Are opioids appropriate for the chronic pain of inflammatory arthritis?

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The opioid debate. I read an article today about how opioids ‘don’t work’ for chronic pain. That chronic pain is not severe enough to warrant opioids (um, really? Why do people continue to think that the words ‘chronic’ and ‘mild’ are synonomous?) and that chronic pain should be looked at and treated largely the same way other *PSYCHOLOGICAL* diseases are.

Excuse me. But OMFG. Clearly the learned doctor who wrote that article has never experienced severe chronic pain (yes, pain can be both chronic, and severe.)

Without opioids (my opioid of choice is oxycodone. Sometimes I switch to oral morphine sulfate for my slow release med) I would live my life on the couch. I’m not much of a cryer. But I would cry a lot. I am not suicidal, but the pain I experience without pain meds has brought me to the brink. The idea that I might have to live with this pain forever, with no chance of relief, no respite, has made me want to quit life at the most base level.

I’m not ashamed of that. But the doctors who refuse to treat chronic, severe pain adequately (or at all) and suggest we should meditate and do pilates and learn to breathe from our diaphragms and talk it through with our psychologists, because really its the FEAR of the pain, not the actual pain, that’s causing our problem, should be ashamed.

Deeply ashamed. Is it not the job of a physician to relieve suffering? In the absense of the ability to heal, at least. To withold treatment that relieves pain is nothing more than sadism. And not the act of a compassionate being.

But getting back to fear…the FEAR of the pain. How can you be afraid of severe pain if you haven’t felt it? And is it not reasonable to fear pain that leaves you keening in the fetal position, incapable of feeling anything except pain? Incapable of doing anything except allowing tears to slide silently down your face?

How can this fear even exist, if this pain is not real, if this pain is not severe, if true, severe pain has never been experienced? It’s utterly non-sensical.

I don’t take my breakthrough pain medications prophalactically. I take them when I start to feel the pain breaking through. That’s why they call it ‘break through’ pain. It breaks through the base level of the slow release pain medication that I take daily. THAT’s what its for. And for me, it’s necessary several times a day. IF I wish to achieve anything, that is. If I choose to try to have any kind of life.

Today I started painting my son’s room. I did the skirting boards and his wardrobe doors. Something that would have taken a normal person maybe two hours was my full days work. It involved extra oxycodone, many rest breaks, ice packs for my shoulder, hands and lower back. And heat packs this evening. But I was able to do it, and I’m proud. Without the oxycodone, there is no way I could have done that. Opioid pain relief works for me. And works reasonably well for me. And I should have access to a medication that alliviates some of my pain and gives me a better quality of life.

It is, and should be, medication of last resort. But it is a valid therapy. And it gives me a life. And no amount of education, or schooling or writing of PhDs means that anyone else knows more about my body, and the pain that I experience, than I do.

My pain is not psychological. My pain is not borne of me being in FEAR of pain. I haven’t had a day without pain in many, many years now. I don’t have time to sit around being afraid of hurting something. It all hurts anyway. And my time on this planet is limited. I’m going to live the life I have to the full. Even if that means having to lie on the couch often, to recover. Or to prepare.

Physicians who refuse to address pain, or prescribe opioids for chronic pain, where it is completely appropriate, such as in the case of active, uncontrolled inflammatory arthritis, are negligent and derelict in their duty of care. In their most basic duty of care.

First do no harm. Refusing to provide pain relief is most definately doing harm.

Um…sorry for the rant. That was going to be a two or three liner. Turns out I had a little more to say on the matter. But this stuff makes me mad. Really mad. While opioids are easier to have prescribed and obtain here in Australia, what I see happening in the US is scary. And is starting to happen here too. Because highly educated intellectuals are pushing their own agenda, whatever that may be, and ignoring the clear statistics that show that less than 1% of people who take opioids for chronic pain become addicted. And people who have suffered quite enough, are being made to suffer more.

3 COMMENTS

  1. I think those of us with chronic pain are the new group that is subject to ridicule. I hate being the new punching bag for Americans. This has been a tough issue for me. I saw my mom nearly die int he 60’s when the doctor abruptly discontinued an opioid pain reliever for significant nuropathy (an outcome of diabetes). Mom spent 3 months int eh hospital and was near death most of the time. She recovered and lived a life of shame and pain until her death in 1986.

    What i recall most is her feet swelled like two small watermelons and no pain medicine for fear that she would be an addict. i know how terrible life is when there is chronic pain and understand the stigma attached because of my own occasional use of opioids for pain relief. Lets hope America finds another way to get their jollies as opposed to making us the butt of the joke.

    rick

    • I’m so sorry your mother was treated so terribly (or not treated as the case may be) Rick, and that you had to watch her go through it all. Especially when it was all so unnecessary. It’s a very cruel joke.

  2. Not everyone who uses an opioid parties on it! I have just been dx with RA and have been in a severe flare over a month. Devestating! I have no idea what to expect in my future. The flare was brought on by a knee replacement. My intention was to get off meds immediately with the knee but when the flare came I have used 1 Tramadol a day. I am in agony. But I am so fearful that I will not be able to get anything from the Dr.s in the future that I am hoarding these Tramadol like gold coins. I have 3 oxicodone left over from my surgery and I am hoarding them as well. I would rather live with the pain than the fear of the pain and that’s what those 3 pills do which is if I can’t handle it I will be able to take one of those three. Pilates, tia chi, hot baths WTF? Are they kidding. I hope that I will find a Dr who will understand that we deserve days without pain. I am so clear I don’t want them when I don’t need them I fear they will not believe me. Thanks for letting me rant. I am new to this and so newly upset, angry, sad and despairing. But I know I can get to positive and thankful too. Maybe not in this moment but I know I will get there. Thanks so much for your post!!

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