Tag Archives for Pain Management

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

I Won’t Let Pain Stop Me From Comforting A Child

I love my cousin’s children. It was incredible witnessing the birth of her third child a few months ago and having been there makes me feel a strong connection to him. However, her older son – he turned three recently – is working on staking a permanent claim on a corner of my heart. He is one of the sweetest, good-natured children I’ve ever known. He’s affectionate, empathetic, already fiercely protective of those he loves, and hopelessly irresistible. So irresistible, it’s impossible for me to say no to him.

When I spend time with him, my lap becomes his favourite place to sit. He plants himself on my lap for comfort, play, and conversations I sometimes have to pretend to understand – after all, not all three-year-olds have perfect pronunciation. I also become his go-to person when he needs to use the potty. He comes to me, no one else, tells me he has to go, then takes my hand, and leads me to the bathroom. I have to hold him in place so he doesn’t fall into the toilet bowl while he does his business then clean him up, and help him get re-dressed. This may not be my favourite part of spending time with him, but the trust he places in me feels like an enormous privilege.

The only problem with not saying no to him is that it adds to my pain levels. Unfortunately, he weighs more than his newborn brother so having him sit on my lap is one of the best and least enjoyable parts of spending time with him – if that makes any sense. There’s also the issue of how often he needs to use the potty because it means standing and sitting back down for the countless trips with him to the bathroom; or wherever else he feels like leading me: getting snacks from the kitchen or finding his toys. All of this added activity puts a strain on my legs and pelvis; and is most likely the reason I had the intense pain flare I wrote about in my last post after an overnight visit to celebrate his birthday two weeks ago.

Still, no matter how I try to justify it, none of this feels like a good enough reason to deny this little boy the physical closeness that gives him comfort, makes him feel secure, and happy. I also have to admit that even with the added pain; I don’t want to change how I interact with him because I want him to feel loved by me always.

 

Crosby, Stills, Nash & Young – Teach Your Children

How Do Some People Do It?

It’s been about two weeks since a significant pain flare up locked my body in its grip. I’ve been trying to block out my pain through numbing my mind by mindlessly watching a copious amount of movies (all six of the earlier Star Wars) and entire seasons of TV shows, while keeping my legs elevated as much as humanly possible on my couch; then sleeping when my body allowed. Roughly translated, that means sleeping when the pain exhausts me. I’ve also talked to as few people as possible, on the phone, or in person because it felt like talking required energy I didn’t have and added fuel to my pain. Fortunately, somewhere inside me the same question kept surfacing: How do some people do it?

How do people with unbeatable diagnoses and/or prognoses beat them? Over the years, I’ve seen countless stories about gravely ill people who inexplicably recover from an illness, for which there is no cure; recover from accidents, when the odds were heavily stacked against them; or learn to walk again after breaking their spines. How do they do it? Are there people blessed with superhuman healing? Are they resilient in a way that science is yet unable to explain and capture in a treatment or deliver in a pill? What is it about a person that makes them so tough they can fight through the worst life throws at them?

I want to know. I need to know because I want to be one of these people. I want the strength to heal my pain, even if it initially causes me more pain and because I want to get better like these people worked so hard to do. This illness that still causes my doctors confusion more than two years after it started and four months after major abdominal surgery, well, I want to figure out how to beat it – with or without a positive prognosis. I wish I knew exactly what I’m fighting to better understand the options I can apply and how to find more if the first set don’t work. But I don’t know; yet, I don’t want to limit myself to what my doctors tell me I can or cannot do to heal. I don’t want to limit my life at all.

I don’t know how other people do it, but I want to beat the odds that seem so highly stacked against me, even if it means approaching each day as if it was the biggest battle of my life. I don’t want to spend more two-week spans feeling helpless or that I’m trapped by pain. I’ve lost a lot because of this illness, but I know it’s time to figure out how to regain fully at least one of the things not completely lost: my fighting spirit. I’ve had to fight for everything my entire life, but I lose a little more of that spirit each week I spend lying on my back.

 

Bon Jovi – It’s My Life