Patient Education

WHY AREN'T MY PAIN MEDICATIONS WORKING?

The idea that chronic pain should be treated with opioids (pain pills) has been shown to be a faulty concept; in addition, the risks of pain medications has been vastly underestimated.  We will work with you to detoxify you from your pain medications using several different techniques.

WHY IS MY PAIN GETTING WORSE EVEN THOUGH I INCREASED MY DOSE?

Another problem that develops with pain pills is a concept call Opioid Inuced Hyperalgesia (O.I.H.).  To explain this, consider an experiment done by Dr. Peggy Compton:  she took patients on high doses of pain meds and normal volunteers not on pain meds.  Both groups put their hands in ice water (the "cold pressor test").  Dr. Compton found that not only did the patients on pain meds not get any benefit, but they couldn't handle the pain as well as the volunteers who weren't on any pain meds.  In other words, the pain meds made the pain worse!

WHY CAN'T I STOP TAKING MY PAIN MEDICATIONS?

You may also have found that your pain medications have become a problem in your life.  We call this the "Four C's":  you Crave them, you take them Compulsively, you lose Control and take more than prescribed, and you continue to take them despite Consequences.  This is, essentially, addiction.  To treat addiction to pain pills requires detoxification and treatment, discussed below.

SO, MY PAIN MEDS AREN’T WORKING.  WHAT DO YOU HAVE TO OFFER?

Christensen Recovery Services does not do injections, surgery or other invasive procedures.  What we do is evaluate whether your pain medications are working for you, and if not, help you deal with it. 

Everyone who takes pain medications for more than several weeks will develop tolerance (they won’t work as well) and most will develop withdrawal (you get more pain and get sick if you try and stop).  This does not mean that you have become “addicted”; tolerance and withdrawal is a normal process.  You may also have developed O.I.H. (see above). 

If your pain meds have stopped helping you, you may need to try coming off them.  This is a frightening idea the first time that you hear it, but it has been shown that over half of patients who come off their pain pills have a lower pain score after they do it.  The trick, obviously, is how to do it?

The first technique to use is tapering your pain medications.  This is normally done at about 10 percent per week, along with “breaks” if you find that you are uncomfortable during the taper.  Although we tell patients that it will normally take 3 months to taper, there is no hard and fast schedule.   Dr. Michael Baron showed that about 3 out of 4 patients did better after tapering.

A second technique is to simply discontinue all pain medications.  This results in physical withdrawal, increased pain, and is typically done in a hospital type setting.  There are specialized centers for this around the country, in Ohio, Nevada, and California, and we can refer you to them if you wish.  However, it is a difficult technique to use as an outpatient.  Your medical insurance will probably not cover this.

Opioid Rotation can also be done.  This technique switches between opioids that are unlike each other, for example switching from morphine to Fentanyl.  This may be the only option available for patients on high dose opioids, including cancer patients, but is a temporary measure and the process will have to be repeated.

Finally, you may want to consider switching to buprenorphine.  The medication, which is known as a “partial opioid agonist”, does not cause the same level of effects as regular pain pills (also known as “full opioid agonists”).  This means that buprenorphine is safer as it is less likely to cause respiratory depression and overdose.  It also does not appear to cause tolerance, withdrawal and O.I.H.

Buprenorphine is approved by the FDA to treat both pain and  addiction, depending on which “brand” (formulation) is used.  The versions that go under the tongue or (sublingual) are approved to treat addiction primarily, while the patches and the ones that go inside your cheek (buccal) are designed to treat pain (Belbuca).  Sublingual buprenorphine (Suboxone, Subutex, Zubsolv) can be used “off label” to treat pain as well.  We can discuss with you how you will transition from your regular pain medications onto buprenorphine.

 

We hope you will turn to these pages whenever you have a question about pain medicaiton issues issues and urge you to contact our practice at any time to make an appointment with one of our providers.