You may have recently read about Las Vegas entertainer Danny Gans whose untimely death was caused by “acute hydromorphone intoxication” and “chronic pain syndrome” according to the death certificate. The story is incomplete and may never be complete – but, clearly, this talented performer died as a result of taking a powerful painkiller, perhaps without a prescription.

Even more recently, pop superstar Michael Jackson died at age 50 in his Los Angeles home from cardiac arrest with the autopsy results pending at this time. News reports stated that he was taking “drugs from prescriptions acquired from multiple doctors.” Stories included information from “sources” stating that he took “straight morphine, Demerol and opiates like Oxycontin. He also takes Valium and Xanax.” Propophyl, a powerful anesthetic has also been implicated as a cause of his death. It would seem obvious from news reports that Mr. Jackson suffered from addiction.

Within the last year, we also lost Heath Ledger to an overdose of the opioid painkiller Oxycontin, anti-anxiety drugs Valium and Xanax, and the sleep aids Restoril and Unisom. And a year before that, Anna Nicole Smith overdosed and died on a combination of anti-anxiety medications and pain killers, specifically methadone.

I can only wonder how many others of lesser celebrity status have died from overdoses of these drugs.

There is an epidemic of prescription drug abuse in this country. The National Institute on Drug Abuse (NIDA) found in a 2003 survey of eighth, tenth, and twelfth graders that 10.5% of twelfth graders reported using Vicodin for non-medical reasons and 4.5% of twelfth graders reported using Oxycontin without a prescription in the past year. In 2006, 16.2 million Americans age twelve and older had taken a prescription pain reliever, tranquilizer, stimulant, or sedative for nonmedical purposes at least once in the year prior to being surveyed.

The Office of National Drug Control Policy Executive Office of the President reported in January 2008 that more teens abuse prescription drugs than any illicit drug except marijuana. In 2006, more than 2.1 million teens abused prescription drugs. Every day 2,500 youth (12-17) abuse a prescription pain reliever for the very first time. Sixty percent of teens (12-17) who have abused prescription painkillers first tried them before age fifteen with age thirteen being the mean age of first non-prescribed use of sedatives and stimulants. I have touched on but a few examples of this growing problem. If you would like to read more you can visit the National Institute on Drug Abuse (NIDA.nih.gov) or the Office of National Drug Control Policy (ONDCP.gov) websites.

These celebrity deaths are symptomatic of the effects of potent pain killers on individuals. Were they addicted? Were they addicts? We don’t have enough information to say. What I found intriguing and concerning is the implication that for them to be addicts would be such a terrible thing.

In Mr. Gans case, the coroner, Mike Murphy, seemed to go out of his way to state that “I want to make it very clear that this is not an issue of drug abuse,” again, as if this would be much worse than dying of the combination effects of taking a drug. This is a result of the stigma associated with drug abuse and addiction. Would his suffering be any less significant if he were an addict? In Michael Jackson’s case, we are reading that it was the fault of the doctor who prescribed the medication. We seem to be looking for someone to blame.

But what if there’s no one to blame? Addicts are sick – the disease is called addiction. It’s a brain disease and the symptoms of addiction are behaviors like being dishonest, fearful, and angry. Addicts display behaviors, which are often disturbing to the person’s well-being and to the people who care. But these behaviors are symptoms of an illness. Addiction is not a moral weakness, nor is it related to lack of will power or character. The disease of addiction is prevalent in our society – 10-18% of the public are suffering and dying from it on a regular basis – from overdose, medical complication, accident, suicide, organ failure, or infections.

It seems to me that the media is suggesting that it’s ok to die from “chronic pain syndrome” but not from “drug abuse” – since drug abuse is much worse – something to be ashamed or embarrassed about.

The truth is that some people with chronic pain abuse drugs and others become addicted, usually inadvertently. No one starts using medications with the intent to become dependent or addicted – some people are “wired differently” – they take a medication, and without realizing, increase the dose in the face of increasing symptoms and decreasing function. The net effect is the drug works less well, life gets worse; they spin out of control and end up doing things that make matters worse. Combinations of drugs are added to treat the symptoms caused by the first drug. This is the spiral of addiction. The “loss of control” of the ingestion of mood altering substances defines the disease. It appears to be willful, but these drugs work in a part of the brain that ends up associating the drug with survival. People seek the drug with little regard for nourishment, relationships, and sleep. The drug takes over the “drive system” mediated by the chemical “dopamine” which is the main neurotransmitter in the brain’s reward system – and when it’s gone, the person craves the drug physically and emotionally.

We will never know exactly what happened to these folks leading to their deaths. We can speculate all day, but I think what’s much more important is that many more people are suffering from chronic pain, problematic drug use, and addiction. Because of the stigma associated with addiction, we are missing the chance to reach out and help them. I say, let’s devote our attention to the living.

A Day without Pain
By Dr. Mel Pohl
My search for A Day without Pain

December 22, 2008
Emotions and Suffering

We all have suffered at one time or another. Suffering is your individual response to a painful stimulus. Suffering is a necessary part of the human condition (none of us escape it) and is an inevitable part of life. How much and how badly you suffer is modifiable, and you can learn to diminish it. In fact, the Buddha taught about this in his classic Four Noble Truths 2500 years ago.

Your experience of pain is a composite of biological (physical) and psychological factors. Suffering is that element of pain that is generated from your emotions. Mood changes, anger, frustration, insomnia, and worry are just a few of the emotions that contribute to your suffering, making pain worse. These emotions are your responses to the pain brought about by your attitudes, perceptions, memories, coping skills, and character traits. Emotional reactions to your pain are constantly changing. When you resist the pain you are feeling, such as get angry with it or yourself for having it or tighten your posture, the pain gets worse and you suffer more.

Additional aspects that contribute to your pain can be your outlook, personal history, cultural background, and reactions of family and friends. So you can see it’s not just how you feel pain it’s also important to understand how you feel about pain. This understanding is a key to reducing your suffering. If physical pain were your only concern life would be different; however, negative emotions experienced before, at, or shortly after you experience pain serve to compound your problem. Again, it’s not how you feel, but how you feel that is often the source of your problem. Negative emotions increase pain while positive emotions decrease pain. Pain +Negative Emotions = Suffering = more pain. This, of course, depends upon the state of your emotions. Therefore, if you can find ways to impact your emotions you can improve your pain.

Many with chronic pain experience what is termed “secondary gain.” Secondary gain develops when chronic pain gives you something positive that isn’t necessarily logical or positive. When this occurs you may find you get more attention from others, you may justify why you should be relieved of certain activities, you may gain an “excuse” for your anger, and it may keep you from feeling other emotions. Secondary gain can be tricky because your pain can bring about perceived benefits justifying destructive behaviors. If you don’t see this, you may have a hard time avoiding this trap. This happens as a subconscious process—you don’t intend to benefit from the pain—but, as you derive benefits, you become “trained” to enjoy and expect those benefits all on a subconscious basis. Knowing this is occurring will enable you to reverse the trend associated with secondary gain.

The power of the mind cannot be underestimated. If you think a treatment will work, often it will work even if no treatment took place. This “false belief” is referred to as the placebo effect. It has been shown to be quite effective because it can alter the functioning of organs in your body. You are more powerful than you realize! It is by feeling empowered that you can change your experience of pain.

Many alternative treatments exist that can help you get [back] in touch with your emotions and by controlling them to reduce or even eliminate your pain. Techniques such as yoga, meditation, and Reiki, as well as many more have helped countless people in pain. You need to know that these treatments take time to work, so you need to avoid becoming impatient. Often a pill will seem the better alternative. These techniques do work if only you gave them a chance. Often the effects are short-lived requiring reapplication of the technique. Of course, it is natural to want relief now. You also want predictability in your lives. Medication provides both immediate relief and predictability; however, medication comes with a price: side effects and potential for addiction. Trying alternative therapies and looking at how your emotions contribute to your suffering will help you modify your experience of pain. Your way of thinking, as well as the way you cope with your emotions needs to change if you are to reduce your suffering. I hope today’s topic has helped you to look at pain and suffering in a new light and with a more optimistic view
Good luck on your journey to discover A Day without Pain.
Mel

Conventional wisdom dictates that if you are in pain, then you find a way to stop the pain. With all the wonder drugs available on the market, use of opioid painkillers is the logical answer for many. The pharmaceutical companies spend a great deal of money and effort to sell these drugs and we, as a society seemed convinced that they are best for moderate to severe chronic pain. If one drug does not work for you, try another. If your pain gets worse, just increase the dosage or get a stonger drug. Most doctors are of the mindset that pain should be treated and that opioids are the key.

Use of opioid pain killers carries with it the risk of addiction. Most people who take drugs don’t become addicted; however, for some the risk of addiction is a real problem. Usually, those that develop addiction have a familial predisposition  and other risk factors.  If you are developing loss of control of your drugs – that is, taking more than prescribed or thinking about the next dose at the expense of other life functions and responsibilities, this is cause for concern.  For these people the choice becomes one of enduring pain without the aid of medication or use medication for the pain and wind up addicted. You may feel you need the drugs for pain relief, and have no alternative to cope with the pain other than opioids.   You may also find that the drug gives you a sense of well-being or even which would be a cause of concern for possible drug problem.
What if you are in pain and seek to relieve the pain without the aid of potentially addictive medications? Thankfully there are a multitude of options.

This brings me to Complimentary Alternative Medicine. You probably have heard of a few of these treatments such as chiropractic medicine, acupuncture, yoga, physical therapy or massage. But do you know much about mindfulness, Reiki, Chi Kung, TENS, and Ayurveda? Though some of these treatments take work and energy – a lot more than taking a pill – the payoffs may be enormous.

It goes without saying that “If it works, don’t fix it”. Well, what happens when what worked at first, no longer works or no longer works as well? What do you do then? In the case of opioids, the decision is often to increase the dose or strength of the medication.  Taking medications as long as the side effects don’t get the best of you is quite reasonable.  But if doses and strength of medications are increasing and you are no longer gaining pain relief, you may be better with less or no medication.? By exploring alternative therapies you may find that you can control (or even eliminate) your pain and do so without using drugs. Have you ever quit using medication? Have you found another way? Do you feel that medication is the only way you can control your pain? Do you find yourself “needing the meds” even when your pain has lessened? Let me know what thoughts arise when you take the time to think about “why” you take pain medications. I’d be happy to hear from you about your experiences with alternative practices other than medication.

Wishing you a day without pain,
Mel

Chronic pain is experienced differently by each individual; however, everyone in chronic pain shares a common interest. We deal with pain and search for relief. Chronic pain can begin to affect anyone at anytime. We define chronic pain as pain that lasts longer than 6 months. Acute pain goes away, but chronic pain doesn’t.

Common causes of chronic pain are nerve damage, disc disease, arthritis, burns, pelvic infections, scarring, or cancer pain. Chronic pain can be caused by chemotherapy, infections, bursitis, multiple sclerosis, whiplash, and many other causes. The pain is real and often misunderstood. You know what pain is like and you know it is real. Science is slowly finding ways to quantify the pain we feel, but physicians often are left with only a patient’s description of his or her pain—without the aid of scientific tests to provide information about how much pain you are feeling.  Doctors and families are often at a loss in assessing pain and helping with the process. The doctor is responsible for determining the best appropriate treatment for each individual. Treatments can include painkillers, steroids, exercise, physical therapy, and others.

Chronic pain affects lives in so many ways. Perhaps you can’t walk or move around like you used to. Maybe you can’t get restful sleep. Ask yourself how chronic pain has affected your life. Pain can be described using many terms. Think about how you feel chronic pain and how you would describe it.

Chronic pain costs our society millions of dollars each year. And there is immeasurable damage done to individuals and families caused by ongoing suffering.  There seems to be no ultimate solution or magic pill to cure your pain, but there are options. You can find relief. There is hope. Keep in mind that the pain you feel is often affected by your emotional state or mood. Often depression is linked to chronic pain. Your perception of pain is valid for you – it’s your experience – but how you respond to your pain may actually make it worse!  What chronic pain do you experience and what are some ways in which you deal with chronic pain? What advice would you have for others struggling to cope with chronic pain?
Wishing you a day without pain,
Mel