Am Academy Pain Medicine, A.P.S., Am Society Addiction Medicine

Discussion in 'Fibromyalgia Main Forum' started by elsa, Oct 24, 2005.

  1. elsa

    elsa New Member

    I wrote this sometime back for some of our members who had been hesitant to take their pain medication out of fear or who had not been getting proper treatment to begin with.

    I am not one of those CFS/FMS patients who suffer the excruciating, debilitating severe pain that requires this type of treatment, however I long support our family members who battle everyday of their lives with just this level of pain.

    All the same, I take my tramadol everyday just as my doctor directed me to. He ordered me to "stay ahead of the pain" and that's exactly what I entend to continue doing.

    In view of this morning's thread against strong pain medication, I thought it timely to re-new this very informative post. ... Elsa

    *** Morning Everyone .... I came across these papers not too long ago and wanted to post for all who are either not being properly treated or who try to hold off taking their pain medication until they can't stand it anymore for fear of becoming addicted.

    You might want to print this out and show your doctor if he is the type to withold proper pain treatment out of misguided notions.

    From a conference attended by the American Academy of Pain Medicine, American Pain Society and American Society of Addiction Medicine.

    This is from a joint consensus paper that clearly defines frequently misunderstood terms, i.e. addiction, tolerance and physical dependency.

    It discusses their definitions in the context of opiod use in the treatment of pain.

    I have taken exerpts from text ... found most of this from the Fmscommunity site.

    Dr. Edward Covington (Director Chronic Pain Rehab Program Cleveland Clinic) Addiction- is a primary, chronic neurobiologic disease that can be identified by the "three C's" ... 1. craving or compulsive use, 2. loss of control, 3. use despite adverse consequences.

    Physical Dependence and Tolerance is often confused with addiction.

    Unlike physical dependence and tolerance, addiction is not a predictable effect of taking a drug, but an adverse reaction in a biologically and phychosocially vulnerable individuals.

    It is important to recognize the difference between true addiction and "pseudo-addiction".

    Pseudo-addiction - Patients whose pain is undertreated APPEAR to behave like "addicts" to get the pain relief they need.

    They may focus on getting more medication and APPEAR to be engaging in drug-seeking behavior. But UNLIKE true addictive disorder, once their pain is properly managed, THIS BEHAVIORS STOPS IMMEDIATELY.

    More then 40% of people with chronic non-malignant pain do not receive adequate pain relief, i.e. - back, arthritis, headaches, fibromyalgia.

    1. Russell Portenoy, M.D. ( Chairman Pain Medicine and Palliative Care - Beth Isreal Medical Center, New York.

    2. James Campbell, M.D. ( Director Johns Hopkins Blaustein Pain Treatment Center)

    .... Are among leading pain specialist working to promote the use of opioids for chronic, non-cancer pain. "Very few patients become addicted to their opioid pain relievers."

    " Less then 0.03% chance you will become addicted on narcotic medication if you are a pain patient. That's 3 hundreth's of 1 percent."

    Physical Dependence - Physiological response of the body to long term use of a drug. People treated with opioids can and do become dependent and will experience withdrawal symptoms if they STOP TAKING THE DRUG ABRUPTLY. While uncomfortable, the symptoms are not life threatening.

    ....( Side note ... Individuals become dependent to many type of medications. Anti-depressants are not narcotic, yet if one has been on them for any length of time, they need to taper off slowly as to not suffer withdrawal effects.

    The T3 hormone I am taking will need to be tapered back slowly should I ever decide to stop taking it so my body won't be shocked by it's absence.)....

    Tolerance - is a need for increasingly larger doses to achieve same level of pain relief. It is a physisological phenomenon. Tolerance has not been proven to be a prevelent limitation to long term opioid use.

    Chronic Pain - Goal of clinician is to provide an opportunity for patients to regain some sense of control over their lives by providing the most effective pain treatment regimen possible.

    The Drug War Propaganda of the 80's has misinformed many or made many hesitant to take/presrcibe the appropriate pain medication for the non-cancer chronic pain patient.

    The Truth - The ADDICT takes his drug to get high, mellow out and AVOID LIFE.

    The PAIN PATIENT takes his drug to GET ON WITH LIFE. It allows them to interact with their family and friends where the addict will go to great lengths to isolate themselves from family and friends.

    Among this whole research section, I found a very good segment on tramadol. This is for those of us who take tramadol and get relief from pain with it:

    Tramadol - Opioid activity with serotonin and norepinephrine. Interfers with the pathways that mediate pain. It has a low abuse potential and is appropriate for long term management of moderate to moderate severe pain and acute pain.

    Concomitant use of tramadol with nsaids offer therapeutic benefits both central and peripheral analgesia. I was happy to see this as I have long taken 2 50mgs tabs of tramadol combined with 800mgs to 600mgs of ibuprofen about every six hours for fibro pain.

    I had alot of blood work done last month showing that my liver and kidney function was spot on, so this combination is safe for me. I also take achiphex to protect my stomach.

    I hope many of ya'll find this helpful. When I came across it, I thought of many who are needlessly experiencing unnecessary pain levels due to wrong impressions.

    Take care,


    [This Message was Edited on 01/15/2006]
  2. dononagin

    dononagin New Member

    Thanks for sharing Elsa.. Good info
  3. Rosiebud

    Rosiebud New Member

    for posting this info.

    You have helped me view my need for painkillers in a new light - I will no longer have to put up with pain because I'm afraid to take my medication.


  4. elsa

    elsa New Member

    Thanks Donoagin for the bump and kind thought. There maybe more people dealing with this ... The excerpts from the articles may give them something to "fight" with.

    Rosie, that was very sweet of you to say. I hate it when people have been scared into thinking their medication would be worse for them then the pain it's designed to relieve. I hope you are feeling better.

    I have been lucky in that I don't experience the bone-crushing level of pain that many others do. However, if I did, I'd be armed with something to insure proper treatment. Maybe this could serve someone in that capacity.

    Rachel had expressed an interest in this, so I'm bumping for a chance for her to read it. Thanks ....


    [This Message was Edited on 10/26/2005]
  5. kgangel

    kgangel New Member

    I have the opposite problem, I can not tolerate mostly all the pain meds I have tried. The side effects of them have affected me terribly. I would love to find something to help me, especially the past 4 going on 5 weeks, I can barely do anything at all , i am of no help to my family lately because I can not even keep up with dishes, laundry , just any daily cleaning that I did and did not even realize how much I did until I could not do it.

    Sorry for going on about it, I just wish I could tolerate something, I am getting rather depressed and I don't like it.

    Thanks for posting though so many are afaid that they will get strung out and not be able to get off something if they have to one day.

    Take Care
  6. elsa

    elsa New Member

    I am so sorry to hear of your tough times. You are not alone in in your inability to take medication for your pain. I guess you've tried it all, in smaller amounts, huh?

    I tried acupuncture some time ago. I found it helped to relief some of my pain and very relaxing/soothing during. Have you given that a try yet?

    I wish I had more suggestions for you. Do you also have difficulty with supplements/amino acids? There are a couple of AA's that have been known to help pain if you're able to tolerate them. You can put amino acid in a google search and learn more.

    I'll think positive thoughts for you. Thanks you for replying in the positive for others. That's truly supportive of you.

  7. spmary

    spmary New Member

    What a dear you are to post about the pain meds. I always thought that if you really need the meds. you won't become addicted. I take tramadol as the only one that really helps. I decided that if I did become addicted I would d
    eal with that too. but I have no worries about that now.
    Thanks you, Mary
  8. NyroFan

    NyroFan New Member

    Good article and a real eye-opener.
  9. fivesue

    fivesue New Member

    I find myself in the category of not having my pain controlled so I'm "looking" for more...I just want to not hurt.

    I'm going to print this out and take it to my doc. I appreciate the clear (brain fog) descriptions of the terms. Descriptions is not the work I want, but it's right there, I can almost touch it, but it's not coming. I hate this.

    Again, thanks.
  10. chris350

    chris350 New Member

    I have posted the awesome article that Dr. Brookoff wrote a few years ago. He mentions "listening to your patients" and not considering the patient a drug addict unless they give you reason to think that.

    If anyone wants to read the article I am happy to copy the article over. Just respond to this message.

    Sick of being undertreated.

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