Prescription Drugs and Pain: the Self-Defeating Loop

Prescription Drugs and Pain: the Self-Defeating Loop

Prescription drugs and pain seem to go together like baseball and hot dogs, but unlike the latter, the former is anything but healthy – when used indiscriminately or for too long. The fact is that overuse of prescription drugs can put you into a self-defeating loop.

Here’s what can happen. You have pain, so you take prescription drugs to relieve it. This works for a while, but you figure, what the heck, I’ll just continue to take the meds so I don’t feel the pain. Over time, however (and how much time is different for everyone), the drugs don’t seem to work as well as they once did. You begin taking them more frequently, maybe even doubling up the dose.

Now you’re in a routine: take the meds, the effect wears off and you feel pain again, take more meds, pain comes back quicker, take more meds…until you can’t get the pain relief any longer. You may search out new medications or combine what you have with other drugs, legal and illegal. What you don’t take into consideration is the cumulative effect of too much medication, too frequently. Another danger is side effects. Taking prescription drugs in combination with alcohol is a really dangerous mix. Talk about adding fuel to the fire. Not only have you put yourself into a bad situation by taking pain medications pretty much non-stop, but you may become addicted to them as well.

What Happens When You Try to Cut Down or Quit

Once you’ve become accustomed to using the prescription drugs to wipe out your pain, you’ve settled into a routine that’s one definitely not recommended by your doctor. You’ve likely found that out when you tried to renew your pain medication prescription and your doctor says it’s only supposed to be used for a limited amount of time. What do you do? You find another doctor, one who knows nothing about your past use of the drugs – and you give him your tale of woe about pain and how you can’t stand it. And viola, your new doctor writes you a script for painkillers.

What have you really accomplished? You already know that continuing to take the pain pills is proving counter-productive. And you may even tell yourself that you’re going to cut down the amount or quit entirely – after this prescription is filled.
Little glimmers of what you feel when you don’t get your dose when you feel you need it is enough to send shivers up your spine just thinking about quitting cold turkey. How will you be able to stand the pain? You never stop to think that you’ve singled out painkillers as a crutch that’s easy for you to use. It doesn’t take any effort on your part to manage your pain in healthier ways. You just pop a pill and go about your business.

Except that it doesn’t work that way any longer. Now you are dependent upon the pain pills just to get through the day. Repeated use of the prescription drugs causes the body to adapt. This may result in the body developing a tolerance to the drug. That means that the individual using the drug requires more of it more often in order to achieve the desired effect (the effect achieved when the person first started taking the drugs).

Repeated exposure can also result in withdrawal symptoms when you abruptly stop taking the drug. Withdrawal symptoms can be mild, moderate, or severe and include:

• Restlessness
• Muscle and bone pain
• Insomnia
• Diarrhea
• Cold flashes with goose bumps (commonly called “cold turkey”)
• Involuntary leg movements

While the decision to stop taking prescription drugs for pain is well-intentioned, it shouldn’t be attempted without medical supervision. You should never just stop taking your meds – whether you’ve been going from doctor to doctor to get them or not. It’s just too dangerous. Going through withdrawal for opioid dependence and addiction may be so uncomfortable that you give up the effort and immediately go back to using the drugs. But taking too much at once of opioids, for example, which already produces drowsiness, causes constipation, and can depress breathing, may result in severe respiratory depression or death. So this is definitely not something you want to tackle on your own.

Still, you need to wean yourself off the prescription drugs for pain. How should you do so in a safe manner? The solution is to go for treatment.

First Step: See the Doctor

Let’s take the example of an elderly person with severe arthritis pain who’s been taking opioids to relieve it. Along with the arthritis, the individual has other age-related conditions or medical problems that require daily doses of other medications. Unable to sleep through the night, the person may take sedatives. Early-onset Alzheimer’s disease may also be present, causing the individual to forget when he or she took certain meds or mixing them up, doubling the dose, or taking them all at once.

Family members notice the change in their loved one. Grandpa or Mom seems to be out of it all the time. They have trouble with motor functions and they seem to have trouble with their cognitive skills. Upon examination of all the prescription bottles on the counter, in the medicine cabinet, or around the house, the family members try talking with the loved one to find out what’s being taken for what condition. If Grandpa of Mom is in a diminished capacity, the family members may – with good reason – urge a visit to the doctor.

This is a wise course of action. The doctor needs to know exactly what the patient has been taking. The family member should accompany Grandpa or Mom to the doctor and bring along a complete list of all medications – or, better yet, bring all the containers.

Some drugs may no longer be needed, or the doctor could determine that certain drugs are working at cross-purposes with others. He or she could prescribe some that won’t produce negative interactions. If the doctor determines that Grandpa or Mom are dependent upon or addicted to prescription drugs for pain, a referral to a treatment facility may be in order.

Be prepared for the reaction from Grandpa or Mom when and if the doctor recommends treatment to wean them off drugs. Insist that the doctor tell your loved one in no uncertain terms what can happen if he or she continues to take these prescription drugs in a manner not prescribed. Call it scare tactics or just common sense, but someone needs to set your loved one straight.

If you are the person who is dependent or addicted, that’s all the more reason why you need the cold, hard facts about the self-defeating loop of taking prescription drugs for pain.

Look at the Big Picture

No one wants to live in a fog. No one wants interminable, unbearable pain either. Getting past the immediate circumstance takes action and outside professional assistance. It’s not an easy decision to make for many. There are many considerations often cited why a person can’t or won’t go in for treatment.

• It’s too expensive
• Insurance doesn’t cover it or there’s no insurance
• Can’t take off from work
• Don’t need treatment – I’m not addicted
• Embarrassment or shame
• Stigma associated (or perceived as such) with drug dependence or addiction
• I can do it on my own
• No one tells me how to run my life
• I’m not going to a place with a bunch of drug addicts
• I don’t want to give up drugs

Countering these objections may take some time. While you can’t force someone into treatment – unless it’s court-ordered or the family delivers an ultimatum (which may or may not be agreed to) – it may feel like you’re forcing it on your loved one. You actually are, and for his or her best interest.

Anyone entering treatment to overcome dependence, abuse, or addiction to prescription drugs for pain should take the long view. Look at the big picture. Life the way it currently is will only deteriorate further. The downward spiral of constant misuse of or addiction to prescription drugs will rob the user of vitality, physical and mental health, quality of life – even life itself. You or your loved one who’s been relying on these meds for pain need to look at what your life can be like without being dependent on drugs. First, you need to get them out of your system. Then you need to learn how to manage your life without the meds. Learning healthier ways to manage pain is part of the treatment process.

It’s certainly worth considering. And, in the long run, it’s a lot less expensive. Complicating conditions caused by drug interactions or overdose can easily run up hospital and doctor bills and further speed up the downward spiral.
Who wants that? Taking the big picture into consideration, a little time spent now in treatment doesn’t seem like too much to go through to come out on the other side in a healthier state, does it?

Figuring Out the Basics

How you go about getting yourself or your loved one into treatment is not particularly difficult. Ask your doctor for a referral or involve your family members in your search. A good place to start your research, if you want to check it out on your own, is the Treatment Facility Locator (http://dasis3.samhsa.gov/) website maintained by the Substance Abuse and Mental Health Services Administration (SAMHSA). You can search by state or do a more advanced search to find drug and alcohol treatment programs at facilities across the United States. You can also call their toll-free treatment referral helpline at 1-800-662-HELP.

If money is tight, use the Detailed Search or List Search options on the treatment facility locator and check the boxes for “sliding fee scale” and “payment assistance.” Then call the facilities to inquire about their programs for more detail.
The locator also has listings for state substance abuse agencies (http://findtreatment.samhsa.gov/ufds/abusedirectors) that include name and address, phone and fax numbers, email and links to websites (if applicable).

You – or your family members – can research facilities and check with your doctor to see if he or she recommends one over the other or has referred patient there in the past, or research ones that the doctor has already recommended.
Once you find a particular treatment facility or facilities that appear to meet your needs, get more information directly from the facility either online, by telephone, or requesting that it be mailed to you. Definitely ask all the questions you need answers to. There’s no sense committing to a treatment program if it’s not going to fit your requirements. It’s also a good idea to visit the facility to see it firsthand – before you decide to go there for treatment.

Look for a treatment facility that’s certified and whose practitioners carry the appropriate licenses and credentials. Other things to pay attention to include:

• Types of treatment offered
• Drug detox services (whether available on-site or off-site)
• Cost of treatment
• Insurance coverage or payment plans accepted
• Facility’s treatment success rate
• Availability of aftercare or continuing care
• Special groups treated (including age, gender, other demographics)
• Typical length of stay

Looking Forward to Recovery

After completing treatment for abuse, dependence, or addiction to prescription drugs for pain, what can you expect? While you will have learned a great deal about how to manage your life without abusing drugs, you will still need the support and encouragement of others as you begin your early days, weeks, and months of recovery. As part of your recovery plan, the one you created with your therapist during treatment, you will likely be attending 12-step group meetings on a regular basis. These groups can provide a lifeline for newcomers to recovery, especially when situations occur that may otherwise precipitate a return to using.

You will also more than likely have some follow-up care as part of your treatment program. This may include ongoing counseling or referrals to other agencies or sources for help. Be sure to take advantage of all such services made available to you.

Family is another critical factor in your recovery. They want you to be healthy and happy and drug-free. They, along with your 12-step sponsor and fellow group members, will serve as your support network.

No one recovers alone. A successful recovery requires a caring and continuous support network. The ability to develop resilience, to learn how to bounce back from daily stresses and challenges, is necessary for long-term effective recovery. Having others to talk with who’ve been through the same types of challenges after overcoming a problem with prescription drugs for pain can help you as well. What strategies and techniques worked for them in times of crisis or stress may also work for you, or you could perhaps adapt them to fit your situation and circumstances.

If you’re thinking about doing something to overcome your dependence on prescription drugs for pain, now is the best time to get started. The journey to recovery begins with the first step. Take that step now. Make the decision to get help. Learn how to manage your pain in ways that don’t involve overuse or misuse of prescription drugs. This will involve a change in lifestyle that may be much more pleasant than you imagine. Meditation, yoga, learning new hobbies, acupuncture, and therapeutic massage are just a few of the things that others have found helps them better manage their pain.

Help is available. Are you ready to accept it?

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