Pain Management VS Med Addiction

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Why is it that when you stop taking certain meds or other substances the body goes through withdrawal? What for that matter does it mean to be addicted to a substance, and how does the body become that way to begin with? How does all of this affect pain management?

To answer these questions we must first understand the basic makeup of the human body. What many people may not know, especially given the complex and amazing ability of the human body, is that it is a very painful place to be. In fact the very processes and abilities that make the body so amazing often times causes all sorts of harm and damage to the body. As a result the body evolved a system to help manage that pain, a system so efficient that most people never even have to realize how painful it is to be human.

The key component of that system are endorphins; naturally occurring chemicals that work much like pain meds that are produced by the body to combat the bodies day to day pain. Under normal circumstances there is no issue with these chemicals and the body works just fine. The problem begins when outside chemicals are introduced to the body that perform the same basic function… pain management; such as drugs and pain meds. What happens is that if the body begins to have too much of these chemicals in the system because there is an outside supply, then the body will actually begin to produce less of them internally.

Not going into the emotional or psychological side of addiction, this is what happens when the body becomes addicted. The body stops producing the required endorphins in favour of getting the same functions covered by the outside substances. If those substances are cut off then the true pain of the human body comes out as there is nothing there to combat it. This of course is not an instantaneous process; in fact it takes time to degrease the internal production of these chemicals. Of course it also means it takes time to again begin to produce them if the outside substances are withdrawn.

In fact if the outside substances are lowered gradually (at lease in general terms, as some will kill you no matter what you do) the body will slowly work to produce more of the endorphins; relying less and less of an outside source. As the body produces more of the endorphins the system will again work to correct itself. Provided that the outside substances did not cause any permanent damage to these systems; which sadly does often happen with a lot of the unregulated street drugs, some will even damage that system after only one use.

So in regards to pain management, what does this all mean? If we use these outside substances will that not stop the production of endorphins and lead to addiction?

In truth there is a very fine line between pain management and addiction. That line is actually drawn in the pain itself. If you take enough meds to be totally pain free, then the risk of addiction grows in direct proportion to the amount of extra medication that was taken. If the amount extra equals the amount the body was producing, the body will likely shut down production. If it was 10% of the bodies production it would likely just reduce the amount it produced.

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You need to understand that the body will only shut down endorphin production when there is too much of the chemicals in the system. Think of it as a fail-safe system to ensure the body is not harmed from overload of these chemicals. This is however based on the needs of the body at any given time, not simple a specific amount all the time. When you are in pain you will need more of these chemicals, which is also why the body can trigger endorphin rushes when something happens to the body.

If you work more to manage the pain by making the pain more tolerable, without ever being rid of it, then the body will not stop endorphin production. The reason is simple… the body needs more of these chemicals that the body can naturally produce. Since the amount introduced from internal and external sources is not sufficient to handle the problem independently one from the other, then they body will continue to produce what it can to keep the system functional.

Unfortunately, when someone is in pain it is hard to just make it tolerable. There is often a huge desire to be rid of the pain and that is a fast road to addiction. So, if that is true what can we do to allow us to have proper pain management while working to limit the option of becoming addicted?

The best way is to monitor how you feel at any given moment. If you feel no pain and/or become high or spacey, then you have taken more pain meds than you actually needed in that situation. The best course of action would be to take less next time and continue to monitor how you feel. If you find the pain is too much to handle, based on truth and not simply the desire to be rid of the pain, then you need to take more meds. Some times you may need more and others you may need less. However, the more that you can sit at a level that the pain is “manageable” the less worry there is from addiction. Each time you go to the level of being high the risk naturally increases.

Sadly, however, going to the side of tolerating more pain than reasonable to limit the effect of addiction is not a good idea either. Like all parts of the body, if you overwork something it can become damaged and shut down. If you make the body produce maximum levels of endorphins for too long if may well stop producing them altogether. Unfortunately, no one really knows how easy or hard it is to do that. In fact the mere idea about testing to see how much pain over what level of time would cause the body to shut down would be seen as “inhuman cruelty”. Yet, ironically having to suffer the same kind of pain without proper pain management is generally not seen the same way. The sad truth is that in some circumstances people are made to suffer pain that they should not have to because of improper pain management.

The problem with pain management is, as we already talked about, people tend to want to make the pain go away. In truth if that was the goal it would be called “pain removal” and not “pain management”. However, since too many people over the history of pain management have gone more towards elimination than management, people have become addicted. That combined with the fact that the meds are by nature addictive addictive tends to make Doctors more leery about giving them out for things that are not as easily defined.

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To show an example of that… if I were to crush my hand under the tire of a truck from say trying to change the tire and the jack failed with my hand underneath the wheel… there is no doubt about the pain and meds will be offered readily. If however the pain is less “assured” and more subjective, say from repetitive stress injuries, then meds are more reluctantly offered out of the fear of addiction.

What complicates this is that we really have no way to rate pain. What system do we have now? What is the pain to you on a scale of 1 to 10 where 10 is the worst pain you have ever felt? Someone who has given birth to a 10 lb baby is quite obviously going to have a different “10” than someone who has broken their leg in three places from a skiing accident.

This also raises an interesting question? What about the person who the worse pain they have ever felt is a stubbed toe or other relatively minor injury? Of course by that token what good is this number if given to someone who has a different idea of what “10” is compared to you? If the nurse is female and her “10” was the birth of her first born… what happens when a male comes and says they have pain of “10”? Not to mention what happens when the person simply cannot handle pain as well as an average person can. After all we have a stereotype about some people who simply get a cold or flu and act like the world is coming to an end. How can we know that their “10” is not actually a “3” in disguise? All of which continues to make Doctors less willing to give meds to manage pain when pain is not easily defined… as in the case of the crushed hand.

So this the brings us to the whole point of all of this… what can we do about it?

In truth all we can really do, at least until someone comes up with a working pain meter, is to try and educate ourselves and others on the realities surrounding pain and pain management. We all need to try and realize the dangers of addiction, and hopefully offer enough incentives from that information to work on managing pain as versus getting rid of it all together. If we can do all of that we can hopefully help reduce the impact of addiction or at least make it happen a lot less than it is feared it happens today.

The more we can help to change the way pain is seen and dealt with, the more we should be able to make proper pain management more readily available to those who need it. After all, if the fear of addiction becomes less a concern, then pain management becomes a more viable option. The best way to do that, as we said earlier, take only what you need when you need it… don’t try and get rid of all of the pain if you can take just enough to be able to easily manage it with what you have taken. Also, don’t worry about taking it all the time in proper amounts if you truly need to. It is often better to have regular ongoing pain management as versus jump start pain management. If you can keep the pain under control and manageable, then you also can help to limit other complications that arise as a result of excessive pain… something you may also have to worry about.

Copyright August 2006 - All Rights Reserved


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