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Opiate medication for chronic pain – the crisis of our time

Those of us who work in the field of pain management may have noticed that recently there is a growing move by medical practitioners to try to get their patients off of opiate medication. There are several reasons for this:

  • the addictive qualities of these drugs
  • the impact on the life of patients
  • the cost and hassle to GP practices of prescribing a controlled drug.

The move has also been fuelled by a growing realisation of where over-prescribing can lead. The situation in the US has been described as an ‘epidemic’ and now much stricter controls on the prescribing of opioids is in place as we discussed in a previous blog post.

And it is certainly the case that prescriptions for opioids were on a very sharp upward curve in the first years of this century in the United Kingdom. Between 2000 and 2010 the number of prescriptions doctors wrote for opiate painkillers went up 7-fold

Recently doctors have come under pressure to reduce prescriptions of over-the-counter medications as part of the attempts to reduce costs in the NHS – this includes some opioid medications such as codeine-based drugs.

But there is also a growing concern, somewhat fuelled by the US experience, about the dangers of addiction to legal opiates and rising death rates associated with their use.

The Advisory Council on the Misuse of Drugs, an independent body which advises the government, has recommended tighter controls on these drugs and reclassifying some.

Drugs may not be the best pain management
There is a growing understanding that, although these drugs may provide a short-term solution for pain, they also can bring many, many problems.

Side effects can be physical, constipation and nausea are common as are drowsiness and tiredness. This of course makes it difficult to manage everyday life. Taking pain-killers can make you feel rotten, even if it takes the pain away.

There are mental effects as well, and these can affect your ability to live everyday life and makes things difficult.

For example, you may feel tired at work and know that this is affecting your performance. You then begin to worry and the resulting stress actually makes your pain worse. Or perhaps feeling drowsy means you do not feel safe to drive. So, you begin going out less, you see your family and friends less and become more isolated. This may mean you have fewer distractions from the pain and then you concentrate on your pain more and the pain feels worse. You feel miserable all round and your pain seems completely out of your control.

Then there are the longer-term effects. Opiates are addictive and can lead to dependence – there is a common pattern where someone is prescribed strong painkillers for a problem, say back pain, and they are then given repeat prescriptions. If this has happened to you, after a while, you may become dependent upon the medication. You may notice that if you stop or cut down on your medication you get nasty side effects, such as stomach cramps or ’flu-like symptoms. Some people may even start to self-medicate by ordering, medicines over the Internet (something it is much too easy to do) or buying over the counter medicines at the local chemist’s

It has been estimated that as many as 30,000 people are addicted to opiates in the UK. Twenty-seven million packs of codeine based medications are dispensed every year.

For many people, these drugs can become a security blanket, and the thought of coming off is frightening. This again can make the pain worse as anxiety increases, causing tension and at a deeper level a sense of hopelessness, of being out of control can become ingrained.

“I am in pain and I am dependent on my pills,” is not a good place to be in if you want to live a fulfilled life.

Do pain killers make pain worse?
There is some evidence that taking pain killers can actually make pain worse as it stops us addressing what is causing the pain in the first place. Here is one man’s story of stopping his addiction to over the counter painkillers.

“Without doubt, the weirdest side-effect of quitting painkillers is that I’m in less pain. I used to get the occasional deep sports massage on my back, and it was agonising. I had huge areas of tense, knotted muscle which when massaged would make me yell out in pain. Within three weeks of stopping the Paracetamol, they had gone, helped on their way by two visits to a hopefully non-habit-forming Chinese therapist. He said that painkillers were bad as they merely masked the pain and made my muscles even more tense and diseased.”

Another way of controlling chronic pain: pain management and relief clinics in person or via Skype
If you are taking opioids, do not stop suddenly. This can lead to unpleasant side effects and can even be dangerous. But do think about controlling your pain in a different way in the long term.

We have made huge strides in understanding pain and how important the mind-body connection is. Unfortunately, this is still not being taught in medical schools so many doctors emerge from training without proper knowledge about how to advise patients.

Practitioners such as myself who work with your mental state and your lifestyle have high success rates and can help patients like you live a happier healthier life. To get started you may want to look at some of the products I have to help you control your pain – www.apaininthemind.co.uk – or you can come and see me at my pain management and relief clinics in Bedford or Milton Keynes. Alternatively, I run pain management and relief clinics via Skype if that is more convenient for you.

News item: Travel issues and pain-killer medication
You may be thinking about holidays. Travelling abroad if you are taking strong opioids, can be a real hassle. You will need to check with the embassy of the country you are visiting to find out if you are allowed to take the medication with you. If they are allowed you will need correspondence from your doctor stating your details, your travel dates and the medications you are taking. If you are leaving the country for more than three months you will need documentation from the home office.

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