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Five Clues That Your Pain Meds Might Not Be Helping As Much As You Think

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Many pain patients have taken opioid painkillers for many years, some for many decades. They report that the opioids help reduce their pain and that without them they could not function.

Unfortunately, many pain patients are having their worst fears confirmed about going off their meds. Many doctors, fearful of loss of their licenses or criminal prosecution as a result of the recent CDC guidelines recommending reducing opioid use, are abruptly cutting pain patients off from their medication or sharply reducing their dose. Many patients report horrific suffering and a deterioration in functioning as a result.

This does not mean, however, that the opioids have been actually reducing the amount of pain that patients experience. Let me explain a few reasons why I believe this.

The Placebo Effect

When a patient is given a placebo, an inert substance such as a sugar pill, and told it is a powerful drug that will help them get well, they often do. This effect is so well established that in order to get a new drug approved by the FDA, pharmaceutical companies must conduct clinical trials that include a control group that is given a placebo. It is only when the group that was given the drug does significantly better than the placebo group that a drug is considered proven to be effective. In clinical trials for drugs for inflammatory bowel disorder, pain control and depression, about 55% of the patients in control groups who received a placebo had significant improvements in their condition.

In contrast, more than 50% of patients who are prescribed opioids discontinue them, either because they do not work or because they cannot tolerate the side effects.

Rebound and Withdrawal

The rebound effect is the production of increased negative symptoms when the effect of a drug has passed or the patient no longer responds to the drug. If a drug produces a rebound effect, the condition it was used to treat may come back even stronger when the drug is discontinued or loses effectiveness.

Drug withdrawal is the abnormal physical or psychological symptoms that follow the abrupt discontinuation of a drug that has the capability of producing physical dependence. Physical dependence on opioids can occur within a week of starting the medication. Common opioid withdrawal symptoms include sweating, goosebumps, vomiting, anxiety, insomnia and muscle pain.

When a patient abruptly discontinues opioids, withdrawal and/or rebound may occur, leading the patient to incorrectly conclude that the severity of the pain they are experiencing is solely due to the severity of the underlying condition, rather than a reaction to the discontinuation of the medication. It is only with the passage of time without the drug that the patient can determine what the actual level of underlying pain really is.

The human body produces its own natural opioids (endorphins) to deal with pain. When opioids from an outside source are introduced to the body, the body reduces its supply of naturally occurring opioids. It takes time for the body to regain its natural capacity to handle pain.

It is irresponsible and highly damaging to patients to abruptly discontinue opioids after long term use, given these issues. With any drug that is being discontinued, slow tapering while increasing other treatment modalities works best.

Comparative Studies

Studies have compared patients who take opioids for pain management to pain patients with similar conditions who don’t take opioids. A large study in Denmark, for instance, found that chronic pain patients who took opioids had worse pain, higher health care costs, and lower activity levels than similar patients not using opioids. The authors noted that opioid usage was significantly associated with reporting of moderate/severe or very severe pain, poor self-rated health, not being employed, higher use of health care services, and poorer quality of life.

Other studies have found that patients who are given opioids for acute pain are more likely to progress to chronic pain than patients who were never prescribed opioids.

Pain Patients Who Get Appropriate Treatment While Tapering Off Opioids Do Better

A study at an intensive three week multidisciplinary outpatient pain rehabilitation program found that patients with severe and disabling pain who were taking daily opioids experienced significant improvement in physical and emotional functioning after participation in the program and withdrawal from opioids.

Pain patients need intensive, multidisciplinary treatment, not dangerous drugs. Please sign my petition to require insurance companies to cover this treatment for all pain patients at www.change.org

For more information, get your copy today:

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6 Responses to "Five Clues That Your Pain Meds Might Not Be Helping As Much As You Think"
  1. Lisa .Masson says:

    I am very interested in what your book has to say…as I battle each and every day with serve Fibromyalgia, and the extensive list of side effects or other conditions that seem to go hand in hand with it…to many to list as well as I am just tired of seeing and admitting that I am that messed up….and there is nothing my drs. can do for me but give me pills. Pills that’s don’t work or pills I don’t want because I can’t function… ?this has been going on since 2009 with me. Most days I just lay on the couch hoping tomor will be a good day. So…sorry for all that…but I am interested in reading your book and trying anything new that doesn’t have me drugged to the point of blowing bubbles ….I just miss the old me and want her back. Lisa

  2. RHONDA WELLS says:

    Greetings; My name is Rhonda Wells. I just wanted to say thank you for the information. I too have chronic pain. R.A. fibromyalgia, D.D.D. On opiods for 15 years. And no Im not better with the opiods. In fact I meantioned to my rheumatologist years ago that i felt as if the pain was more severe between doses. I thought it was my imagination. Im taking myself off of them gradually, but the pain is excruciating! Loved ones have recommended marijuana. But its illegal in our state.

    • Cindy Perlin says:

      Marijuana would be helpful but it’s not the only thing. Some people with RA find that eliminating gluten has put them in remission from RA. Aspartame (Nutrasweet) and MSG are also common culprits in chronic pain. Kratom, an Asian herb that I just learned about and that the DEA just tried to ban, has been helpful for many. A more comprehensive approach which includes an anti-inflammatory diet, exercise, mind/body approaches and hands on treatment like physical therapy or massage can all be helpful. Please read my book for more information.

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  5. Laura says:

    I took opioids for four years following a huge accident and the eight surgeries to put me back together. I shudder to think what those years would have been like without opioids. I am so grateful for these medications that made the excruciating pain that I experienced bearable.

    When my last surgery resolved most of my pain, I tapered off of all opioids over about six months. My surgeon allowed me to set the pace of the taper and even did refills a few days early a few times when I tried to taper too fast and ran into withdrawal symptoms. Because I was in control, the taper was surprisingly easy and the only withdrawal I experienced for any length of time was yawning and watering eyes.

    The entire tapering process was empowering and humane. I was allowed to listen to my body as it reset itself to functioning without these medications. This time also allowed me to slowly adjust psychologically to the fact that I didn’t need these meds anymore.

    The psychological adjustment to tapering off opioids was as important as the physical one. Opioids had been a vital part of my life for years and I think it was important to be given the time to gently let them go. I shudder at the cruelty of forcing people to drastically cut dosages after having taken these meds for years or even cutting patients off cold turkey. It’s not just the physical hell of withdrawal and massive rebound pain, it’s the psychological shock of taking away a medication that allowed life to be manageable from one day to the next.

    Dealing with chronic pain is a constant fight to regain control over one’s life. Yanking away an important support that allows one to control pain is psychologically damaging and is incredibly cruel. Even for patients who still have access to meds, living with the constant fear that they’ll be taken away at any time adds so much more stress and suffering to lives that are already very difficult. Pain patients are just the latest victims in the unending, futile drug war that has destroyed millions of lives around the world.

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