Category Archives for Pain Medication

Futile Emergency Room Resistance

For the first time since having surgery last August, I landed in the hospital emergency room on Sunday. I was struggling with a pain flare up all day and finally had to surrender to the fact that my pain medications were not doing all they could for me in the pain management department. After trying to be still, crying, talking myself into a space of calm, and trying desperately – but failing miserably – to sleep through the pain, I gave in. When you’re barely moving and still have intense pain in your feet, ankles, thighs, hips, pelvis; and lower back pain that feels like it has tentacles spreading up your back, it’s hard to keep assuring yourself for hours on end that the increasing waves of pain will pass. On Sunday, there was no ebb to the painful tension enveloping my body, so the dreaded emergency room became my last resort.

Before making the decision to go I contacted some of my friends who usually make themselves available to keep me company while I sit through the hours of IV medications slowly dripping into my veins. Unfortunately, on Sunday afternoon, as one would expect, most of them were locked into plans. The ER is uncomfortable enough, but having to face going in on my own always makes it worse. It’s also partly why I held off from going in for so long. Later in the afternoon when I could bear it no longer, I accepted the offer of a neighbour who had come by to drop off some items from the farmers’ market to go with me and keep me company until someone closer to me could come be with me. I’m certain I would have waited hours longer before going if he hadn’t stopped by.

Emergency rooms, especially on a weekend, tend to be populated with interesting characters. When we arrived at my local ER on Sunday, there were people from all walks of life waiting for triage to the right level of care. One woman suffering from obvious mental health issues was shouting incoherently at the top of her lungs what must have been a badly patched together montage of events from what sounded like a tragic life. As she became more animated and the flow of expletives in her ranting increased, the hospital security guards and police were called to subdue her. When I finally made it into the ER treatment area I could still hear her shouting from a distant corner, and I overheard the nursing staff assuring security they could leave because she was securely restrained. It hurt my heart to picture that woman strapped to a hospital bed against her will.

Thankfully, I didn’t need that kind of intervention. However, once the nurse recorded my vitals I knew that my body was in crisis. My blood pressure was 162/82. That’s not the highest it has ever been but it was high enough to confirm for the nurse completing my intake, that my pain was real and I wasn’t in the ER seeking drugs when I said my pain was an 11 or 12 on the pain scale. After a 90-minute wait, I was finally seen by a doctor who had me list the cocktail of pain medications I take daily so she could understand what I was coping with and what she might be able to do to help me. I could tell from how little she said that she was trying to wrap her head around someone with a body as small as mine taking such high doses of pain medications yet still feeling so much pain. I tried to get her mind moving by telling her what treatment(s) I had received in the ER for past pain flair ups, and that seemed to jumpstart things.

My friend J arrived a short while before my discussion with the doctor started. It was good to have her there because she has been through this scenario with me many times before and is sometimes faster at responding to questions about my condition than I am when I’m in that state. J’s arrival also gave my very kind neighbour a chance to slip away and head home. He had sat with me for a few hours then hung around chatting with J and me, for longer than he needed to, to make sure I got some treatment before he went home. His presence reminded me how blessed I am to have so many people in my life who care about me, even when they have no vested interest to do so.

After consulting with the ER Attending Physician on shift, the doctor returned and told me they were going to start by giving me a shot of my old faithful injectable Toradol, and that I should take the scheduled dose of my pain medications, which at this point were about 90 minutes overdue. Unfortunately, I wasn’t paying close enough attention when she said I would receive an intramuscular shot of Toradol instead of an IV drip. For anyone who’s never had a needle plunged into a muscle, unless you have masochistic tendencies, give it a pass. The pain in my arm after that shot rivaled what I was already feeling in the rest of my body. The nurse instructed me to rotate my arm to get the medication flowing through me. I flapped my arm around like a bird with a broken wing for about ten minutes. For all the good that it did because my pain was unaffected.

When the doctor returned to check on my progress, my blood pressure reading had dropped to 160/82. For the first time, the Toradol wasn’t working. She went off to get more advice. What she tried next was an IV with an added milligram of Dilaudid, which is part of my regular pain medication regimen, and Lidocaine. Lidocaine is a local anesthetic that prevents pain by blocking the signals to nerve endings in your skin. It’s usually used to numb skin before painful procedures: think about the shot to your gums before your dentist starts drilling. Within 30 minutes, after the drip was opened, I started to feel some relief, and the sure sign that things were moving in the right direction was my blood pressure began to fall.

With this positive result unfolding the Attending Physician came by my bed to talk to me. He was empathetic with my situation and concerned that I am living with this extreme pain. He wanted to know what treatment(s) aside from pain medications I have received and added a few suggestions for future treatment(s) to my list. He also made it clear that if the effects of the medications I received wore off I shouldn’t hesitate to return to the ER; and that if I did I should tell whoever treated me to try the Lidocaine, as unusual as it may sound. He even asked if I wanted to have an extra top-up of Dilaudid to make sure the positive effects I felt didn’t wear off too soon. However, because I still had a dose of Dilaudid left in my pillbox for the night, I opted instead for another dose of the Toradol.

Once the IV drip stopped and I got dressed, I became acutely aware of how hungry I was. The night’s ER adventure ended at 2:00 AM with J taking me to a nearby 24-hour diner to get a huge Chicken Parmesan sandwich with French fries, and a slice of cream cheese icing-covered carrot cake to go. More importantly, although I had resisted going, my visit to the ER gifted me with the knowledge of an alternative cocktail of medications to bring my pain back to a level where I can cope if I need extra support again in the future.

 

Chumbawamba – Tubthumping

 

Opioid Induced Constipation & The Undignified Big Pharma Response

Last Sunday, like millions of other people, I watched Superbowl 50. As usual, there were some great commercials throughout the game. However, I can’t forget one commercial from the 2nd quarter. Not because it was funny and creative like most of them were, but because of the targeted medical condition: opioid induced constipation (OIC). The reason I can’t forget it was how embarrassed I felt as my friend with whom I watched the game laughed at the inappropriate humour the pharmaceutical company used to promote its product. For those of you who don’t suffer from chronic pain or have never had the need to take opioid (narcotic) pain medications for pain relief, I assure you this condition is a real thing. The Australian Pain Society states, “One of the most common adverse effects of chronic opioid therapy is constipation. Up to 95% of patients prescribed an opioid report constipation as a side effect, which can occur soon after taking the first dose.”

Opioid induced constipation is also known as opiate bowel dysfunction (OBD); and according to the American College of Gastroenterology “constipation may be debilitating among those who require chronic analgesia [pain relief]. OIC/OBD affected an average of 41% of patients taking an oral opioid for up to 8 weeks.”   The reason for this is that “opioids cause constipation by binding to specific receptors in the gastrointestinal tract and central nervous system, resulting in reduced bowel motility through direct and indirect (anticholinergic) mechanisms.”  In short, the opioid pain medications delay or block messages throughout the body that tell you when you need to empty your bowels.

I understand that a commercial’s purpose is to grab its audience’s attention in a short time. However, the tone of this commercial failed to convey the seriousness of this condition, while using lowbrow humour to flog the product. Practical Pain Management, a publication founded and written by pain experts, notes that although opioids have been in use for centuries; it’s only in recent decades that this kind of medication has received any significant attention and investigation. Sadly, “we are only beginning to understand and identify the many side effects of opioids. Constipation, nausea, emesis, pruritus, respiratory depression, and somnolence are well known. However, not so well known are effects on immune function, urinary retention, endocrinopathies, gastroesophageal reflux (GERD), gastroparesis, sleep apnea, cardiovascular system, osteoporosis, emotions, dentition, and renal function.”

This lack of knowledge about opioids begs the question, how many people know that if a patient that has OIC/OBD does not receive the proper medical treatment it “may cause rectal pain and bleeding, abdominal pain and distension, urinary incontinence, faecal impaction, rectal tearing, and, in very severe cases, bowel obstruction and colonic perforation?”  How aware are people that OIC/OBD can reduce a person’s quality of life as much as the chronic pain doctors prescribe the opioid medications to treat? The Australian Pain Society also notes that, “Some patients would rather endure chronic pain than suffer from the severe constipation that can arise with long-term opioid therapy. One study found that approximately one-third of patients missed, decreased or stopped using opioids in order to make it easier to have a bowel motion; the majority (86%) of these patients experienced increased pain as a result, which reduced their quality of life. Reducing the opioid dose is not considered useful, as analgesia [pain relief] may be compromised and constipation may not resolve.”

I know that 30 seconds isn’t a long time and not all the points I raise most likely could have been touched on in that amount of time. However, I do know that the pharmaceutical company could have approached this issue in a more dignified way. When the commercial ended – and my friend’s laughter died down –, I did educate him about the seriousness of OIC/OBD, and how I’m affected by this condition because of the large doses of opioid pain medications I have to take to manage my pain. I hope that others who might have been in the same situation during the game were able to have similar conversations. If not, here’s a link to a therapeutic brief from an Australian Pain Society study that gives information about OIC in plain language in a downloadable PDF file: Opioid-induced constipation– a preventable problem

 

Bob Dylan – Dignity

Constant Exhaustion and Missing Meds

Lately, I’ve been constantly exhausted. A part of it is my messed up sleep schedule. The other part of it is my pain medication level. However, this constant exhaustion is causing a problem: I’m missing some of my pain medication alarms or falling back asleep before I take a dose of my medications – as I did this afternoon.

Missing some of my scheduled medication times is causing my pain levels to fluctuate, and my goal to taper my pain medications to a lower dose is not going very smoothly. I know that I only had surgery a month ago and my body is still healing, but this constant exhaustion is making it hard for me to develop a normal routine and it’s frustrating me.

I’m wondering if anyone has any suggestions about how I can cope with this.