Tag Archives for journal

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

First Blogiversary Reflections and Gratitude

When I started this blog a year ago, it was because I didn’t feel I was being heard in real life; especially by the doctors trying to figure out the cause of my illness. Filling the pages of a journal felt flat and empty. Although I was purging my emotions and thoughts in writing, it didn’t fulfill the need I had to be heard. I needed a place to speak uncensored and honestly about everything that had happened and what continues to happen to me because of my illness without worrying about judgement from friends and family. I created this space with the hope that someone would read my words and truly hear what I have to say, and maybe even learn from my experiences. I had no idea that this blog would lead to so many incredible things.

Writing here became a complement to my therapy sessions. I’m fortunate to have a great mental health support team while I make my way through the difficulties imposed on my life by illness and its unavoidable isolation. The talk therapy sessions with my therapist, which are mostly virtual now, help me to get out of my head and see what’s happening to me through the compassionate eyes of another person for a few hours each month. My therapist also helps me find positive ways to cope with my unending pain and overwhelming low, blue periods. However, writing here gives me an immediate outlet to articulate my thoughts and feelings. I’m connected to people who sympathize and want to extend their support, and people who truly empathize because they have lived through or are living with physical or emotional pain similar to mine.

Because of this blog, the support system I have now extends beyond my family and friends. The community I connect to stretches around the globe. It amazes me that each time I write here my words are reaching people in parts of the world to which I’ve never traveled. I have the opportunity to share my life experiences and be inspired by the lives of so many others living with chronic illnesses. Even though it might expose their vulnerabilities, people who connect to this space share their knowledge about living with chronic pain, medications, medical treatments, and self-advocacy in a world where doctors don’t always give the lived experiences of patients enough credit. This community makes me feel less alone and isolated, and I hope I do the same for some of them.

Others have helped to reawaken my creativity when the frustration I felt because of the haze of pain medications was at its height. I found muses here that brought poetry writing back to me with questions they ask in their lives about trust, truth, and change – among other things. I even found beautiful music that helps in moments when I need to calm my mind and body, and feel grounded so I can create my own art in the art/gratitude journal I never would have started without this blog. There are so many creative thoughts, images, and ideas exchanged in this community that it’s possible to learn something new every day.

Looking back at this year of writing, I can see how I managed to hold myself together. More importantly, I can read about the help and support I received here and in real life, and I’m grateful for all of it.

 

Elvis Costello & The Attractions – Every Day I Write The Book

This Big Girl Cries When She Hurts

After locking the door behind me when I came home today, I started crying uncontrollably. I used every ounce of emotional and physical energy while I was at my doctor’s appointment and then when I went to pick up my medications from the pharmacy to hold myself together, but there is so much grief and pain building up inside me that I needed to let some out. The past few weeks are coloured with disappointment and uncertainty about whether I’m ever going to get better and those feelings are adding to the size of my ball of grief.

Crying helped to release a small piece of my grief, but I still feel what remains sitting heavily in my body. A glance in the mirror revealed how much the saltiness of my tears irritated my eyes as I looked into the red puffiness that stared back at me. My nose and cheeks reddened with a bright tint from the pressure that built up in my head from the rapid rush of blood. There is congestion in my nose because the overflow of tears that couldn’t escape through my tear ducts had to go somewhere, and my lips still trembled even though my sobbing stopped. My body is numb now because my tears carried so much of my unwelcome emotions away with them.

Sadly, I can’t think of what else I can do to cope with what I was told and the grief it is causing except to cry.

 

Big Girls Don’t Cry – Frankie Valli and the Four Seasons