Monday, June 16, 2008

the stigma of pain medications

From the "chaps my ass", maybe that's not quite the right description. How about "pisses me off"?

The stigma of being ill. It's there, and it's real. If you've ever been sick and not wanted to tell someone the truth, you've been there.

Why? Why should we be ashamed of being sick, of having an illness? Why should some symptoms of a disease be acceptable, and some not?

I'm not talking about polite conversation here, about descriptions of diarrhea. There's a time an place for thing which may squick people. And I know there's the grey area where polite society meets genuine social stigma, a taboo.

Pain Medications

I'll admit, I've felt ashamed of the fact I have to take opiates/opioids/narcotics/the heavy-duty shit or whatever you call them. There is a genuine stigma, a social taboo, associated with taking opiates on a regular basis. If I don't take them, I'm in severe pain, and that's the end of it. Well, the opiates also slow down the digestive tract, which in me is a good thing. There area actually prescription anti-diarrheal meds that are opiates.

But I digress.

Why should I feel ashamed of taking an opiate every day so I can maintain functionality? Why should anyone feel that way?

You're just getting high. Pain patients only want the narcotic high. She keeps getting stronger drugs, she's hooked. Candy-man. Taking narcotics every day makes you an addict. Addict...dope-head...not really in that much pain...cope with it, everybody had pain...

Did I miss any?

Why? Why should this be?

I expressed my nagging anxiety about being on opiates to the psychiatrist who did the psych consult for me, to prescribe the meds to even out the steroid/demerol psychosis. He asked me to define "addiction" and I ended up with more or less, using or taking something for the pleasure of it, because of a want, not a need.

A want is addiction. A need is a symptom and a controlled medical condition.

I had to get over this anxiety. Why should I be afraid of being an addict? How do I take my meds? Every 6 hours maximum of 4 a day, says the bottle. But sometimes, when the pain is bad, I take two and ration out the remainder to last until my refill.

Both the psychaitrist and my pain doctor said the same thing.

It's OK.

It's OK. Some days are worse than others, and that's the nature of pain. The 4 a day is a guideline, and a double dose is fine; what would be prescribed, and perfectly safe.

I signed a contract with the Pain Center that I would use my opiate prescription exactly as prescribed. I would not take extra or double doses, I would not run out early. If I break the terms of the contract, I will be completely SOL as they drop me as a patient.

My doctor said it was fine to break the contract in that way. It's expected, from every patient, just as long as I don't go trying to get early refills.

- What about nausea/vomiting with the Crohn's? I asked. If I take a double dose, throw it up [he could see the anxiety building in me], I'll come up short...

Hmmm...well, if that happens, we know about your Crohn's and you take both phenergan and zofran for nausea/vomiting? Just let us know, I'll make a note of it in your chart, you can have early refills in this case, until your Crohn's settles down.

- What about alternative routes? Trans-dermal patch, oral gel...

We can give you some fentanyl patches to use for bad days. They're not for breakthrough pain, that's what 2 percocets are for, since the fentanyl patches takes a couple of days to build in your system. Use them for a few days instead of the tablets during bad stretches. Talk to us if you look like you're going to run short. We'll take care of you.

- OK, but sometimes I think the phone messages I leave end up being a game of telephone and by the time it gets to you it seem like I'm not having as much of a problem as I actually am...

Yeah, that happens. Just call us back, make sure I get the message. I'll take care of you.

I'll take care of you.

Now, as a patient, I really should keep a pain diary. Log my pain levels each time I take my meds. I have three diseases which are painful individually, not to mention the snowball effect pain has. It has real physical effects that are negative. Higher blood pressure, higher pulse, higher stress overall.

I do not need any more stress. It has a history of making my diseases worse, especially the Crohn's.


So I've just revealed to the entire blogosphere what I take, why, and even how much and how often. I feel better, less stressed, because I know there's no shame in taking my medications the doctor has prescribed, needs me to take.

But. This should never have been an issue in the first place. I'm not telling you about taking my migraine preventative, after all. That med is not an issue in society.

Why should being treated for severe pain, by an anesthesiologist be any different?

It shouldn't. Unfortunately it is. For me, for other patients, for society. There's something very wrong with that.

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