I know how emotionally charged the topic of pain medications can be. This is one subject that usually garners strong opinions from pain patients, their doctors, pharmaceutical companies, the insurance world, and now even the military and our government. But certainly those who suffer with chronic pain carry the strongest sentiments about their medications. And I know this is an area that is frequently met with deep dissatisfaction by patients. As a pain expert for WebMD and with my 18 years of private practice experience, I know that pain patients across the country are often unhappy with their medication situation, including how much relief they get, the way they get treated, and even with their doctors.
In fact, I have even seen a few pretty rough reviews on the Internet of yours truly by patients who were not satisfied with my own medication recommendations for them. Needless to say, I know the hornet’s nest you can walk into when you start giving opinions and advice about pain medications, so please be gentle with me.
The first step in discussing pain medications as a general topic is to clarify the context. In other words, there are differences between acute pain and chronic pain, and there is a wide spectrum of chronic pain problems from fibromyalgia, to sciatica, to arthritis, to neuropathy and so forth.
One of the biggest differentiators between acute pain and chronic pain is that with acute pain we are talking about very short-term treatment, but when it comes to chronic pain, medications may be used for years or even decades. The implication here is that there is a big commitment involved when something is used for years at a time, and there should be a sound grasp of the potential side effects, complications and pitfalls.
View Your Body as a Temple
In my book Take Charge of Your Chronic Pain, one of the key elements of successful pain management that I identified was taking on the philosophy of viewing your body as a temple, which means being extra careful about what you put inside it. That includes giving importance to good nutrition, proper hydration with clean water, and even breathing fresh clean air. This mindset should also apply to the medications that you ingest. If you want to be healthy, active, happy and thrive, then it stands to reason that part of getting there means ingesting high-quality molecules to support that transformation.
When it comes to medication choices and decisions, try adopting the perspective that your body is a very special place and you want to be real clear that what you are putting into it is going to help you go in the direction that you want both in the short term and for the years ahead. Both you and your doctors need to think through the potential long-term implications of staying on any particular medication for an indefinite time period. Will the benefits outweigh the risks?
Sometimes doctors feel pressured to prescribe pain medications at office visits or do so out of habit. A great question to ask your doctor when he or she recommends any treatment or medication is “Doc, if it was you or your spouse in my situation is that what you would want to do?” The answer to this should be “yes,” and if it isn’t, then perhaps the plan should be re-evaluated before proceeding.
Be a Scientist
As you probably can appreciate, there is an awful lot to pain and treating pain that is poorly understood. I have seen many patients over the years with terrible pain problems where none of their doctors could figure out what was going on. Many times, medications get tried out of desperation or hope without clear scientific support. That isn’t necessarily a bad thing, but it is good to be clear that what is being tried is happening without clear scientific studies to back it up.
Be informed about the science or lack thereof about what you are doing. For example, one research model often used to study nerve pain is done on patients with diabetic neuropathy. If a medication studied is found to work well on diabetic neuropathy, that doesn’t mean it is scientifically proven to work on a different type of nerve pain, but you and your doctor may still decide to try it on your painful trigeminal neuralgia problem.
It is also important to think about the long-term implications of any medication that you are considering for chronic pain treatment. What are the possible side effects? Are you comfortable assuming those risks? Will tolerance develop? If you don’t see yourself being on a particular medication for a prolonged period of time, then what is the reason for starting it in the first place? Beware of trying brand-new drugs — many times the worst complications don’t become realized until after they hit the market.
The Politics of Opiates
The political pendulum has swung in this country to the point that there is now a lot of controversy surrounding the safe and appropriate use of opiates. Doctors and pharmacies are under a lot more pressure and scrutiny now than they were several years ago when it comes to narcotic pain killers. This impacts patient care as well as the doctor-patient relationship. Now, urine drug screening and running prescription drug monitoring reports are a part of the daily routine for clinics and patients. The reality is that if you are on opioid-based medications, then a lot of people are looking over your shoulder.
Naturally, a big reason for this shift toward tighter regulation and compliance is to improve safety and curb the steep rise in prescription addiction problems and overdose deaths. But there are other issues surrounding prescription pain killers. For one, they are costly, and there is a good chance your insurance company is not thrilled about paying for them. In some cases, the monthly costs can run in the thousands of dollars.
Another issue, which we all have to face, is that there really isn’t strong scientific evidence that has been produced that has shown the long-term use of opiates to be successful for the more chronic management of pain. Everyone assumed that opiates would be a great option for challenging chronic pain problems when they became commonly available, but now we know that what works well for acute pain may not do the same for chronic pain. And we are just now starting to appreciate some of the physical, cognitive, and psychological effects of their long-term use on our patients. Again, I’m not saying using any class of pain medication is necessarily wrong, but be informed about what that means when making choices.
Know the Alternatives
I think it is fair to view medication management as just one of many ways to treat and manage pain. Sometimes we are too quick to jump to a new medication to solve every health problem, as opposed to diving deeper to explore the root causes of a problem. Effective pain management can be much more than symptom management with medications. For example, one way to treat a pain flare-up is to take a medication for breakthrough pain, but recognize that there are many other ways that a flare-up can successfully be handled including using stretching, meditation, diaphragmatic breathing, or massage as examples.
We don’t want medications to stand in the way of us listening to our bodies and understanding why it isn’t feeling well. Did we lift something with the wrong body mechanics? Are we flaring up because we take on more than we should? Is there extra stress at work or at home right now? Being too focused on medications can keep us away from problem solving and exploring other potentially healthy and valuable ways of managing pain.
Whether we are talking about medications or other ways of managing pain, what is important is to evaluate how these treatments support your goals, improve your well-being and help you function, both today and in the future.