Managing Pain

Reasonable goals of pain management are to reduce discomfort by 50 percent or more without impairing function, and, where possible, improving function. It is clear that long-term opioid treatment for people with chronic pain is quite appropriate for some. The best way to tell if the opioids are working for you is to answer three questions:

1. Is your pain totally or mostly relieved, or at least significantly better?
2. Is your function maintained or improved?
3. Are the side effects (constipation, fatigue, mental clouding, itching, nausea, vomiting, urinary problems, constricted pupils, dizziness, sweating, muscle and bone pain, confusion, muscle spasms, and sedation) absent or tolerable?

If the answer to these questions is yes, then you can stop reading this chapter now. This is successful opioid treatment and needs no intervention.
After Paul's spinal surgery, he found himself consumed with the pain. His life had become unbearable. He could not sleep, take a deep breath, walk, stand, or do any of the things most people take for granted without discomfort.

Although Paul had been taking pain medications for months after his last surgery, they weren't quelling the pain. With urging and occasional demands by Paul, his doctors prescribed stronger and stronger opioids. It wasn't long before he was in a prescription program that included an extremely strong time-release opioid (morphine SR, slow-release), as well as a short-acting drug (Lortab) for breakthrough pain. He was also taking zolpidem (Ambien) to sleep and carisoprodol (Soma) as a muscle relaxant. The medications were not the perfect answer, but they worked to get rid of the pain, sort of.
One of the main tenets of opioid therapy is that the dosage should be set at a level at which pain is controlled with the least amount of side effects. Unfortunately for Paul, he soon began to experience many of the unwanted side effects of these potent drugs. His pain was numbed, but so were his mind, his speech, and his emotions. There were times when he would sit in a stupor in his bedroom, unable to communicate. His mind was not as sharp. His memory was foggy. The drugs Paul took to control the pain had begun to smother his life. He could not work or even carry out many functions around the house.

Excerpted from A Day without Pain (Revised and Updated) by Mel Pohl, MD, FASAM of Las Vegas Recovery Center. Copyright 2008, 2011 by Central Recovery Press. Used with permission.