Dear Friends in Pain,

I was shocked "one more time" to see in another RSD group many
treated poorly by lack of medication management, and by physicians
who continue to deny opioids for pain management as being safe, and
needed for many who suffer. I send again this letter from a very
formidible and credible pain physician a necessary statement of
"safety."

When we come to the crossroads, with so many NSAIDS and non
opioids not only causing bleeding, but now heart issues, kidney
failure (the list continues) there is no OUTLET much less life left for
those who suffer; who's very lives depend on the ability to walk,
get out of bed, and or live again. This physician is ONE of many
who not only support the scientific proof that opioids for medical
therapy and management of chronic pain a safe alternative, but
who humanely fight the "good fight for the many" who without this
cannot continue onward.

One has a right to choose; whether it be to DENY MEDICATIONS
and side effects that can damage, or hurt, or EXPENSIVE BLOCKS
and or life threatening treatments that ONLY COST IN INSURABLE
BENEFITS BUT CAUSE HARM....

Peace to all!
Karen





CHRONIC PAIN AND OPIOIDS
DEBUNKING THE MYTHS


BY FRANK FISHER, M.D.


WHAT IS CHRONIC PAIN?
Chronic pain is a progressive disease of the nervous system, caused by
failure of the body's internal pain control systems.The disease is accompanied
by
changes in the chemical and anatomical makeup of the spinal cord. Chronic pain
is a malignancy, in the sense that when it goes untreated, it increases in
intensity and spreads to areas that weren't previously affected, damaging the
sufferer's health and functioning.

WHY TREAT CHRONIC PAIN WITH OPIOIDS?
Opioids are substances naturally produced within the body to regulate pain.
They are commonly known as endorphins, and recognized as producing the state of
euphoria known as the runner’s high. Chronic pain victims, who
can’t
produce enough opioids on their own, often benefit from supplementation with
pharmaceutical opioids

WHAT ARE THE GOALS OF TREATMENT?
Lowering of pain levels.
Reducing suffering through restoration of functioning in life activities, as
close to normal as possible.
Arresting and reversing the damage done by chronic pain to the nervous system
and overall health of the patient.

ARE OPIOIDS DANGEROUS?
When taken as prescribed by your doctor, opioids are among the safest drugs
available.

WHAT ABOUT THOSE "OXYCONTIN DEATHS" REPORTED IN THE MEDIA?
Oxycontin, like other opioids, is safe for patients who take their medicine
as prescribed. “Oxycontin deaths” occur in habitual substance
abusers, not
patients, and are usually the result of combining the drug with overdoses of
alcohol and other drugs. These are deaths associated with Oxycontin, not
caused by it, and they are not occurring in patients.

WILL I HAVE TO TAKE OPIOIDS FOR THE REST OF MY LIFE?
Opioids can be discontinued whenever they are no longer needed. Patients
often recover from chronic pain, and return to active lives.

WILL I GET ADDICTED, AND HOW CAN I TELL IF I AM?
Opioid addiction in pain patients is extremely rare. Addiction is defined by
the American Society of Addiction Medicine as, continued use in spite of harm.
If opioids make your life better by controlling pain, you are a pain patient.
If they make your life worse, and you continue to use them, you are an
addict.

WILL I HAVE TO TAKE LARGER AND LARGER DOSES TO CONTROL MY PAIN?
For most patients, their dose remains stable over long periods of time.

WILL I GET HIGH, OR LOSE CONTROL?
When opioids are taken on a regular schedule, tolerance quickly develops, and
the psychological “high” goes away, leaving the user feeling
completely
normal. Long-term opioid users, as a group, have driving records for accidents
and violations that are the same as everyone else’s.

WILL I HURT MYSELF BECAUSE I DON'T FEEL ANY PAIN?
No. Opioids improve functioning by reducing pain levels. They don’t
remove
all the pain, or the ability to perceive new pain.

WILL I BECOME DEPENDENT?
You may. Dependence means that if opioids are abruptly discontinued you will
have a physical withdrawal reaction, similar to having the flu. This reaction
can be prevented by gradually tapering off the medication. Dependence is a
physical phenomenon, not a sign of addiction.

WHAT IF I HAD A PREVIOUS SUBSTANCE ABUSE PROBLEM?
This should not prevent a trial of opioids. Studies at Harvard Medical School
and the University of Washington indicate that a past history of substance
abuse has little predictive value for failure of opioid treatment. If you have
current behavioral or substance abuse problems, you may have trouble with
opioid treatment.

ARE THERE ANY SIDE EFFECTS?
Constipation, nausea, itching, insomnia, and drowsiness commonly occur. All
of these side effects can be successfully managed

WILL THE MEDICINE DAMAGE MY LIVER?
No. Opioids occur naturally in the body, and are not harmful to any organ
system. They can be taken safely for a lifetime, if necessary. Anti-inflammatory
non-opioid medications such as Motrin, Naprosyn, and Vioxx, on the other hand,
kill 16,500 patients each year through bleeding from the stomach, and are
toxic to the liver and kidneys.

WHAT IS THE CORRECT DOSE?
The amount that allows optimal functioning is the correct dose. There is no
upper limit to the dose of opioids that can be safely used, when the medicine
is increased gradually.

WHY WON'T MY DOCTOR PRESCRIBE ENOUGH MEDICINE TO CONTROL MY PAIN?
He is too scared. As part of the War on Drugs, law enforcement is conducting
a witch hunt against pain doctors who prescribe opioids compassionately. Most
physicians won’t risk being targeted by law enforcement, because they
have
families to support. As a result, chronic pain sufferers have become
non-combatant casualties in the war on drugs.

THE NEWS CALLS OXYCONTIN "HIGHLY ADDICTIVE." DO YOU THINK IT IS MORE
ADDICTIVE THAN OTHER FORMS? IT CERTAINLY IS MORE EFFECTIVE.
The idea that one opioid is more addictive than another is a misconception.
The prevalence of opioid addiction runs far below that for other common drugs
of abuse, such as tobacco, and alcohol. This is not for lack of exposure
either, because 23,000,000 people have surgery each year, and most receive
opioids
afterwards. The fact is, most people don't like opioids, and this is borne out
by experiments at NIDA, and mentioned in textbooks.
There are clearly differences in preferences expressed by people who pursue
opioids for the psychological reward they experience. So far, this is not borne
out by the scientific literature, but anecdotal evidence really leaves little
doubt.
The mistake often made, is using this preference observation to jump to the
conclusion that one opioid, such as Oxycontin, is more addictive than another.
The flaw in this reasoning is the extrapolation that because there are
preferences for specific opioids within the population of abusers, this means
that
certain opioids can cast some sort of evil spell over the rest of us. This
simply isn't the case. The fact remains that most human beings still aren't
inclined to abuse opioids.
I agree with your observation that oxycodone is more effective in the
treatment of pain than many other opioids. It seems to be the case, that the
more
effective opiods are also those preferred for their psychological effects. For
the reasons discussed above, this would not be a problem for the field of pain
management, except that doctors are blamed for not preventing abusers, who
would find a source of opioids anyway, from getting what they prefer.
The phenomenon of tolerance prevents chronic pain sufferers from experiencing
the psychological rewards that abusers pursue. Paradoxically, they take too
much, to be able to get high.


Comments/Opinions
Frank B. Fisher, MD
frankbfisher@...
Or webmaster@...
510-233-3490



Karen Hallenbeck~Sikorsky~George BS,RN,UM,QC
Owner-Moderator
"AnGeLsInPain"
"OneVoiceInPain"

http://health.groups.yahoo.com/group/AnGeLsInPain

Interqual Certified
Published Psychiatric Researcher
Advocate for those in CIP, HIV, Psychologic Pain
"A Higher Power is necessary to find the ability to withstand self
destruction.."


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