The Brain Behind Pain: Exploring the Mind-Body Connection by Akhtar Purvez MD

Author:Akhtar Purvez MD
Language: eng
Format: epub
Publisher: Rowman & Littlefield Publishers
Published: 2022-01-15T00:00:00+00:00

CHAPTER 7

Beware the Evil Twin

NOT SO LONG AGO, BEFORE EVERYTHING WENT TERRIBLY WRONG, chronic pain patients were a bonanza for the companies that produce opiates.

Some medications are prescribed only for the length of a short treatment—antibiotics, for example. Maintenance drugs (like those for lowering blood pressure) might be longer term, perhaps even over a lifetime, but are normally taken only once or twice a day.

Opiates were the best of both worlds from a pharmaceutical provider’s point of view. The doses are generally more frequent, and the length of the prescription was often essentially open-ended.

In many ways, however, this was a recipe for disaster.

Opioids continue to be the flagship drug when it comes to defusing pain, both acute and chronic. Sometimes, they succeed in that function when nothing else does.

The problem is, the way in which they affect the human body can send their users down the path of diminishing returns. Although every individual might react differently to an opioid regime, most eventually begin to develop a resistance to it. When that happens, they need to take more pills to achieve the same effect, then more still. Lest we forget, heroin is an opioid.

On the surface, there is nothing easier for a doctor than writing a prescription—a couple of scribbles, a quick flip of the wrist to separate sheet from pad, an extended hand.

If the recipient is a chronic pain patient, however, this simple transaction can be a moment of profound anticipation. Chances are, many other medications have already failed, yet there is always hope that this will be the one to restore normal life.

For the physician, conversely, there is often a lurking sense of uneasiness. Perhaps gun shop owners—the responsible ones, anyway—have the same feeling when they hand over their merchandise.

Much can go right with today’s drugs, but much can also go wrong. With first-time patients, I can only assume that they will follow my instructions and the information on the bottle and not take too much or too little. If the medication is an opioid, I trust that it will be used for pain relief and not recreation or the search for forgetfulness.

Increasingly, these are too many “ifs” for the average physician, which is why many of the stronger medications for chronic pain are now most often prescribed by pain specialists. Unfortunately, their ranks are dwindling instead of increasing.

These are some of the scenarios that could lead to misuse of an opioid drug:

An elderly person might take his or her medication several times in a short period because of a memory lapse.

A patient might misunderstand or misjudge the amount of time it takes a particular medication to “kick in.” Thus, when no relief is felt in what that patient believes is a reasonable time, he or she may take another pill under the assumption that more is needed.

A depressed person, living alone, might be more inclined to combine too many pills with alcohol.

The same patient, in too much pain to work or even be active, might be tempted to get high on an extra pill out of boredom.

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