Nothing to Fear but Pain Itself
CrazyComposer
http://my.webmd.com/content/article/1738.51438
----------------------------------------------------------------------------
----
Nothing to Fear but Pain Itself
Some unexpected casualties in the war on drugs: pain patients who avoid
potent opioids out of fear of addiction, doctors who won't prescribe them
because of red tape, pharmacies that won't stock them because of theft
worries. Is OxyContin the latest example of a much-needed drug that's fallen
victim to 'opio-phobia'? By Peggy Peck
WebMD Medical News
Aug. 13, 2001 -- Oncology nurse specialist Carol Blecher, RN, MS, AOCN,
knows the face of pain and the face of fear.
Cancer, says Blecher, is not a gentle, silent enemy but rather a painful,
raging foe, which must be fought with powerful weapons that often cause
their own unremitting pain. So easing or eliminating a patient's pain is
often Blecher's primary concern.
"But every day patients and families come to me filled with fear about
taking opioids," she says -- narcotic drugs like methadone, morphine, and
OxyContin. That fear, called "opio-phobia," can stand in the way of relief
for many patients.
At her office at Valley Hospital System in Ridgewood, N.J., Blecher says the
media frenzy surrounding abuse of the long-acting painkiller called
OxyContin has fueled patients' fears. "Now patients and families are asking:
Does this drug make you an addict? I have to just tell them over and over
that they are taking the drug for pain, not for addictive reasons," says
Blecher, a spokesperson for the Oncology Nursing Society.
Drug a 'Lifeline' for Cancer Patients
The furor surrounding use of opioid painkillers is very frustrating for pain
management specialists like Syed Nasir, MD. "I take care of people who have
cancer, and for these people [OxyContin] is a lifeline," says Nasir, a
neuro-oncologist at the Culichia Neurological Clinic in New Orleans.
Both patients and physicians have traditionally been wary about the use of
narcotics for pain relief, he says, because of fears it could trigger
addiction. It makes for a great movie-of-the-week plot -- traumatic injury
leads to unrelenting pain that can only be eased with morphine, turning an
unsuspecting housewife or grandmother into a raving junkie -- but such tales
have little basis in medical reality, says Nasir. In fact, he says, only
about 1% of people who take drugs such as OxyContin for treatment of chronic
pain will become addicted.
How It's Abused
Johns Hopkins University cancer expert Michael Carducci, MD, tells WebMD
that some cases of OxyContin abuse may be related to confusion about how the
drug should be given. Doses of older long-acting opioids, such as MS-Contin,
could be increased from two times a day to three, four, or more times a day.
OxyContin, on the other hand, is "a twice-a-day drug, not three times, not
four times a day," he says.
The drug's special formulation allows for an immediate release into the
bloodstream followed by "12 hours of slow release, so each pill lasts for 12
hours," says Carducci.
Abusers of the drug discovered that if extended-release OxyContin pills were
ground up and snorted or injected, the user could, in effect, get the entire
12 hours' worth of drug at one time, resulting in a much more intense high.
Such use has been blamed for around 100 deaths nationwide and prompted the
FDA last month to strengthen warnings on the drug's label, likening it to
morphine. The agency also mailed letters to doctors, pharmacists, and other
healthcare providers alerting them of its potential for abuse.
And just last week, manufacturer Purdue Pharma announced its plans to
reformulate the drug in an effort to discourage such abuse. The new form of
OxyContin -- available in three to five years -- will come mixed with tiny
beads of naltrexone, a drug that counteracts the effects of narcotics and is
used to treat heroin addiction. The naltrexone is designed to be inactive as
long as the pill is intact -- crush it, however, and the high-busting
naltrexone is released.
Media Overkill?
While the torrent of news stories about OxyContin abuse has certainly raised
public awareness of this deadly new drug trend, it's also fanned the flames
of opio-phobia, say critics.
As the point man in implementing new federally mandated pain-control
measures at Johns Hopkins, Carducci says he deals daily with the results of
painkiller paranoia.
"I am implementing this plan in which all patients are asked if they have
pain, and then a pain care plan is started," he says. "Now it makes that job
even harder because people are afraid to take drugs for pain."
New Drug, Old Fears
Many pain experts are concerned that scary headlines are making opio-phobia
worse, says Daniel Bennett, MD, a Denver-based pain management specialist.
Bennett, co-founder of the National Pain Foundation, recently joined other
pain specialists for an international symposium on the problem of irrational
fear of opioid drugs.
Much of the attention being paid to OxyContin abuse is silly because very
similar drugs like "MS-Contin have been around for 10 years or longer," he
says, with no attendant bad media.
The U.S. has a history of opio-phobia that stretches back to legendary
newspaper publisher William Randolph Hearst, says Bennett, who used his
newspapers to campaign against the dangers of opium almost 100 years ago.
In the current environment, opio-phobia is flourishing because both
physicians and patients are uneducated about pain and pain treatment.
"The average physician has less than two hours of formal training in the
treatment of pain," says Bennett, assistant clinical professor at the
University of Colorado Health Sciences Center in Denver. "Yet, the number
one reason for visiting a doctor is because of some painful problem."
Dependence Doesn't Equal Addiction
Even though pain leads people to seek medical help, too many patients suffer
needlessly because they have misplaced fears about the use of opioid
medicines, says Akshay Vakharia, MD, a pain management specialist at the
University of Texas Southwestern Medical Center in Dallas. Those fears often
stem from confusion about the difference between dependence and addiction.
Patients who are treated for long periods with opioid medicines like
OxyContin -- meaning more than two weeks -- will experience physiological
dependence on the drug. That means, simply put, that if the patients
abruptly stopped the drug they would have symptoms of withdrawal, such as
tremors, nausea, diarrhea, and sweating. In many cases the symptoms are mild
and not like Diana Ross' bathroom histrionics in "Mahogany." And if the
patient is gradually tapered off the drug, there are no symptoms and, most
importantly, there "is no relapse, no drug-seeking behavior," says Vakharia.
Bennett says he and other pain experts want to get the message out that
addiction is not a significant risk when drugs like OxyContin are used to
treat pain. Moreover, he says that the whole concept of tolerance, meaning
that patients get used to the drug at a low dose and then need higher and
higher doses to overcome pain, is flat-out wrong.
"If the patient is started on an opioid and the dose is adjusted to a level
where pain is adequately treated, the patient can be maintained on that same
dose for the long-term," says Bennett. When a patient complains that pain
has returned "it usually means that either the disease has progressed or
there is something else, another condition," he says.
Moreover, Bennett says, even after years on opioids, patients can be taken
off the drugs without fear of relapse. He points to one of his patients who
took methadone for a painful hip defect. After many years the patient had
hip replacement surgery, which freed him from the pain.
"We weaned him off the methadone and he has been methadone free for two
years, no problem. Taking the drug did not make him an addict," says
Bennett.
Why such a low risk of addiction with such powerful narcotics? It seems the
body processes drugs differently when they're taken for genuine pain and
when they're taken for recreational purposes.
"Patients without a history of addiction who actually have bona fide pain
don't get high when they take these drugs for pain," says psychiatrist and
addiction specialist Elizabeth Wallace, MD. For most pain patients OxyContin
"relieves the pain but doesn't give the buzz," says Wallace, director of
professional services at Professional Renewal Center, a drug treatment
center in Lawrence, Kan.
It's yet another of the missing pieces of information that contributes to
the opio-phobia phenomenon. Yet until both physicians and patients are
educated about the real opioid story, such misinformation and fear will
continue to stand in the way of "getting the job done: treating patients and
their pain," says Bennett.
Medically Reviewed
By Dr. Dominique Walton
--
齯滌`偕爻,虜,齯滌`偕爻,虜,齯滌`偕爻,虜,齯滌`偕爻,虜,齯滌`偕爻,虜,
CrazyC...@home.com
Peter Amsel
The ingeniously CrazyComposer
They say that genius and insanity are closely related. . . .
So, who are "they" anyway?
齯滌`偕爻,虜,齯滌`偕爻,虜,齯滌`偕爻,虜,齯滌`偕爻,虜,齯滌`偕爻,虜,
Terminus Est
I have just been discussing this a lot.
I think that there are several other cultural concepts at work here besides
the ones in the article, all of which combine to make it hard for humans to
get proper treatment for pain.
One is the myth that pain ennobles one somehow, and that seeking relief from
pain is cowardly and dirty. For decades, medical practitioners have
routinely rx'ed pain meds that they knew were inadequate for the treatment
of serious pain or no pain meds, expecting patients to suck it up and deal
with the pain. I grew up going to a dentist who refused to give novocaine or
other anaesthetics to children.
I'm reminded of the priest I heard who suggested that terminally ill
patients in chronic pain "offer their suffering up to God". Right, that does
a lot of good.
Another myth/paradigm is this fear of addiction. What's the big deal if
those in chronic pain, particularly terminally patients, become a bit
dependent on pain relief? Which erodes "quality of life" faster...
debilitating chronic pain or a little jones? Do these chronic pain sufferers
suddenly metamorphose into scary junkies, skulking in alleys to mug little
old ladies for their next Oxycontin fix?
A great thing that the article mentioned is that properly maintained levels
of pain relief pose little or no danger of "addiction", and that in any
case, the dangers of this are over-dramatized.
I also think that our culture's innate (and insane) hatred of pleasure plays
a role in this. It would be a very bad thing indeed if anyone seeking relief
from chronic debilitating pain should somehow obtain even the slightest bit
of drug-aided pleasure from their treatment. Better to deny pain relief
entirely than to risk this. (Irony intended.)
I would apply all of the above to drugs used to treat psychiatric illnesses
as well.
"CrazyComposer" <crazyc...@home.com> wrote in message
news:DK9g7.59265$281.10...@news4.rdc1.on.home.com...
> Original article:
> http://my.webmd.com/content/article/1738.51438
>
> --------------------------------------------------------------------------
Saya
Softly
Saya
"CrazyComposer" <crazyc...@home.com> wrote in message
news:DK9g7.59265$281.10...@news4.rdc1.on.home.com...
> Original article:
> http://my.webmd.com/content/article/1738.51438
>
> --------------------------------------------------------------------------
--
Mad Ness
motrin for lower back pain so bad it took out my from from the herniated
disk that caused the problem. That such a LAME way to go.
Yet CIA and relatives continue to 'bring in the goods' on the crack front.
r
"CrazyComposer" <crazyc...@home.com> wrote in message
news:DK9g7.59265$281.10...@news4.rdc1.on.home.com...
CrazyComposer
news:LUig7.122119$EP6.33...@news1.rdc2.pa.home.com...
> Thanks my dear....guess I should also take this as a "hint"
>
> Softly
> Saya
Dearest,
I was not directing it to anyone in particular ... actually, my mother
pointed the article out to me this morning from WebMd .... However ... if it
would help your idiot nurse, not Julie, understand the meaning of pain, by
all means, show it to her.
I cannot understand how these "professionals" can pretend to care for
someone with chronic pain, and then watch them while the writhe in it ... it
does not make sense.
As I said to my mother, I was finally given OxyContin because I told my
doctor I was ready to kill myself and someone else if something wasn't done
for the pain. I said this not with a straight face, but almost in tears ...
and my doctor saw that I was serious.
It was one of the most difficult places I have ever been ... and now, I can
barely describe the difference thanks to effective pain control.
Breakthrough pain varies, as I am sure you know, and other things such as
stress and the weather are factors, but overall ... I could not go back to
life before OxyContin.
On a day like today, for example, without the control of OxyContin, I would
probably be dead. I woke up in absolute agony ... it was heavily overcast
outside ... and it has been raining most of the day -- not heavily, but
enough that things have not settled enough for my body. But ... after my
morning dose ... well, the pain level went from a 9.5 down to about a 5 ...
not a low as normal (it usually gets down to about 3 with OxyContin), but I
could think straight. However, my nerves were still a wreck and thanks to
the elevated pain level I was much more susceptable to anxiety and the
triggers to the PTSD which lead to all types of other problems. Needless to
say, it has been a difficult day.
So, my dear, thanks to this medication I have some semblence of freedom to
my life again -- something I had lost for years.
It was great talking to you earlier ... and I hope I can call later -- ring
once and I will call back. :-)
xoxo
Peter