Before we dive into everything, though I am sure you have heard it, there is this thing called “the opioid crisis.” It is not something any American can get away from really, every time you turn the news on or read something online, its there. People are addicted and they are dying. It’s really more terrible than I can put into words and I could probably write several posts on opioids and addiction and all that madness but for right now, I want to talk about something that I read the other day. It is a new treatment that is getting a lot of attention and surprisingly, much of the attention is good.
The article I read is from Vox and the podcast is called The Impact: “The controversial way doctors fight pain without opioids.” I have to advise you that listening to this podcast, regardless if you agree or not, is definitely worth the 25 minutes. I think it goes into far more depth and you can actually listen to two chronic pain patients and their experiences, as well as the doctor who has brought this controversial idea to the forefront.
It goes without saying that opioids are usually last in the arsenal of drugs that doctors reach for to treat chronic pain. They come with side effects that can be very dangerous, the most frightening, of course, being death. Taking opioids regularly can change the brain chemistry of the patient taking them. I mentioned that in some of my first posts and it was my surgeon who told me. He also told me that along with lowering a patient’s threshold for pain, it may prevent the brain from producing its own, natural opioids in the future with long term use. So deciding to take opioids should never be done flippantly and it’s understandable that alternatives are being looked at. One such alternative is called: Pain Acceptance.
In 2015 Dr. Ballantyne wrote an article proposing that perhaps, doctors should not be focusing so much on eliminating pain completely, but only reducing it to about a 2 or 3. She posits that in life there will always be a measure of pain, as that is the nature of being human; we grow old and in growing old we begin to have pain we did not when younger. However, she does say that doctors still have a responsibility to work on eliminating pain and also that there are some patients who should continue taking pain medicine. So how does “Pain Acceptance” work? Very literally, just the way it sounds. A patient accepts that they will not have a pain free life. Here is where I comment on how I feel about all this so far and bring up a couple of my own questions.
Pain patients as a whole; accept their pain very early on. This is not to say we do not kick and scream and stomp our feet on the ground angry as all hells that we are in this predicament, but we have no choice but to accept that this is how things are going to be. In the beginning, you do hope that this pill will work, or that surgery will “fix” things, but you find out that things are not so simple. I am also wondering at those few who should continue taking pain medicine and I am puzzled on how the determination will be made that they need it. Since opioids should be strictly regulated and the dispensing of them should be rare, who makes that rare list? Will there be some sort of guideline, check-list or group of criteria qualifying for opioids?
In the beginning of the podcast we meet Sam who has been suffering with chronic pain for many years and who has found a modicum of relief from opioid use. He understands the dangers of opioid use, especially in his case where his dosages are very strong, but the alternative is an inability to participate in life and be the father and husband he’d like to. Still, the effects of the medication are not lost on him as he often deals with a medication fog that leaves him unable to remember, even milestone events in his life.
On the other end of the spectrum is a woman named Kristin Geiger, who suffers from syringomyelia, a rare disorder that affects the spinal cord and causes chronic pain who is embracing pain acceptance. Her reasons for this acceptance include: embarrassment in taking opioids as where she lives is the epicenter of the opioid crisis, many people associate opioids with drug addicts and this leads back to embarrassment, the area in which she leaves has made it more difficult for doctors to prescribe pain medicine and her long time doctor decided to stop prescribing pain medication which left her having to search for another doctor who she could trust enough that she would feel comfortable taking pain medicine again. Unable to trust she decided that this was a good time to wean herself off opioids, going from 10 pills a day, to two. She did experience some withdrawal symptoms, but ultimately the weaning process was a success. Now she meditates and does yoga to help her accept the pain in her life. One thing she did describe that she found makes it difficult for people to accept pain, is that doctors are always talking about that new treatment or drug that will fix everything. Here is where I stop and add my commentary and questions.
In my own journey through this mire of chronic pain I have learned that we all are pretty desperate for any new idea, surgery or pill that might work to “cure” us. Sadly, for most of us, there is no cure and long term pain is what we come to accept. There! Right there, I used the word. Accept. We do accept our diagnosis and prognosis and we accept that our life has become about pain. I think what it comes down to is a refusal of our spirit to become complacent and just accept pain. Why should I, at 43 years old, submit to the next 25-30 years if I am lucky, to pain? Further, how would pain acceptance among those struggling with fibromyalgia affect how doctors treat these patients? This is an illness that is dubbed an “invisible illness” for a reason, and one in which the medical community is already skeptical of and one where there is not nearly enough research on or ideas of how to treat it. Would this new treatment method suddenly give those in the medical community a pass not treat these patients? As a woman with fibromyalgia who has already experienced the rebuff of doctors who do not understand the disease or the widespread pain, I think it would make it much too easy to continue this as well as give them the reason they were looking for.
Going back to Sam, whom we heard from in the beginning, says that you hear pain acceptance and you hear man-up. I am really inclined to agree with him here for those same reasons I mentioned above. Not only is something like fibromyalgia misunderstood, but chronic pain in and of itself, is misunderstood. People know what it is like and can relate to, getting a headache or spraining their ankle and being in pain for a couple of days or a couple of weeks. But unrelenting pain that lasts months, years, decades? Not only does the average person have a hard time with that but doctors don’t even know what to do with chronic pain patients.
I am a reasonable person who really is willing to try anything. I have done everything from physical therapy to meditation and I still meditate regularly as well as incorporate music therapy to deal with my chronic pain. I could see some being successful with pain acceptance but I also see many who would not be able to function in their every days lives and that worries me. It also leaves me to wonder how those already addicted would deal with pain acceptance as part of their treatment and let us not forget how at the beginning of this post I explained how long term opioid use changed brain chemistry, leaving a person unable to produce natural opioids would function without their medicine. I do not know how to solve the issues at hand.
It is with all my heart that I wish for a cure for chronic pain. A pill, like Sam mentioned that could rid chronic pain without altering brain chemistry, causing addiction or any other harmful side effect would be perfect. I would wish that no other person would suffer because their doctor felt forced to curb writing out opioid prescriptions and that no other person would take their own life because they were in so much pain that they felt like there was no other alternative. But no matter how hard I wish it will not change the reality of things: people are in pain and I think they should have access to everything that could change their lives for the better. We only have this one life to live.
Thank you for reading and accompanying me on this journey. Please remember these are my opinions that I share with you on a subject very personal to me. Everyone who walks this path will have a different experience and a different opinion.
*Credit to Sarah Kliff of Vox, who created this podcast and wrote the accompanying article.
https://www.vox.com/2017/11/13/16387320/pain-acceptance-opioid-epidemic-chronic-pain-treatment [article including podcast]
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