If you suffer from chronic pain of any kind you probably remember when your doctor diagnosed you with it. You may have many questions about the diagnosis and prognosis and wondered how you’d get your life back.
You or your practitioner (or both of you) probably discussed painkillers.
Maybe you’ve had someone else in your life that suffered from chronic pain and you saw firsthand how it negatively impacted their life. Over the counter options like aspirin or ibuprofen didn’t seem to do anything for it. You needed something stronger, like Vicodin. It seemed to be the only way out of pain.
Your doctor may have reinforced the notion painkillers work, claiming they’d ultimately alleviate your pain and help you live a normal life.
But new evidence has proven that old way of thinking to be flawed.
If this sounds familiar or you’re scared, don’t be alarmed. It’s not your fault and it’s not entirely your practitioner’s fault either. You’re not alone; in fact, you’re one of the millions in this country who has pain and has been provided a prescription opioid without informed consent (1).
In the last 30 years, we’ve seen a huge shift in the prescription of opioid painkillers for those suffering from pain. It’s become commonplace for those with long-term, often times debilitating pain, to look to their practitioner for some kind of painkiller to treat their pain and just to make the days easier.
Yet in the last few years, there’s been more and more media coverage of the growing and extremely fatal opioid epidemic that has been ravaging the United States. This epidemic wasn’t caused by some flood of black market opioids, but by the over-prescribing of opioids by a well-meaning but ultimately harmful medical community.
You can learn more about How Doctors Were Duped, Patients Were Hooked, and Why It’s So Hard to Stop in my interview with Dr. Anna Lembke, MD on the Healing Pain Podcast.
Despite this, people still rely on painkillers as the answer to their problems, and practitioners are still prescribing them.
When the medical world first started embracing painkillers, it was due to the pharmaceutical industry spreading misinformation that over-stated their effectiveness for treating pain. Before this, they’d only ever been prescribed for extreme pain or pain as a result of end-of-life illnesses.
This was compounded by a large-scale transition of smaller, independent private practices into highly centralized and industrialized healthcare systems. This meant that doctors no longer reported to their local patients but to boards and directors often with financial interests first. In the long run, this change inadvertently turned doctors into salesmen and patients into customers.
And the abundance of opioid prescriptions turned those patients into repeat customers, dependent on painkillers for their pain and their peace of mind.
The first step in reversing the epidemic is to inform patients and practitioners up to the dangers posed by opioids
Whether you’ve been recently diagnosed with chronic pain and prescribed an opioid painkiller or you’ve been dealing with pain and all your life, understanding the facts about painkillers will be beneficial.
The 4 Myths of Painkillers
Because of how long practitioners have been prescribing painkillers, the misconceptions have gone from being spread by the pharmaceutical industry to facts that practitioners all over the country tell their patients every day. Chances are if you didn’t hear these sentiments from your practitioner, you’ve heard it from someone else in your life. It’s high time we set the record straight:
Myth #1 Opioids Are Effective in Treating Chronic Pain
The first and most important myth to bust is that opioid painkillers are effective in treating your pain. Painkillers are just that, painkillers, not medication designed for you to heal. If you suffer from short-term pain (that’s any pain that affects you for less than 6 months), then painkillers may be a great treatment option (1). But if you fall within the vast majority of people with a long-term chronic condition (greater than 6 months) like fibromyalgia, for instance, opioids aren’t a cure. They do not improve your ability to function long term.
However, it’s important to remember that no one doubts your pain. Chronic pain is real. You know best of all that the pain you suffer is real and it is interfering with your life.
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There’s room for painkillers in treating chronic pain, but it should be in the beginning stages of treatment and used intermittently. This way your body doesn’t build up a tolerance.
The lowest dose, for the shortest amount of time.
Myth #2 No Dose is Too High
As mentioned above, you should only take painkillers sparingly in the beginning so that your body doesn’t build a tolerance. That’s the second myth about opioids that desperately needs to be cleared up, that you can’t build up a tolerance.
This is why practitioners and physicians saw it as the miracle treatment: they believed that their patients wouldn’t become dependent.
But you can build up a tolerance to painkillers, which can lead you to be prescribed larger and larger doses just to get the same effect. Does this sound familiar to you? Has your doctor been prescribing larger and larger doses just so you can sleep?
This can lead to what is called opioid-induced hyperalgesia, which basically means that if you take opioids daily, your pain capacity is lowered and you’re more sensitive to pain (2). Some even report the spread of pain to areas where they did not initially feel it.
This, as well as the stress of managing doses and taking the right pill at the right time, is one of the unseen effects of painkillers, especially now that there has been so much media attention on opioid addiction.
Myth #3 Low Addiction
Another common myth purposefully spread about opioids was that as long as you received your prescription from a doctor, the chance that you’d become addicted was low, around 1%.
In actuality, the percentage is much higher than that: around 30% chance of addiction (3). Even if you have no history of addiction, your prescription is from your practitioner and you’re responsible with it, you still face the risk of addiction and dependence (4).
The longer you take opioid painkillers the lower your tolerance for pain will become. Eventually, you’ll require more and more doses for the simplest of tasks. Pretty soon you’ll find yourself growing dependent on your painkiller for things like sleep, work or even the slightest activities (5).
The risk of addiction increases the longer you take them and the lower your tolerance for pain becomes.
Myth #4 Pseudo-Addiction
The final myth that was perpetuated about opioids was that, in addition to the risk of addiction being almost nonexistent, that any symptoms or behaviors of addiction weren’t real.
Practitioners were led to believe by the pharmaceutical industry that these symptoms were really just symptoms of pain and that the patient required more (6).
All of these myths are incredibly harmful for you as someone dealing with chronic pain. But none more so than the belief that your addiction isn’t real.
Addiction is a disease and an unnecessary and dangerous burden to add to your already existing burden of chronic pain. You’re probably worried what an addiction could do to you or your family.
And depending on how informed your practitioner is, she may be incredibly surprised to hear about this dependence. Especially since the large health systems that many doctors are part of only have strategies for prescribing painkillers and not on actively weaning you off them.
Where Do We Go From Here?
With a topic like this, it’s a challenge to outline one simple solution. Not only is there a need to come up with more effective, active coping and rehabilitation methods but also to change the way practitioners and patients think about opioid treatment.
You’re not alone in dealing with this pain, just like you’re not alone or helpless in treating it.
You’re not alone in dealing with this pain, just like you’re not alone or helpless in treating it. Share on X
Practitioners
Your practitioner likely doesn’t want to get you hooked on opioids. They want to help you recover from your pain but our clinics and practitioners have been swallowed up by large, inter-connected and bureaucratic health systems.
They’re now pressured to deal with patients faster, getting them in and out of the office with a prescription as quickly as possible. They now have supervisors with deadlines and profits to keep in mind. This means patients became customers and healing became prescriptions and surgeries because that’s what healthcare covered, and that’s what paid.
As a result, practitioners were forced to prescribe painkillers because painkillers were what healthcare insurance covered. Yet before the flood of painkillers in chronic pain treatment, practitioners did prescribe treatments that have been known to work on chronic pain like physical therapy and psychotherapy.
But it’s very hard for health insurance to be convinced to cover these as they too have come to believe that opioids are the only solution. Your practitioner is struggling with recommending something that you might not be able to afford.
Yet it’s easy for your practitioner to write you a prescription for a painkiller and it’s even easier for your insurance to cover it. This means that you and your practitioner may grow to rely on it, as it appears to be the easier solution. But you haven’t set out a plan to be eventually weaned off painkillers, haven’t developed active coping strategies or looked at alternatives.
The cause of this epidemic of opioid addictions has to be realized as stemming from the over-prescription of painkillers. It’s not just a few bad elements spreading it on the black market. Most people with opioid addictions are people like you, normal everyday people suffering from chronic pain.
But because of the ineffective way we deal with chronic pain, thousands now have stress-inducing painkiller dependencies. And your practitioner probably hasn’t been trained to screen for symptoms or treat addiction. That’s because the old, outdated view was that addiction was a problem of will rather than an actual disease that we could track to a cause.
Practitioners need to normalize addiction from painkillers. If we begin treating addiction the same as a disease, specifically within the practitioner’s office rather than being left to outside specialists, then they become empowered to bring you real, meaningful change.
Another alternative that has recently become more and more popular is pain psychology. Practitioners may not view pain psychology as the best way to treat pain since they weren’t taught it in medical school. But if practitioners work with or recommend specialists in pain psychology, they will be able to give patients the tools to cope with pain effectively.
To learn more about pain psychology and how active coping strategies can help heal your pain, listen to my interview with Dr. Beth Darnall on the Healing Pain Podcast.
Ultimately, practitioners and the field as a whole needs to be incentivized not to prescribe pills but to explore more effective alternatives. They must also understand the myths they learned all the way through medical school and have picked up after it. They need to learn the truth that is emerging.
Patients
Just as practitioners have to be empowered to prescribe effective alternatives and find real change in the lives of the people they care for, you, the patient, have to be confident and realize how much power you have over your chronic pain.
No, chronic pain isn’t in your head; it’s a real yet entirely manageable condition. This is why opioids can and should remain a treatment option for some (7). But chances are, you and many others just like you are diagnosed with chronic pain and immediately seek out painkillers as the quickest solution. Who wouldn’t? It’s only normal.
But this tends to instill in people a defeatist mindset. Large, profit-driven healthcare systems can turn patients into customers, but patients may easily turn themselves into victims.
You are a victim of chronic pain, but you do not have to remain a victim. Chronic pain can be treated relatively easily. Understanding the same myths that your practitioner believes will help give you the confidence you need to fight your pain.
It’s normal to feel depressed or defeated when you’re living with chronic pain. Confidence is important in keeping up your mental health. It’s not uncommon for an identity to form around different groups of people with pain.
Online forums and online programs and patient advocacy groups are available to help.
These can be great when it encourages recovery and a positive outlook on treatment. And it allows you to realize that you’re not alone.
These groups are also great support if you struggle with addiction from painkillers. Remember, you’re far from the first one to experience this. It won’t destroy your life but it’s normal to feel overwhelmed by the thought of it. It’s the same for your doctor. You need to know the facts going in if you’re going to be prescribed painkillers
This is where a support system really comes in handy. This will allow you to reach out to others with your condition, who have also struggled with dependency on painkillers. There are more than two million people in the United States addicted to opioids and the vast majority of them are normal people like you who became addicted through their doctor’s prescription.
This will help you work with your practitioner to explore alternative treatment. Some of these alternatives include:
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- Physical therapy
- Psychotherapy
- Acupuncture
- Massage therapy
- Nutrition
- Supplementation
- Social support
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Your practitioner wants to help you just as much as you want their help. You can’t go in expecting them to instantly solve it; the two of you have to be empowered to work together and find effective alternatives to the old solution of just prescribing a painkiller.
Chronic pain can feel overwhelming at times and painkillers can seem even more overwhelming. But neither you nor your practitioner is alone in this struggle. If patients and practitioners can come together, realize the myths that have been spread about the true effectiveness of painkillers, and recognize exactly how much power both sides have, we’ll see a change in how society views painkillers.
And most importantly of all, we will see a change in how we view and treat chronic pain. You’ll no longer have to bear the burden of a lifetime of painkillers. Instead, you’ll find your chronic pain easier to handle and much less of an intrusion in your life.
