Women and Chronic Pain
Recently, the news seems drenched in the horrors of the “opioid crises.” We watch as mothers and fathers abuse opioids with children in the car, or leave children at home, unsupervised while they go get high. Organizations like WHO and The Centers for Disease Control, are practically screaming at us the dangers of opioid abuse. These are organizations that I respect and value their opinion, but in the case of opioids I think the demographics of which they speak and the true scale of the issue is less than it seems. How can I possibly contradict the gold standard of statistics by a group whose sole focus is diseases, prevention and protection of citizens? I am not exactly contradicting them as much as I am questioning who they are including in these statistics. Opioids can range from prescription medicine to heroin use which I think skews the data and definitely alters perception of why is an addict.
Here are some statistics: According to a poll done by “Scientific America” in 2015: 38% (or 92 million adults) are prescribed opioids. That is roughly 1/3 of U.S. adults. About 10% of those prescribed opioid medications become addicted. About 5% of U.S. adults were misusing opioids by not following a doctor’s orders. Misuse could range from not using drugs as directed or using them without prescription. [https://www.scientificamerican.com/article/more-than-a-third-of-u-s-adults-prescribed-opioids/] 1% of those adults in the study, approximately 1.9 million Americans, had an opioid disorder. The demographics are also interesting: Adults ranging between the ages of 18-49, men or college graduates were less likely to have been prescribed opioids than those who were older, female or not college graduates. According to NIH.gov being a woman “increased the odds of past year non medical analgesics by 43%. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3164783/]
Approaching this opioid crises is difficult, in my opinion, because not everyone who takes opioids becomes addicted. Take myself, for instance. I have been on opioids now for almost 2yrs. My use of them has been steady though there have been instances where I take more or less, depending on pain flares and I have never had any side effects. Those times where my use was minimal, I never felt any kind of withdrawal and I know people who have had symptoms of withdrawal by simply cutting out one pill during the day. So why do some people become addicted?
Among the very first things I talked about in my blog, around the first 3-4 posts, is that opioid use and chronic pain changes the brain. It changes both structure and function and as I was told by my surgeon, my brain will never be the same. In an effort not to delve to deeply in the science of this let me try to explain. You have receptor molecules that allow opioid molecules to attach to them, and through a biological process release dopamine into the brain, creating a feeling of euphoria. This euphoric experience can offset existing pain condition, but those without a pain condition can experience an unnatural euphoric high. The Mu receptor has been identified as the primary opioid receptor. Mu receptors in the brain adapt to surplus opioid-induced euphoria by becoming opioid tolerant. Tolerance is recognized as a symptom of opioid addiction, but absent of any other identifying symptoms, it is indicative only of physical dependence on opioids. [http://www.helpmegetoffdrugs.com/addiction#tolPD]
Tolerance and addiction are not the same thing. If I were to classify myself it would opioid tolerant, not addicted. Here is why: What sets the two apart is the compulsive drug-seeking and abuse. Both opioid craving and opioid withdrawal frequently drive patients’ drug seeking and use. There is a theory put forward that the constant activation of the reward circuit, alters neurological function causing them to be “hyper-sensitized,” which causes “pathological” cravings for opioids even in response to moderate stimulation. [http://www.helpmegetoffdrugs.com/addiction#tolPD
Even genetics and environment can contribute to abuse. Taking the opioids even after the pain has subsided can contribute to addiction. Genetic factors such as: Stress, depression, anxiety and environmental facts can all contribute to the decision to take more medication than is warranted by the pain. [http://www.helpmegetoffdrugs.com/not-addicted] Some research seems to indicate that women are more sensitive to pain then men. I would love to see the research on this, not that I doubt the findings, but because I find it interesting that a woman could go through natural child birth but still somehow be more sensitive to pain. I’ve also read other research that seems to indicate that women have high pain tolerance, so which is it? Also, according to NIH, women are more susceptible to cravings which means they are more susceptible to relapses and continued use which also sets women up for more frequent over-dose of medications. [https://www.drugabuse.gov/publications/research-reports/substance-use-in-women/sex-gender-differences-in-substance-use] It is believed that because women have a longer life expectancy that this can lend itself naturally, to a woman experiencing chronic pain. Too, women who “experience chronic pain, report a greater intensity of pain and tend to experience more sensitivity to experimental pain stimuli and that due to a women’s smaller body mass relative to men and differences in the absorption, metabolism and elimination of certain medications, the therapeutic window for women may be smaller and they may be more likely to experience dependency and withdrawal.” [https://www.hindawi.com/journals/prm/2016/1754195/]
I strongly feel that more studies need to be done on the effects of chronic pain and women and also those medications used to treat women and their chronic pain, so that maybe we can understand how to treat it better without the possibility of dependency that we are seeing. I hope that this post is more eye-opening about chronic pain and addiction in women, and why perhaps more women do become addicted. I wish I could offer more clarity on the situation but I feel that if you are reading this then you probably know someone who this affects, or are affected yourself and so you already know how very muddied these waters are. As I sit here, three days post-op from sacroiliac joint fusion surgery, trying to distract myself from the pain and really hitting a wall with both my surgeon and pain management doctor, whose hands seem to be tied in what they can prescribe for me and told me my best option is to go to the E.R., I am really starkly and brutally made aware of the situation for so many also in my shoes. Before we condemn women and men to an eternity of pain because a small percentage find themselves addicted to pain medicine, or make the choice to abuse pain meds without a prescription, I think we need to look at the faces of chronic pain, study chronic pain more and have something else in the arsenal to fight back with. I believe it is morally reprehensible that you can deny someone pain medication, who has never abused it, who truly needs it because of a remote possibility and not even have an alternative. We are human beings.