Author: Anita
Posted: Mon Aug 08, 2011 2:09 am
I am new to the forum and I was looking for a place to write my thoughts about chronic pain and meds and then saw this post by Dr. Junig. I am so grateful for his post, I just wish I would have seen this the first week I was put on meds. Here is what I want to add to this, my individual story of how tolerance/dependence develops. My pain started 4 years ago and it is a very debilitating neuropathic pain condition. I was an athlete my whole life, very active in many many activities- running, cycling, horses, skiing… total outdoors woman my whole life. I was also someone who just had no interest in drugs. I tried pot a few times, but I’ve never liked the way any medicine including opiates made me feel. I’m not saying this from a judgmental place, but just a clinical point- I don’t get psychologically addicted to substances, but I sure did develop a physical dependence on opiates. When I started with my dr. he gave me vicodin and told me to use it sparingly and I did just that- about 1 1/2 pills a day for a long time, several months in addition to Cymbalta to help with the nerve pain. Since that low dose seemed to work, he was thrilled. Said it was totally safe. THey discouraged Neurontin or Lyrica and said that since this conservative program was woking so well, why rock the boat. I still go to PT as well. After a few months they switched me over to 10 mg of MS Contin 2x a day… still low dose. They wanted me on longer acting opiates for better blood levels. No doctor during this time ever had a talk with me about escalating doses. Never. THey applauded the fact that I never asked for Vicodin refills, that I managed to have pain controlled on low doses. However, the pain that emerged after a couple of years- the w/d at night, that was a huge puzzle that is now figured out, but it really trashed my quality of life. It has had me thinking how this very typical scenario has been very dangerous. I’m a nurse and I certainly know how doctors work. I think in my dr.’s effort to give me good care, he was pleased that the opiates worked so well and so he was not motivated to try anything else. WHen I went to 2 pain dr’s… one didn’t deal with the kind of neuropathy I have and the second one just said "You won’t be able to tolerate the neurontn or Lyrica so given that you are on "low doses" this is all quite benign. So, Hmmm… I believed them. Now for 2 years they did give me quality of life, except I had 2 bouts of serious constipation, and the w/d symptoms started at night and I could not sleep, and I was in more and more pain. I approached my doctor several times about this and he denied that this could happen. You shouldn’t be tolerant he’d say… you are on such a low dose…..( get me a bucket about right now 
Anyway, I had him refer to a new pain dr. and she got it and agreed with my problem of tolerance/dependence. SO, she prescribed the methadone taper ( I was on 5 mg 3x a day for pain for about 5 weeks before I started the taper), tapered so fast I had bad withdrawal and now I’m here on Suboxone. So.. this story could have been resolved at many different points along the communications. First, my dr could have told me, or as I now believe, he should have be mandated to make me sign an informed consent form to be on long term opiates. Just think, if I had a form to sign that stated I could get seriously hooked, have to take another serious opiate to get off.. I sure as heck would have made a different choice. For almost 2 years I rarely slept at night cuz my bone pain would start, my sweating would start, my insomnia would start and last all night. I’d awaken exhausted and the cycle would start all night long and then make my primary pain much worse and I was not very functional during the day. I honestly don’t think doctors who give out opiates understand what they are setting patients up for. I really truly thought that when it was time to taper, I’d taper it just like any other drug that needs a taper. I mean, I never took more than I needed, took less than I needed.. I just thought after that last dose, so be it… I’m done. Doctors mostly learn that alcohol withdrawal is bad and benzos are bad… but the word you hear over and over for opiates "uncomfortable". THat’s all… "uncomfortable. Well, an ill fitting shoe is uncomfortable. An awkward first date is uncomfortable. Burning dinner is "uncomfortable". Opiate withdrawal- is hell and way way more than uncomfortable. So, here I am wondering how the heck this supposedly super educated, smart RN, with doctors in the family got into this position. I think it stems from ignorance and naivete on the part of doctors. I certainly think their intention is to help, but then as Dr. Junig writes… it really gets dicey. I think informed consent would be a good place to start in educating patients on long term use of opiates. He brought up the exception was a person with cancer pain and I agree. My brother died last year from cancer and while treated he quickly became dependent in a very short time at very low doses. He ended up losing his life to cancer, and when I feel sorry for myself, having to take suboxone, I remind myself that my brother would be quite thrilled to even have the opportunity to be on suboxone right now. So, that thought certainly puts things back in perspective for me. But still, this insidious path to dependency/addiction is that proverbial sliipery slope and my regret is that I did not understand that the rationalization of my low doses did not at all protect me from dependence. So, now with every chance I have, I will be educating doctors that care for me, doctors that I know socially. As others have already said "This is where I am now" but I’d like to prevent others from going down this path.
Anita
