Part 3 of 3...Chronic pain robs people enjoy life: The Benefits of Relief

From: Helen Dynda (
Wed Apr 30 12:28:39 2003

X> Part 3 of 3...Chronic pain robs people of their dignity, personality, productivity and ability to enjoy life ..... >From the New York Jane E. Brody...January 22, 2002 76&ei=1&enºa9c35fc871f0a9 .....(I was unable to access this article at this Url.)

The Benefits of Relief

Unlike an addict, whose life becomes increasingly constricted by an obsession with drug use, a patient using the drug for pain experiences an expansion of life when relief comes from this life-inhibiting disorder, Dr. Schneider said. An addict gets high by taking the drug in a way that rapidly increases the dose reaching the brain. But opioids properly used for pain do not result in a "rush" or euphoria. When given for chronic pain, opioids are typically given in a form that provides a steady amount throughout the day.

Nor do pain patients require ever-increasing amounts of opioids to achieve pain control, because patients in pain do not become "tolerant" to properly prescribed opioids. Higher doses are needed only if an inadequate amount of the drug is given in the first place or if the pain itself worsens with time.

Tolerance does develop to some of the common side effects of opioids, including sedation, respiratory depression and nausea, although constipation tends to persist as long as the drug is taken. But an opioid taken to relieve chronic pain does not block acute pain sensations that might result, for example, from surgery or an injury. A broken arm or gallbladder surgery will hurt just as if no opioid were being taken and will require additional treatment with some other analgesic, Dr. Schneider said.

Of course, round-the-clock narcotics are only one aspect of proper treatment for chronic pain that fails to respond adequately to lesser drugs. As Dr. Schneider explained, chronic pain is "a primary disorder" that can itself cause disabling complications, including difficulty sleeping, muscle spasms and depression.

Thus, pain specialists commonly prescribe a low-dose antidepressant like Elavil to promote sounder sleep, muscle relaxants and anticonvulsants to relieve spasms, anti- inflammatory drugs, full-dose antidepressants to counter depression and an increase in physical activity to improve mood and reduce feelings of incapacity.

Patients may also be referred to psychologists for cognitive-behavioral therapy, physiatrists (for exercises and pain-relieving injections), physical therapists, hypnotists, biofeedback specialists and even acupuncturists, Dr. Schneider said.

To help reduce the risk of drug abuse, Dr. Schneider and many other pain specialists insist that before receiving opioids for chronic pain, patients sign a "contract" that, among other things, insists that only one doctor and one pharmacy be used to provide opioids and that no change in dose be made without prior consultation with the prescribing physician.

The contract also states that there will be "no early refills," no matter what the excuse, and that patients must agree to undergo random urine drug tests if the doctor suspects the drug is being abused.

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