also need either more of them or up the mg. im on only 10 mg now 2x a day.i would like to get off but nothing else works. i was on oxycontins.my pain mang doctor wont cooraperate with me. said dea is comming down on them lol.
May 24th, 2008 at 9:40 pm
to Pam:
Hey I have been on methadone for a while now and I am telling you that you do not want to stay on this med. You are not living. I guess everyone is different though. You would not beleive the weight gain I have had from methadone. I am trying to switch over to suboxone but I have been told that I need to switch to oxycodone first for at least 5-7 days and then start the suboxone. I am now trying to find a doc. that will help me do this! If you stay on methadone don’t go up to high on your dosage.
May 25th, 2008 at 10:49 pm
I’m all for coming off the pain meds that I’m addicted to now. But until the doctors can take away the original pain, why come off them. If you can’t function without them, why take you off them unless they can cure the reason you started taking them in the first place? I’m prescribed perc 15mg per 4xday and 40mg oxy 3 per day. I take the percs 2 at at time because they don’t work and I take the oxy’s 2 in the morning and 1 in the afternoon. Oh yeah, When I run out, everything hurts worse and I have a real hard time moving. Is that what it’ll feel like if I de-tox? Who wants to feel like that? What helps? Chronic Pain is CHRONIC. How else do they fix it?
May 26th, 2008 at 7:16 pm
I know, Bonnie. That’s exactly why this is such a difficult problem to fix: do you deal with the pain or do you deal with the addiction? Eventually, the pain meds won’t work either, which creates a whole other dimension to the issue. I wish I had an answer.
May 27th, 2008 at 1:18 am
Tanya, I know you have to be on 30ml of methadone before switching to suboxone. I do not know how long you must wait before switching over. Yes, it is good to find an appropiate doc to help you with this. You making the right choice.
May 27th, 2008 at 1:22 am
Doctors put people on opiates with the idea to take it as short as possible before another not as addicting drug kicks in to help relieve the pain. I fully understand, because I had severe fibrommyalgia, and did not want to stop painkillers either, but then I end up taking 5x DF118 (dihydrocodeine) per dosage. It could of killed me and at that stage it did not much for my pain. The thing with opiates is your body getting dependant too quickly and eventually will stop working and then you are in trouble.
May 27th, 2008 at 1:30 am
Tanya, I never heard of switching over to another opiod before going to suboxone. Pam, you are not on such a high dose of methadone and suboxone is not going to help with chronic pain, it is basically just to gett you off the methadone. What are you going to use for pain then? Maybe he should up your dose to 30mg for a while and then you could go to suboxone when your pain is more under control? What type of pain do you suffer from, if I may ask?
May 27th, 2008 at 8:25 am
I have had chronic back pain for years stemming from 2 herniated discs - which I was on about 4-6 vicondin a day but as time moved on I needed more. Then Oct ‘06 I got hit by a taxi cab when I was in the cross walk and flipped over the cab landing on my head, compound fractures of my right fib/tib bones. They were scooping the bones off the street and putting them back in my pants. 6 days in the hospital and I was on morphine, oxycontin percs.
So, three operations and two years now I am still having major pain. I have talked to my doctor (been honest really helps) and said and would like to try and lower narcotic intake. well I have gone too low a few times and I have had to fast de-tox on my own. The first couple days are rough (nausses, no sleep, cant get comfortable for more then a few minutes without having to move again, then diaria and 5 -7 days your left with your chronic pain. and a three days till you can renew prescriptions. I have had various conditions that have made me take more and run at faster. Detoxing is not fun but neither is the pain.
May 28th, 2008 at 7:05 pm
I’ve seen both sides of this battle field; and I must say the medical community is so incredibly ignorant and arrogant when it comes to pain and the use of “effective” pain control methods, especially long term opiate use. I’m only 30; and have been fighting what 99% of my doctors called “chronic pain with no known origin.” In other words, hey, she’s young, and she knows what she’s asking for, she must be a drug seeker!!! Forget the fact that I’ve delivered babies for 7 years, dated an anesthesiologist, and do know a thing or two about pain - “real pain”!!!
When I had an active part in my treatment, low dose Oxycontin (20mg) twice a day, worked great with physical therapy and massage. However, once I moved to Oregon (where I’m from and do love - I’m not trying to put Oregon down), the doctors became archaic and adapted the attitude that my pain was suddenly depression related. Sure I’d become depressed; but the pain started first. Basically, since I was asking for Oxycontin and because “Oregon is more strict” regarding prescribing this medication (so they said - but I’ve yet to see that on the other end, as the health care provider), they put me on EVERYTHING else; none of which worked.
So, the doses kept getting higher until eventually I was on Methadone 160mg a day (40mg four times a day). After almost a year of complete functionality at this level; and still in pain, I was flat out mad (I suppose I still am). I eventually took myself off of it, cold turkey. NOT FUN!!! Of course once I was “clean” and still in the same amount of pain, I had to have surgery; and was put on Oxycontin, which worked wonderfully but unfortunately at a high dose (which my insurance company wouldn’t fully cover - and now that there’s no more generic Oxycontin, I can’t afford it). So, once again, here I am, having to go cold turkey; only this time I’m not starting out in pain. However, I’d rather be “disabled” and in pain than go back on any of the other opiates, knowing they won’t work.
Moral of my story: don’t believe anything one doctor says to you if it doesn’t “jive” with what you’ve experienced. And, definitely don’t let yourself be put on methadone for pain control! (Well, yes I’m biased against it, and yes, it does work for some people; but it’s SO LONG ACTING, it takes FOREVER to get out of your system - making “drug holidays” to drop your tolerance an impossibility.)
Oh, and it turns out, after several years of “a fibromyalgia/depression diagnosis combo” I actually have arthritis, degenerative disc disease, and I’ve broken off pieces of a part of my spine at several levels - and that took changing (or being fired by) over 10 doctors in 3 years, to find one that would order an MRI, instead of just looking at my past several years of “mental health - or lack there of” and “substance use” - all of which was ALWAYS prescription and legal (frustratingly so, since I’m a nurse who has to follow the rules).
Good luck to you all!!!
May 29th, 2008 at 4:21 pm
Bethany, that’s such an intense story. Thank you so much for sharing your experience. I’m really impressed with the way you’ve managed to keep such a level head through all this. To call what you’ve been through “frustrating” is the understatement of the century. I wish you the best of luck. Let us know how you’re doing.
May 29th, 2008 at 11:40 pm
Zelda:
I was told by a clinic about switching over to oxycodone before suboxone. The reason is you have to be off methadone for 5-7 days before you start taking suboxone so during those 5-7 days of stop taking the methadone you take the oxycodone to replace the methadone so you dont start withdrawing and hurting. I want off the methadone more than anything. I have researched the suboxone for weeks now and it has said you pretty much are drug free after so long and it is alot safer than the methadone. I pray that you all find your answer and soon. No one deserves to live like this.
May 30th, 2008 at 7:00 am
I have been on subutex and suboxone for 2 years. I was allergic to suboxone (the naloxone in it) so the doctor put me on subutex. I do not think that I would have ever stayed clean without subutex. It took my cravings totally away, like a miracle! People say that they get “high on it, well not if they are taking it the right way! And the great thing is that you don’t crave to anymore. It is a great drug if you want to get clean and sober. Then after you are for a while, you will see all that you have missed, and never want to miss out on life again.
May 30th, 2008 at 9:49 am
Tanya, the only thing concerns me is the following. Are you still in pain,because the suboxone does not help for pain. I was prescribed for pain and it did nothing and on other websites, you’ll see that it’s not meant for chronic pain.
May 30th, 2008 at 3:50 pm
my chronic pain was caused by a car accident some 25 years ago.after a year of bed rest and medication i tried to go on with my life.had to change professions since activity would cause me to be bed ridden.became alcholic using as pain killer.hospitalization in mental hospital to get off booze,then came opiates in form of percocets till was up to 10 a day then the oxys.10 mg,20mg,40 mg finally the 80 mgs problem is a police crackdown on doctors left me with a retired doctor with unable to find a new doctor that will perscribe i must be weak i started buying on the street as many attempts couldn,t bear the pain,now i.m broke after losing my wordly poccessions sold to buy pain killers…the depression is begging to make suicide as the only way off of this merry-go-round
May 30th, 2008 at 4:35 pm
Wayne, I know this difficult for you. I’m so sorry this has been so hard. I wish you only the best and hope that you find a way through this.
May 31st, 2008 at 2:34 am
I too have chronic pain from crohn’s disease and herniated discs. Crohn’s causes pain in all your bones and joints. I too started out on Vicodin and need to keep upping the doses. Then I changed doc’s because they wanted me on the patches and they made me suicidal. So this new doc put me on Methadone. And for me it was a Godsend. Methadone is used for chronic pain. It has a long half life of 22 hours which makes this a good med for chronic pain. Your Percoset and Vicodin have a half life of about 3-4 hours thus you have to keep taking it all the time or you are in withdrawls. I take 40mg a day and I am in no way pain free, but I don’t want to up the dosage much either. Methadone is by far the safest pain med there is when it is used correctly. It does not damage your liver or other organs like all of the others. From reading all of these posts, most of you have confused pain pill addiction with dependancy. Addiction is a brain problem in that addiction causes alcoholism and drug addiction. But, dependancy is what the body experiences on pain meds. Let me clarify. Addicts crave the pills to live and function. Most people on pain meds are not addicts. But, your body does develope a dependancy to the pills. This is two completely different situations. If you do not have a problem with alcohol or illegal drugs then you will probably not have to worry about addiction. Dependancy is caused by the body needing the drug to keep itself from going into withdrawls. Medically there is only about a 10% or less chance that you will become an addict from taking the pain meds as directed from your doc. However, your body will still have to be withdrawn from the meds when the time comes. I for one can tell you, it is so much harder on the mind and body to be in pain all the time. I have been in pain for 19 years. Only on pain meds for the last 8. Pain is the killer. Pain is what will drive you to suicide. Methadone is very, very safe when taken exactly as directed. I am thankful for it every day. Maybe some of you that have posted need to hook up with a good pain management doc. They will change you life for the better. Don’t be afraid of methadone. It is one of the best if least used pain meds there are. Excuse my spelling please.
June 2nd, 2008 at 8:07 am
Wayne, I do know what you’re going through. My doctor left his practice due to the crackdown. You’re not weak. I also know the narcotic dealers in the neighborhood. Please send me a note as I do NOT want you to hurt yourself. A friend of mine and myself are going thru the same thing (pretty much) as you are. Treatment for the pain or treatment for the addiction. I’ve lost my job as I can NOT function for the pain. Disability has denied me twice so I do need to find a job but who can drive on pain killers let alone work…Where do we get money? Finding a pain doctor is hard depending on what you are. I was able to find one but I don’t know for how long as the pharmacy wants to red flag me because I take pain killers. It is definately hard to move forward when you keep getting knocked backwards.
June 2nd, 2008 at 4:40 pm
Wayne, I am so sorry you are going through such crap. I am just myself starting to seek help with my addiction to percocet and I am scared of trying to deal with my chronic pain without the medicine but please hand in there, I have spent a fortune on buying percs too but it does get better, I have friends that have been to hell and back but dont let it take you. You will see when you get clean that life is worth living. Please go get help, tell the doctors even if its the emergency room. please dont give up suicide helps nothing.
jan
June 3rd, 2008 at 8:14 am
Someone PLEASE listen to what I have to say and direct me to the right place to give this information to. I know this program is making money for themselves, however, I successfully detoxed myself with minimal if no withdrawel symtoms using a combination of methadone and Lyrica. I did the methadone in the 3,2,1 and 1/2, then 1 and then 1/2 as well as each day taking 300 mil’s of Lyrica. I’m telling you it worked, I was up everyday doing the things I needed to do and I slept well at night. Believe me, I couldn’t believe it myself, I just kind of fell upon this detox process and it worked, I am now free of opiates and I feel great just in 6 days, Pass it on!!!!!!!!!!
June 7th, 2008 at 10:37 am
Hi All, I was A paramedic until i was carrying a Pt. down a flight of stairs on a stretcher with my partner and the stairs broke right underneath me, and i went through. I have suffered from herniated L4 L5 S1 discs and now disc degeneration. The wonderful company i worked for let me go due to my injuries on their time and doing their job( im not the first). This happened in 2002. I have been on every painkiller known to man and find that Vicodin 10/325 works the best, however I can’t move with out it due to 10/10 pain. Bethany’s story hits so close to home as i have gone through the same B.S. that she has.Being a medical professional I can tell you that the D.R.’s I have seen have all done or said pretty much the same thing, your depressed blah blah blah, well I wasn’t until i had to live with pain for the past 6years! I have found that marijuana has helped with the pain as well but who wants to go through life stoned 24/7? so yes i am addicted to vicodin but on the same token (no pun indented) it gets me through life, and allows me to work and function close to normal. I’m just lucky that I could go back to my old profession in the Music industry. The medical field (as Bethany will probably agree)is all about WHO you are and the insurance game,not what can we do to help.I just wonder after taking the meds for so long how bad am i screwing up my body? i keep the apap low in quanties so as to not do liver damage. Thanks for listening.
June 9th, 2008 at 10:37 am
To all of you,
I feel for you all, I to am in the same situation as you all. I was on oxycontin for a c-section that went wrong. I was on 20mg 3 a day. I was given the for 3 months then taken off with no notice. So of course I went through detox. So here I am trying to do whatever I can to get them. Finally after years of the bull I went on methadone I was on them for 3 years. I couldn’t take it anymore I wanted my life back so I detoxed cold turkey. Eventually the pain started coming back again from the car accident I was in years ago. I didn’t want to go back on the pain killers but I had no choice. My back and legs would lock up to where I had to have my son get me out of bed. So now here I am on pain management. I am on 4 15mg roxycontin which is the same thing as oxycontin. But like you all I have to take more just to ease the pain because of my tolorence is so high but there is a highlight to my story and I hope It can be of help to you all. Along with the roxy’s I am on Tramadol it is an opiate agonist. It acts the same way an opiate would but it is non narcotic and yes it helps take away the pain. But the better part is that when I run out of my meds like we all do cause a 30 day supply is really a 15 or 20 day supply, this med works, you are not sick when you take it.So, I say to all of you If you are serious about lowering your dose of narcotics then ask your dr for tramadol. I am proof it works. I know exactly what all of you are going through and I wouldn’t wish that on anyone. Another name for this med is Ultram but it is so expensive that the generic is best to get so make sure you tell your dr you want the generic form of Utram. The only thing that is different is Ultram comes in extended tabs and tramadol does not. But on my eyes if you take Tramadol cause you’ve run out of your meds it does help…If anyone would like like to know more or just vent you can e-mail me if you like. My e-mail address is TyJacChelsMom@comcast.net
Blessings to you all
June 9th, 2008 at 5:54 pm
First came the diagnosis of lupus by being diagnosed with transverse myelitis, a million to one complication of Lupus. This meant my own body destroyed my own spine at the thoracic level. Then came three failed discectomies over three years. Chronic pain now runs my life. On bad days I crawl to the bathroom crying the whole way. Now after six years of Duragesic and actiq use now at very high doses. My husband decided with my doc that maybe I should detox. I was given 8mg of suboxone every 12 hours, suffered terribly from withdrawal, then went into convulsions. I am scared to death– who do you trust? All his accreditations were ok! these meds are costing 15,000.00 a month and ruining my marriage no less my life. I just wish I could find help!!!!!!!!!!!!!
June 10th, 2008 at 8:01 pm
Wayne, I know all to well about losing everything over painkillers! Even to the point that I tried to commit suicide because I was out and could not go to work without them, crazy but that is what this merry go round is all about. I have not only lost worldly items I have lost custody of my children. I now have been on a Suboxone treatment and life has picked up, God is there for me also. I see life in a different light, I breathe a different air and I see my children as much as possible. Don’t give up remember this it always helped me when I was down. “I once complained because I had no shoes, until I saw a man with no feet”Hang in there, my prayers are with you and I wish you all the best you can make it!
June 13th, 2008 at 8:08 pm
I suffer from chronic back pain from degenetrive disc problems. Two discs in my lower back have no cartlidge and are rubbing together. Short of surgery (fusion) all I am left with is pain managment. I was getting steroid injections in my spine and also injections called facets, about $1500 per visit every other month. The injections worked wonders for my pain. Then I got laid off and lost my insurance so the doctor turned to opiods for treatment (Methadone-60 MG ~ day and lortab 10 as needed for break through pain) this went on for years after I started working for myself, still no insurance. After tolerance built and I ran out early I could not stand the withdrawl pain and called 911. They took me to the hospital and the med. staff made a spectacal of me, charged me about $2500 to do nothing. They in turn called my pain doctor who cut me off cold turkey with no disscusion possible of tapering off.
She told me it is not her responsabilaty and to go sign in to rehab. Still no insurance mind you. After all the years I was her patiant, all it comes down to is her drive for MONEY when the money stops she basically kicks you to the curb.
June 14th, 2008 at 6:55 am
Has anyone actually detoxed from suboxone yet? If so please email me at managethis8@yahoo.com, I am really scared
June 14th, 2008 at 8:04 pm
My wife has claimed migraine headaches for almost four years now. In 1500 days she has been to many different Dr offices for mid-level injectable meds about 200 times for nausea and pain; on continual meds at home all sedatives- phenergan,valium,clonazepam,lortab,phenergan cough syrup with codiene,zanax, zanaflex (most effected by-halucinations and highly emotional and angered),phentynal suckers (wrecked our new car while driving around sucking on 8 of these in 1 day - 2 max per day)),and for the last year her rhuematologist, who sees her for fibromalgia, has been prescibing Stadol nasal spray (said most addictive legal RX)- one bottle per week, for migraines- a rhuematologist prescribing for migraines? go figure that one- and he has never talked to me, the husband, about any of it.. One bottle should last as perscribed at least three days. It lasts her about 1 1/2 days.
In addition, she has been to local ER’s almost 500 times for huge amounts (enough to kill the Dr that gives it- he/she says)of opiate injectables (at first in the butt; now IV)all around our area and where ever we are at on vacation (seldom go because of her condition). Twice she was forced into detox and treatment, never finished; she says she is not like those street drug people; they are having fun with it; she takes legal prescribed stuff and only because she hurts. I dont deny she hurts; she has a hard time just geeting around the house, except for Dr and ER visits.
I have one question; Can a migraine sufferer @ a #10+ watch TV, have all the lights on and read a news paper, play with our dogs, go to the casino and play slots for hours, go to the local ER with a #10+ and see that the wrong Dr is on call (small town; 5 Dr’s (we know all of their cars)and only 2 will give her anything)so we leave and at her request go by a local restuarant and I get food to go and we go home to eat and she stays up for a couple hours reading the paper and watching TV. One more story: I go out of town on business and take my wife; there are several casinos near our hotel; while I am in meetings all week she is playing slots. One of those days she plays for 12 straight hours; picks me up, says she has a #10+ migraine and has to find an ER. We find one nearby and she gets a huge amount of opiates, phenergan, and valium. She asks the DR for more because it has not worked on the pain, he says no more, we get out in less than 10 minutes, drive three blocks and she wants to stop by Walmart to get a few things, we shop for 1/1/2 hours. All with a #10+ migraine?
For you who sympathize with her, she has always been a self medicated person and I have (31 years)and will always love her; for those of you with questions - I know I am an enabler. I along with her mother and father (in the same small town)have tried everything but tough love. That seems to be very near.
What is as disturbing as her condition is the fact that NO Doctor has ever asked me to the side to get the facts from me; I have journaled in detail, alot of it.
My conclusion: Migraines are the PERFECT CRIME- Doctor can’t prove they have a migraine or they don’t; all they go on is the symptoms. How easy is that? The doctor should compare symptoms vs. actions; and rely on family member ,ALSO.
Thanks for your time and any reply or addvice.
July 30th, 2008 at 10:48 am
TERESA-
Let me just start out saying that METHODONE is not safe at all!!! It happens to be one of the most dangerous drugs….not only do people overdose on them because of their half life, that can last 24-48 hours..the high comes and goes in waves…so they feel the need to take more.I have had to see someone overdose on Methodone to feel this way and do the research to find out why more and more of the people in my area die from this drug. My boyfriend also suffers from Crohn’s Disease and it has tremendous effects on the organs and bones. Trust me do the research. Plus the withdraws are worse than if you were doing heroin and last much longer! Please understand that I am not saying these things to be rude or negative, just concerned. Methodone clinics do not tell you that methodone is addicting and people think that it is a simple safe way to get off of opiates without withdrawals…..this is not true. But as long as the Methodone Clinics keep making there money…I’m sure they will keep handing it out with a smile.