Addiction, Tolerance, Dependence #1 *Repost

When those of us with Chronic Pain are prescribed a medication- that we have discussed with our doctor at length, have been informed of all possible side effects, understand what exactly it's function is, why, how, and when to take this medication; and a really great pain doc will let you know exactly what you are getting yourself into, we must all understand the words: Addiction, Dependence, and Tolerance.


These three words are so often used incorrectly, interchangeably-- when they are not; and all three are very misunderstood. When a pain patient needs an opioid or other strong medication to help take some of the pain away, you will run into these words. I don't want you to feel that family, friends, or others that are NOT in your shoes, hear a certain word and try to talk you out of going on a medication that could change your life for the better; so much better. You could have a quality of life again! This decision, of course, is made between you, and your pain specialist. It is you two that talk privately, it is he/she that hears your deepest sorrows, frustrations, and clear descriptions of where the pain is, how long it lasts, what you do that ***exacerbates it, (makes it worse), what helps the pain, and what you feel like on the days that you just don't think you can take it anymore. The others in your circle, including family, friends, co-workers, and those that just think that you must hear their opinion--or the story of Uncle George; certainly mean the best, of course--they care about you; but what do they know of the medications they are so quick to judge--simply because of a WORD??? ONE lonely misunderstood word?


***Receptors***: another medical term that needs to be understood well by pain patients that take medications. This word has so much to do with the entire order of things, in the way that the physiologic part of the body works in conjunction with the medication. Just remember this word and we'll get to that later.


When you first start on an opiate, you will most likely feel the side effects of some euphoria at first, tiredness, constipation, upset stomach, and others. Then... you find yourself after just a while, and I'm speaking a matter of weeks; not feeling one of those side effects: the euphoria. This is where the word receptors comes in. Those of us with pain, have receptors open; waiting for something to fill them, and that is a pain medication. Then those receptors get what they are waiting for, and are filled, like little holes inside you, and when they are blocked, this goes into the whole "Pain Gateway Theory", and the now-filled receptors are able to take that medication and use it to do exactly what they are needed for: To stop the pain. Here is where a very hated, and misused word comes in: Addiction.


The peanut gallery around you hear that you are taking an opioid and immediately say, "No, don't take those, you will get addicted." The latest and most respected studies have shown repeatedly; that those in real pain, that take opioids, that have those pain receptors finally filled; do NOT get addicted. That is an extremely rare occurrence.


Then what is Addiction? This is a state of being. Not a state of feeling. It has nothing to do with pain at all. Addiction is a disease, with a state of mind in which the user is constantly chasing that euphoria. They will do anything to get it: steal, divert, lie, and even begin to think about selling their own things for the money to obtain the drug, or even their own bodies to get it. They will sweet talk those that they know can write a script for them, (possibly a co-dependent in their lives), they will literally become another person, as their only focus is on obtaining the drug, FOR THE HIGH; THE EUPHORIA. In a pain patient, the euphoria is very transient. Why? Back to the Receptors. The medication has a purpose, a place to go, a job to do. In an addict, the receptors that are open are those for euphoria. There is no physiological reason in the body to take these, therefore, all they feel is the high. The #1 sign to look for in Addiction, in the addict, is a change in the person's life--in a negative way. Either it is the person being gone a lot more than usual, as they need the extra time to meet up with those that have the drugs, they start to show signs at work if they are using on the job, or if they are medical personnel, they begin to make a lot of mistakes, especially in charting and in the count of controlled substances, wasting a lot, not accounting for the medication at all, giving too small of a dose and not charting that they threw the rest away, getting a medication from the pharmacy without a doctors order for that patient, and simple, outright stealing, as in the nurse who signed out of the pharmacy a very very strong IV medication for a patient that had been discharged weeks before. In other words, their lives start to fall apart. They do not act like themselves before the addiction behavior began. It is noticed by their significant other, (unless they are also using), the family, friends, and co-workers. You can not be an Addict and not have it come to a point where you hit bottom. I've seen it with both drugs and alcohol in addicts.


So, when the pain patient takes a medication for pain, none of the above needs to happen! We don't need to fight and argue and lie and pretend and shoot up in a bathroom then try to hide being so high you can not speak right or do your job safely. Those of us with pain, are slowly becoming used to a new substance in our body, and that takes us to: Tolerance.


Tolerance is a state in which the body becomes to get used to the amount of medication being prescribed, and we find that the amount we are taking just simply doesn't work anymore, or as well. We become tolerant to that medication, and to have our pain managed, the dose, and/or the dosing frequency, need to be changed to get the same effect. Notice that this has nothing to do with the word addiction. Addiction stands alone, and it is not a word to use in the world of the Chronic Pain patient. There are no equals, no sameness in the two worlds. Pain patients' worlds are already 'messed up' by the pain; but we don't focus only on the medication every second, because we are not addicts, constantly seeking that high. Addiction is a disease. Having Chronic Pain and taking medications prescribed exclusively for that, and monitored very closely by our pain management doctor, is our life, not our disease.


To be continued...............