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3 mistakes pain patients make
By | July 7, 2010
it’s summertime! and the living is easy… right?
here in oregon, it has been cool and breezy until this week. we have missed the life-threatening heatwaves seen around the rest of the nation. for example, at the lilith fair (women’s music festival) in portland, according to rolling stone magazine, fans huddled under blankets, and performers turned blue with the cold, when they opened on july 2nd!
july 4th weekend couldn’t have been more lovely, with blue skies, bright flowers, and cheery breezes.
despite the weather becoming more and more beautiful, more and more patients with chronic pain have been running out of pain medication early. why would this be?
at first i was puzzled. but now i think it’s because of the beautiful weather! people are feeling a little better, or at least a little more ambitious, and are overdoing it on activities. that knee-high lawn won’t wait another day for you to mow it – but if you overdo it, you’ll have a bad day tomorrow!
because narcotic pain medications are dangerous drugs – something you might underestimate if you have been taking them daily, for months or years, for chronic pain syndrome – their use must be strictly controlled. let’s talk about some common mistakes people make, who take these medicines.
first, a review. this part is important, because it explains the proper approach to this problem:
– chronic pain is not the same as regular pain. the “nociceptive” pain-sensing system of the body evolved to alert us when we are injured. if you sprain your ankle, the pain caused by inflammation keeps you from walking on it – then when it heals, the pain goes away.
– in chronic pain, the original injury healed months or years ago – yet the pain remains. one example is “phantom limb” pain, in which, for example, a missing foot still hurts, aches, itches, or burns. (in other cases, as in fibromyalgia, there may not even be an identifiable injury.)
– in regular, acute pain, you can easily say, “the pain comes from the sprained ankle.” but in chronic pain, you have to say instead, “something changed in the nervous system.” due to this change, the body-mind continues to register pain.
– chronic pain does not tend to get worse and worse. over time, it tends to get better. for example, in phantom-limb pain, often the nervous system eventually recognizes that the amputated foot is gone, and stops sending pain signals. this can take days, weeks, months, years, or decades. it stands to reason that the same thing may happen with other forms of chronic pain – the nervous system re-tunes and heals.
(due to the acute-problem focus and funding of western medicine, there’s very little research on long-term outcomes for a lot of conditions.)
note: even though chronic pain itself does not tend to get worse, the effects of an altered lifestyle can take their toll. if your back hurts too much to exercise, your muscles will waste away and your bones become weak, and these cause their own aches, pains, and exhaustion.
– in my opinion, the goal of using chronic pain medication is to keep a person functional – preventing worse physical, mental, and social problems – while the person works on re-tuning and healing the nervous system, over years or decades.
to achieve this goal, a person takes a stable dosage of pain medicine on a regular schedule, maintaining a steady amount of partial pain control at all times.
– a person who has chronic pain can also get injuries causing regular acute pain! for example, a person with chronic daily neck pain, can suddenly get a gout attack in their foot. a person with chronic pain from sickle cell disease can suddenly get a toothache. these sudden pains are different (are not chronic pain), and should be treated differently!
– a person with chronic pain can also have it get worse temporarily due to over-exertion, emotional stress, lack of sleep, illness, doing too much yardwork, etc. this pain is also different, and should be treated differently.
…this brings us to 3 common mistakes that pain patients make, and how (and why) to avoid them.
mistake #1: taking “extra” chronic pain medication to deal with temporary acute pain.
do you remember when you did not have chronic pain? in those days, when you tore up your hands doing outdoor work, or got a migraine headache, or twisted your ankle or knee, what did you do?
solution: treat acute pain acutely.
– REST the injury, and rest yourself.
– take tylenol and ibuprofen as appropriate for your situation.
– use ice and heat, soaks and wraps, ointments and rubs, massage and gentle stretching.
– if you think a procedure is needed – an x-ray, a dentist visit, etc. – call your doctor and/or go to the urgent care or emergency room.
– do NOT take more of your chronic pain medicine.
mistake #2: taking “extra” chronic pain medication to get through a special project or a special event.
this is challenging, because friends and family members often have activities they want or need you to participate in. narcotic pain medicine could help you to feel and act like your “old self” for a short period of time. however, if you misuse your medicine this way, you will run out early, and then be much more disabled by pain AND drug withdrawal later.
solution: plan ahead for events that are likely to be hard for you.
– do NOT arrange to do more than you can tolerate, hoping for the best. do NOT allow others to plan over-strenuous activities for you.
– PLAN how you will combine an event with a reduced level of activity (for example, how you will participate in some parts of a wedding or a family vacation, and NOT participate in other parts).
…arrange for assistance with tasks, chores, and transportation (for example, get help with packing, etc.).
…plan how many hours you will be up at a time, and where you will rest in between.
…make a plan for how to politely explain your limitations to others, or remind them about your situation (over and over, if necessary), in a way they will understand.
– use tylenol and ibuprofen, as well as the other treatments listed above, to minimize the impact on your body.
– do NOT take more of your chronic pain medicine.
mistake #3: “overdoing it” on a day when you feel good, then “needing extra” chronic pain medication.
everybody has good days and bad days… but when you have chronic daily pain, these extremes are accentuated! over time, you’ll start to predict that the worst days often follow a few days of “overdoing it.”
solution: you need to have steady levels of activity and rest that are about the same every day, whether it’s a good day or a bad day.
one important way to enforce enough rest and prevent “overdoing it” is to commit to taking a siesta (daytime nap) at a certain time every day. plan your daily schedule around it. don’t let anyone interrupt it. it’s very important for recharging your daily energies.
you should also redistribute your activities, so you’re not trying to get everything done on a “good” day. you can re-purpose the old nursery rhyme of “wash on Monday, iron on Tuesday, mend on Wednesday,” etc. – in other words, have a revolving list of tasks, one a day, so you don’t get behind.
for example:
“laundry Monday,
groceries Tuesday,
recycling Wednesday,
tidy up Thursday,
vacuum Friday,
yardwork Saturday,
visiting Sunday.”
this is much better than
“laundry/ groceries/ garbage/ vacuum Monday,
collapse in pain and exhaustion Tuesday/ Wednesday/ Thursday/ Friday.”
don’t “overdo”, and do NOT take more of your chronic pain medicine!
… you’ll notice a motif among these three mistakes and their solutions.
it’s a motif that applies, not just to chronic pain, but also to chronic fatigue, chronic effects of brain injury, and other chronic issues (many of which overlap).
the motif is: “the new normal.”
before, maybe years ago, when you were younger, back in the past, there was a certain set of conditions in your life that you defined as “normal.” perhaps “normal” to you meant “i get eight hours of sleep every night,” or “i do my own heavy lifting,” or “when i need something from the store, i just walk there and back.”
if you have developed a chronic disabling health issue, the “old normal” is not very likely to ever come back. that is the truth. you can make yourself very frustrated and depressed, and waste thousands of dollars, desperately chasing after the ultimate surgery, perfect practitioner, magical treatment, or medicine and dosage that will allow you to “get back to normal,” if you are still operating under the “old normal.” unfortunately, there are a lot of smooth operators out there who are quite willing to take your money and give you nothing in return but false and temporary hopes.
but you can trade false hopes for realistic control of your life. you need to create and claim your own “new normal.” it is much better to choose your own definition of “normal life” than to have others impose it on you. you need to be able to say, “here is how i normally operate, given my current limitations, day by day,” rather than having friends, family, or doctors tell you, “this is what you SHOULD be able to do, so just do it.”
– avoiding mistake #1 will help you to juggle your chronic limitations along with the unexpected, temporary problems that naturally arise.
– avoiding mistake #2 will help you rearrange the important events in your life to fit the capabilities you now have.
– avoiding mistake #3 will help you move on with your daily life in a sensible, organized fashion.
as a doctor, of course, i would be relieved if i knew that YOU knew how to keep from over-relying on pain medicines inappropriately. if the medicines were harmless, of course you could take them whenever, for whatever you saw fit! unfortunately, drugs don’t work that way. not even vitamin pills work that way.
please keep your eyes on the prize! the goal is, again, for you to be able to work and play “normally” (according to whatever is the “new normal” for you), while your body, mind, nervous system, spirit, and all, re-tune and recover from all that has happened to you.
work carefully, play joyfully, rest patiently! (and drive safely.)
have a great summer!
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July 8th, 2010 at 9:19 am
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