Pain and Addiction Myth
For those of us who live in pain daily, who fight: To get out of bed; To live a reasonable life, for us there is one and only one question on our mind-- Isn't there anything that can stop or lessen the pain?
Many of us have tried nonpharmacological treatments and they are help somewhat but there is something else that can help most of us. No it's not a new miracle drug, Yes it is readily available but most of us don't get enough of it, if we get any, to control the level of pain that we must live with.
What is this treatment? NARCOTICS or opioids (if you've concerned about not getting peoples' emotions stirred up, use opioids). Many doctors do not know how to administer the narcotic medications. I've heard many myths about opioid use from the medical and general community. I'd like to dispel some of these myths but first I'd like to give a short explanation about how opioids work in the body to stop pain.
In order to feel pain (or anything) our body sends messages from the site of pain to the brain and back by the following process. A stimulus causes the nerve cells to release neurotransmitters (chemicals that allow the electrical impulse to move from one nerve to the next). The first stimuli is the incident that causes the pain (a pin prick). The stimuli causes the nerve to release the neurotransmitter which carries the electrical impulse over the space (synapse) between nerves. Then the neurotransmitter fills an open spot (receptor) on the next nerve cell. This neurotransmitter and the electrical impulse acts as the stimuli for the cell whose receptor site is filed. The process is repeated thousands or millions of times as the pain moves to the brain and the signal from the brain moves back to the site. The type of neurotransmitter that is released and the receptor site that is filled (which is controlled by the type of nerve cell that is carrying the message) determines what type of pain is felt. Opioids work by filling some of the open receptors on many of the nerves that carry pain thus closing the receptor and preventing the neurotransmitter from carrying the pain signal to or from the brain.
Myth #1- Anyone who takes narcotics gets addicted.
An addiction is a psychological obsession about acquiring and using a substance that provides a feeling of euphoria. A person can be addicted to many things. Addiction is not the same thing as a physical dependence, which is when your body is used to having a chemical and stopping that chemical without slowly lessening the amount you use , will cause an adverse reaction by the body. I'll deal with the myth of physical dependence next. Now back to addiction. By understanding how pain is carried in the body, you can understand how a person in pain can use opioids and not get an euphoric effect. Repeated studies have shown that when a person is in pain, their body uses the morphine with no side effect of euphoria. Dr. Ronald Melzack, (who developed the gate control theory of Pain) and his research colleagues have found that morphine works in the limbic area of the brain. which has much to do with the ability to emotions.
Studies on no addiction: Many physicians feel that narcotics cannot fill the receptors on the sympathetic nerves so that they cannot reduce the pain of RSD but what about all of the bone pains, the muscle pains, the myofacial pains and all of the other sympathetically independent pains? As most patients know, narcotics can help with these other pains and if the proper amount of the proper medications can be properly administered, the pain can be lowered to a more tolerable level. In fact, there is a theory that if enough narcotics are given and the threshold reached, the narcotics can actually control neuropathetic pain
Myth #2- Everyone who uses opioids becomes physically dependent on them and will go through withdrawal if the drug is removed quickly.
I can stop taking massive amounts of narcotics cold turkey and not go through withdrawal. I know others who have had the same experience. For some reason, if a person in pain is not given enough narcotics to control the pain, he/she seems to have more physical dependence. Give studies
Myth #3- Because of tolerance, opioid users will need an increasing dose of the medication to keep pain control.
Tolerance is when our body gets used to a drug and in order to get the some effect from the drug, more is needed. This is true for the street user, for those seeking an euphoric effect. Unfortunately, for most of these people the increasing dose never produces as good a high as the first one and they are constantly seeking the elusive "best high" Pain patients never feel a high because their body metabolizes the drug differently. Studies have shown that a pain patient may need increasing doses until the maximum effect id reached, then the only reason that the dose needs to go up is because the condition worsened.
Myth #4 Opioids can actually cause pain.
If you're given opioids that do not fill enough of the receptor sites, you are constantly teasing your body. If the medicine is allowed to wear off before taking the next dose or you use it as needed, or when the pain get severe, you are defeating the proper usage of opioids. Without enough or with the constant pain, relief, pain cycle the body is being teased and learning a pattern of pain. By increasing the dose, and filling up all of the receptors, the pain can be better controlled, then the theory is to reduce the dosage to the lowest analgesic (pain free) level. This is also Dr. Portneoy's belief. Only when the opioids are administered directly into the spinal cord, can too much opioids cause pain of it's own.