Chronic pain is a common medical problem shared by roughly 100 million Americans-close to one third of the U.S. population. In the past few decades there has been an alarming trend of using prescription opioids to treat chronic pain. But these opioids-the main prescribed analgesic-come with hidden costs, and this book reveals the ramifications of their use and provides a low or no-risk alternative. Armed with the right information, you can make informed decisions about your pain care. By appreciating the risks and limitations of prescription opioids, and by learning to reduce your own pain and suffering, you will gain control over your health and well-being. Each copy includes Beth Darnall's new binaural relaxation CD, Enhanced Pain Management.
|Publisher:||Bull Publishing Company|
|Product dimensions:||6.00(w) x 8.90(h) x 0.60(d)|
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Less Pain, Fewer Pills
Avoid the Dangers of Prescription Opioids and Gain Control Over Chronic Pain
By Beth Darnall
Bull Publishing CompanyCopyright © 2014 Bull Publishing Company
All rights reserved.
One Girl's Story
The girl had wrenching stomach pain for as long as she could remember. It was a pain that would come and go without rhyme or reason and lord over her life like an uninvited narcissistic relative showing up at her door. When the pain visited her it demanded her attention.
Although the girl had spent her life dealing with these unwanted pain visitations, she knew very little about their source but was well aware of the direct impact on her life. Eating and even breathing were difficult when the pain arrived. All she could do in response to these bouts of pain was to lie in a quiet room and wait for the razor-sharp stabs in her stomach to subside to a more tolerable level that felt something like churning needles of pain.
What was so perplexing to the girl was that these random pain attacks stood in stark contrast to the rest of her life. She was a competitive athlete, she was socially engaged with her peers, and she had a work ethic some might describe as obsessive. All through her childhood she was never evaluated for this pain or its root causes. Instead, she dealt with the pain silently and alone. Then a tragic event happened when she was 18. The death of her boyfriend pushed her to the edge of her coping skills. She was away at college, a thousand miles from home.
"Mom, my stomach is killing me," she told her mother over the phone, her voice full of desperation and fear as she recounted her symptoms. "It's never been this bad. It hurts to breathe. What if it gets worse?" Uncharacteristically, she burst into tears. Her mother, who could do nothing directly for her, urged her to get help. With a long-standing line of stoicism now finally breached, she called for a taxi and frantically told the driver to take her to the nearest emergency room.
She wasn't sure exactly what to expect when she walked into the emergency room of her university's hospital, but she desperately hoped the doctors would finally be able to explain her pain and offer her a cure that would fix the problem once and for all.
All of the standard tests — blood screens, X-rays, and physical examinations — came back negative. While the doctors offered her no answers about the cause of the pain, they gave her one thing: a prescription for Vicodin. So the girl went home and took the medication--exactly as she was prescribed to do.
The year was 1990. The girl who was rushed to the hospital in a taxi was me.
* * *
I never received treatment for the underlying issues that had caused my pain — likely a combination of food sensitivities, a reaction to traumatic experience, and chronic stress, with a bit of undiagnosed irritable bowel disorder on the side. And within this soup of possible causes and diagnosis is the point.
Clearly, I had some medical problem that was being aggravated by my body's reaction to the stress I was creating by worrying about the pain and its source (i.e., catastrophizing it). In other words, rather than coping with the pain, I was reacting to the pain, and this reaction was one of a combination of factors that joined forces to create my pain cycles. Had I not learned other ways to resolve my bouts with pain I might still be taking opioids today, even though studies show that opioids are not an effective treatment option for the sources of my pain.
After leaving the emergency room that day, I continued taking Vicodin for about 8 months, and I did find relief in the soothing numbness it brought to my life. In many ways, the medication provided a welcome vacation from mourning the loss of someone I loved and struggling to keep my focus on class assignments. Eventually, I began to take the pills before I really needed them to "stay ahead of the pain." At the time this seemed a perfectly reasonable decision since my primary care physician at the student health clinic kept writing prescriptions.
Over time — and on my own — I arrived at the conclusion that Vicodin was not helping me. I noticed my choices and my reactions were different when I was taking opioids. I felt spacey and passive and eventually concluded that I just wasn't quite myself anymore. So, without talking to my doctor or anyone else, I stopped taking the medication and self-prescribed a new treatment.
The new plan forced me to finally deal with the factors that led to my pain becoming unmanageable in the first place. This difficult process truly changed my life. It deepened my self-awareness and prepared me for a future of helping others caught in this cycle of medication-centered pain management.
Eventually, I became a specialist in chronic pain psychology whose practice approaches pain management in a holistic way by focusing not just on the physical symptoms but also on the person dealing with the pain. This approach means that I give my patients full information about the risks and benefits of taking opioid medications and encourage them to make informed decisions about using these medications. And if a patient decides to seek pain relief using opioids, I provide guidance on how to need as little of the medication as possible. It's an approach that I recommend no matter what type of pill is involved. For me the simple fact is this: taking fewer pills should always be the goal.
Clearly, minimizing the number of pills or avoiding them altogether to manage pain differently is one of the main goals of this book. Less Pain is designed to put its reader in charge, just as I put my patients in charge. Part I of the book (chapters 1–4) presents the problems associated with the exclusive use of opioids to control pain and shows readers how to make an informed choice about using medications. Part II (chapters 5–11) focuses on what you can do to reduce your pain to avoid or reduce the need for pain medication. These techniques include ways to calm your nervous system and reduce your suffering, as well as different ways of thinking about pain. You'll also learn about choices you can make that support reclaiming control of your life. With this information as background, this book will show you how to develop a personalized pain control program — your empowerment program.
I wrote this book to share the techniques that helped transform my life and the lives of the many clients* I work with every day in my clinic. I am convinced, based on my experience and those of my clients, that the techniques in this book will change your life as well.CHAPTER 2
A Painkiller Trap?
In 2013 the Centers for Disease Control reported that the amount of opioid prescriptions sold in 2010 was enough to medicate every US adult with a typical dose of 5 mg of hydrocodone every 4 hours for 1 month. These startling figures represent a 300 percent increase in the sales rate over 11 years.
What is going on? Why the striking increase in opioid prescriptions? Has the opioid prescription boom helped people with chronic pain? Are patients actually getting better? What are the medical risks that come with long-term opioids? What are the psychological risks? Do patients understand these risks? Can we reduce opioid prescriptions by treating chronic pain better? These are the questions I set out to investigate.
People take opioids because they want their pain to be better managed and they may mistakenly believe opioids will make their pain go away. In fact, when it comes to chronic pain, opioids offer limited pain relief. Without knowing about the limitations of opioids, people may fall into the trap of taking more opioids in an effort to achieve a mythical "pain-free" life.
If you take opioids, you have not done something wrong nor have you failed. Indeed, it is possible to take these medications mindfully as one part of your pain care plan. And once you learn the skills that empower you to need and use less medication, you'll be one step closer to the goal of shrinking your pain without pills and avoiding some of the serious medical problems associated with opioids.
Why Are Opioids Overprescribed?
Physicians, nurses, and other prescribers often struggle to manage the complexities of patients who have chronic pain. The average prescriber of opioids is a generalist — often a primary care physician — and not a pain specialist. Many general physicians have a limited understanding of the full range of opioid risks, and they may be unaware of the alternatives. You might reasonably expect your doctor to tell you if there is something different or better than opioids, but many doctors don't know this information because chronic pain is not covered well in medical school, if at all.
A 2011 study found pain education is "fragmented," delivered to medical students in bits and pieces in the midst of courses that focus on specific diseases, such as arthritis or cancer, rather than as a stand- alone topic. As recently as 2011, fewer than 4 percent of medical schools reported having a required pain course, and these pain courses ranged from 1.5 to 13 days. Less than one in five US medical schools even offered a pain elective. Many US medical schools did not teach any dedicated pain courses, and many others committed fewer than 5 hours to pain education over 4 years. Now consider that your physician or prescriber probably completed medical school well before this study took place, when pain education was further lacking. Moreover, the psychology of pain — a critical aspect of chronic pain that influences pain and the prescription and use of opioids — is not taught at all.
Poor medical education for pain extends to Europe, too. A recent survey of European primary care doctors found that 90 percent were dissatisfied with their initial training in chronic pain treatment. Up to 46 percent reported discomfort in prescribing opioids for chronic pain due to lack of training.
While pain is the most common reason people visit their family doctor, care providers have been placed in the unfair situation of treating people with chronic pain when they are inadequately trained to do so. Doctor surveys suggest that after completing primary care residency training, half of doctors feel only "somewhat prepared" to counsel their patients about pain. Close to one-third of doctors surveyed reported feeling "somewhat unprepared" or "very unprepared." It is no wonder that physicians, nurse practitioners, and physician assistants report discomfort in treating chronic pain.
For doctors treating chronic pain, opioid education focuses on the specifics of prescribing, policing, and monitoring medication use. Often the emphasis is on catching addiction or on protecting the doctor from legal repercussions — all while omitting the most important information: what can a patient do to better manage their pain themselves, without a pill?
With many primary care doctor visits lasting 15 minutes or less — sometimes much less — it's easy to see why the appointment is focused on writing a prescription. Often, what gets left out are the discussions about lasting alternatives to prescriptions and critical education about any medications being prescribed. The following story illustrates just some of the problems that can arise when the focus remains on pills alone.
* * *
One day I received a call from a primary care physician I know very well, Dr. Bower. "Beth, I have a patient I am hoping you can see. She has chronic back and neck pain that's been worsening; she's on opioids and seems to be unraveling. She's asking me to increase her dose again, and I'm not comfortable with that. Is there any chance you can see her in the next few weeks?"
Within the week Jaqui was sitting in my office. She was 36, married, and had two sons, ages 4 and 2. She took a short-term medical leave when she began having trouble keeping up with the duties of her administrative assistant job due to back and neck pain. Overwhelmed, she called Dr. Bower — the person who was supposed to fix her pain. When Dr. Bower denied her request for more hydrocodone, Jaqui went into an emotional tailspin. "What am I going to do?" she thought. "I won't be able to work." Then she began having panic attacks.
Almost as soon as she sat in my office she began crying. "All I wanted was help with my pain," she said as she wiped her face with a tissue. "Now Dr. Bower either thinks I'm a head case or she thinks I'm a drug seeker. I'm not sure which."
I assured Jaqui that neither was the case. Dr. Bower just wanted to find the best treatment pathway for her, and it wasn't clear that more opioids would help. Jaqui didn't see it that way. "My pain is worse and I can't work," she said. "I don't understand how more medication wouldn't help that."
I nodded. "Let's take a step back so I can learn more about you, your history, and what's going on now," I said.
I learned that Jaqui's back and neck pain began 2 years ago following a car accident. At the time, she was 7 months pregnant with her youngest son, Caleb. Her 2-year-old son, Nathan, was in the car with her when the crash happened. Nathan was fine — he had been riding in his car seat. Terrified about the health of her baby, Jaqui rushed to the hospital. She had trouble breathing on the way there and felt shaky as her heart raced. She was told these were signs that she was having a panic attack. Jaqui was relieved to learn that her baby was healthy. She was told she had whiplash and was prescribed opioids.
Most whiplash pain resolves in a few weeks, but Jaqui's pain never really improved. She had trouble sleeping. She found herself worrying about things — mostly about the safety of her children — so she tossed and turned for hours before falling asleep. Her pain would also wake her up during the night. The physical demands of a baby put further strain on her neck and back.
Her pain became chronic, and Dr. Bower refilled her opioid prescriptions every month. She took one OxyContin in the morning to help her get going, another in the afternoon when her pain seemed to get worse. Recently, at bedtime she began taking more opioids that were prescribed to her "as needed for pain." She also found the opioids helped calm her mind so she could settle into sleep. Right away I understood that, in part, Jaqui was taking opioids to help her anxiety.
To her credit, Jaqui had met her goal of returning to work 8 months earlier, but the transition was fraught with difficulties, more pain, and a request for more medication. Jaqui chalked up her pain to the workday: she was commuting, sitting all day, and unable to take care of herself like she did when she was home with the kids. But I suspected there might be more to the story.
"How did you feel when you went to work and left your boys at day care?"
She winced. "Terrible. My husband, Tom, would take them to day care, and I would have him call me once they were safely out of the car." Even though her boys were not injured in the car accident, Jaqui had been imprinted with fear for their safety — especially when it came to driving. She didn't think about it too much during the day, but at night when she went to bed and had no other distractions, fears about her boys would creep into her mind and sometimes stay for an hour or more.
Despite her pain and anxiety, Jaqui held it together until 2 weeks ago when she called Dr. Bower for more medication because her pain was worse again. I asked her if anything stressful had happened. She took a deep breath. "I had a near-miss while driving with the boys." A car suddenly darted into her lane. Perhaps it wasn't that close of a call — she couldn't be sure — but she slammed hard on the brakes and everyone was scared. The boys began crying and then so did she. She realized that in her own hasty reaction she could have killed them all.
Nobody was hurt and the boys quickly calmed down. Jaqui, on the other hand, was badly shaken up. The incident stoked her fears, muscle tension, and pain. She could no longer manage at work. She began worrying that she might have reinjured her neck.
When Dr. Bower denied her request for more opioids, Jaqui was bewildered. "What am I supposed to do? Suffer? I need to work! All I have ever been given for pain is opioids and now suddenly it's wrong?"
Whether opioids were right or wrong for Jaqui is debatable, but it was clear that opioid medication alone was not helping her. I could see, in fact, it was causing her problems. Her increasing anxiety was worsening her pain — and her distress about her pain — and it was leading to opioid dose escalation. The overfocus on the opioids was actually compounding her anxiety because the only thing that reduced her distress was a pill. Now she was fretting about her boys, her pain, and making sure she had prescriptions and enough pain medication!
Excerpted from Less Pain, Fewer Pills by Beth Darnall. Copyright © 2014 Bull Publishing Company. Excerpted by permission of Bull Publishing Company.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
Part I The Problem
Chapter 1 One Girl's Story 1
Chapter 2 A Painkiller Trap? 5
Chapter 3 Know Your Specific Risks 19
Chapter 4 Be Aware of Opioid Pitfalls 51
Part II Your Solution Is to Gain Control
Chapter 5 Know and Treat the Full Definition of Pain 79
Chapter 6 Calm Your Nervous System to Reduce Your Need for Prescription Opioids 97
Chapter 7 Shift Your Thoughts and Emotions to Reduce Your Need for Prescription Opioids 119
Chapter 8 Change Your Choices to Reduce Your Need for Pain Medication 153
Chapter 9 Tapering Off Prescription Opioids: Tips for Success 167
Chapter 10 Putting it All Together: Your Empowerment Program 177
Chapter 11 An Example of Mindful Use of Prescription Opioids 193
Appendix: Historical Notes 197
About the Author 231
Most Helpful Customer Reviews
I have a medical condition called Trigeminal Neuralgia and the pain is severe. This condition is euphemistically called the "suicide disease," so you get the idea. My doctoral studies are in organizational psychology, so I have access to university research on the subject. There are three basic possibilities: drugs, surgery or psychology. I currently take an array of medications that I would just as soon not. This includes oxycodone. The bottom line is that opioids work, but you have to live with the side effects. I haven't tried surgery because it has a low success rate. Since my doctoral studies are in psychology, I understand the medical theory here. But the bottom line is that I bought the book and it didn't work. I seriously wish it did. At this point, all I can do is hope for a medical break through for a non-opioid mediation.