Thursday, April 26, 2007

The Nuances of Pain Medication and Addiction

When I was in my early 20's I was dating someone whose brother got into a terrible car accident. He was hit head on by a drunk driver. Among many injuries, his legs were shattered. He was, as you may imagine, in great pain. They had him on a morphine drip with a button he could push for an extra dose of pain medication. Despite the fact that his pain was not always covered, he refused to press the button. He held a strong belief that if he took too much pain medication he would end up addicted. He felt it was better to suffer the pain of his injuries now rather than deal with going through the difficulties of a narcotic addiction later. In my life, I have witnessed varying degrees of this same idea resulting in a strong resistance to taking much needed pain medication. I have also seen the opposite occur: a festive enthusiasm about the opportunity of having narcotics available which resulted in an addiction. I have seen both sides of this coin in my own experience and have concluded that this kind of drug therapy must be approached with consciousness and responsibility.

Example 1:
A few weeks after my first transplant, I was on a schedule of Percocet every 4-5 hours. One day, I was feeling very good. The nurse came in to give me my next pain med and I refused it, telling her I was fine and didn't need it at that time. About one hour later, I began to feel some discomfort. Quickly thereafter, an intense amount of pain set in. I called the nurse and asked for that Percocet. She brought it to me and I eagerly swallowed it waiting for relief. I grimaced and waited. I cried and waited. Nothing. I called the nurse again and told her I needed more pain medication. She explained that I would need special permission from the doctor and she would give me more as soon as she heard from him. I waited another forty-five minutes before I got another dose. By the time she got to me, I thought I would go mad.
What I learned that day was something I had never known: if you let your pain get away from you, it will take a much larger dose to bring it back down to a comfortable level. I was trying to show off or be some kind of hero and I learned my lesson. Falling behind on your pain medication can have disturbing results.

Example 2:
A week or so after my G-Tube placement I was still on a narcotic for pain. While the site didn't hurt too badly, I kept taking my pain meds. At about two weeks, I was still reaching for my medication when I would feel the familiar discomfort returning. One day, as I was about to pop the pill in my mouth, I realized something. The symptoms that were causing me to reach for the bottle were no longer related to my surgery. They were the lethargy and "icky" feelings that show up when you are coming down off of the cloud of narcotic peace. It was almost like the early stages of having the flu. Once I realized this, it became crystal clear to me how people become so easily addicted to these medications. If you aren't paying attention, it would be so easy to keep taking the narcotic to medicate the effects of not taking the narcotic. I took notice that day, didn't take any more pills, and went through a day of feeling puny. I never felt the need for another pill after that. Now, I am sure to evaluate if I am taking a pain medication for the pain or for the more subtle side effects of the medication.

Example 3:
Doctors do not want their patients to be in pain. In fact, pain management has become a key piece to practicing good medicine. My doctors had all the right intentions when they sent me home after my second transplant with 3 months worth of narcotic pain medication. I never took one pill after I left the hospital. I simply didn't have that much pain. Just because your doctor sends you home with it, doesn't mean you need to use it.

The Verdict:
Dealing with pain and pain medication can be tricky. There is a balance that must be struck between not stopping too early and getting into trouble and continuing too long and getting into a different kind of trouble. The only answer can come from within. It is the patient's job to do an internal survey and ask yourself where the pain is coming from and how severe it is. Those on the outside can only estimate your needs for pain treatment based on other people's experiences. It is your job and responsibility to make the decision about that next pill based on your personal and actual situation.

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