Is pain an important enough symptom to warrant painkillers?

Many people think that pain is not important enough to warrant painkillers.

Take the poison

The patient in front of me was clearly in pain. His face was drawn, his hand clutched his side and every breath caused a sharp, stabbing pain across his chest. He had mesothelioma, the sad sequel to a life in the navy as a young man where loose fibres of asbestos were wrapped around the engines he worked on every day. He’d had radiation treatment to the chest but now the pain was worse again. He was a feisty fellow in his mid-seventies, determined to remain active and involved as long as possible. He lived with his wife and two beagles and was furious about the cancer, about the breathlessness and now about the pain. His wife, Bev, shook her head and frowned at him, her hands on her hips. She was used to dealing with his stubborn streak and had spent the last 50 years working around him one way or another to get what she wanted.

“Ron,” she said fiercely. “Just take the bloody medication like the doctor told you.”

“I’m not taking that crap,” said Ron between grimaces. “Just give me another bloody Panadeine Forte.”

“You’ve had four so far today. You can’t have any more.”

“Then just shoot me.”

“Oh for God’s sake, love, take it!” Bev held the small white tablet out in the palm of her hand, her face softening. Ron shook his head resolutely.

“I’ll get addicted. It’ll kill me. I’m not taking it and you can’t make me.”

He was right. We couldn’t make him. As a doctor, I knew that pain relief would not only ease his physical pain, it would also assist his breathing. And better pain control would mean better breathing, less chance of pneumonia and a better quality of life. Bev knew it would improve his mood and make him less snappy with the grandkids. The fears that Ron expressed are very common concerns for people who are suddenly faced with the need to take strong pain relievers.

It’s an interesting comment on the human condition that we’ll happily take a whole lot of medications that are a lot more dangerous than pain relievers without a second thought. But offer someone a prescribed painkiller, and prepare yourself for a recitation of excuses: “I’ll get addicted. It’ll make me too constipated. They only prescribe that when you’re going to die. There won’t be anything left when I get really crook …”

Pain is just not an important enough symptom. It should be.

In reality, patients with cancer pain don’t get the same addiction patterns as people using opioid drugs on the streets. We know that good pain control actually prolongs life, and that many, many patients need opioids to manage pain for years, and that they live active lives. Today’s pain and palliative medicine offers a wide range of options in pain management near the end of life.

Thanks to Bev’s constant nagging, Ron eventually tried the recommended painkiller. It helped. He was pleasantly surprised. The sky didn’t fall, and he slept better. Bev told him that they mustn’t let their fears and ignorance destroy their quality of life. Ron also started to take medication for his bowels.

Do you have a similar attitude towards painkillers? Do you put off taking them for fear you’ll become addicted?

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    COMMENTS

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    tisme
    13th Aug 2018
    11:05am
    I have arthritis from head to foot and fear that if I take the meds I know I need they will get to a point where they wont work anymore. the thought of the risk of addiction is also always there
    tango18
    13th Aug 2018
    11:21am
    I'm 75 and without painkillers I wouldn't be able to function. Have been taking for about 18 months now and wouldn't (by choice) go back to how I was. Yes the dose has had to be increased once, but addiction - so what!! - it's not like I have to commit crimes to get them, they are legally prescribed and I can live and not just exist!
    Ted Wards
    13th Aug 2018
    12:00pm
    I did until a recent chronic flare up of arthritis (I was born with it) in my ankles and feet. I could not walk and the pain was so intense that if I had anything to hack off my feet, I would of. I eventually relented and called in the after hours doctor who sent my straight to hospital. He thought I had either dislocated my ankle or fractured it. After xrays, it turned out to be chronic inflation and I was kept in hospital because I lived alone and didn't have anyone to assist me. I was given endone for the pain and a Valium (not together) to assist me to rest or sleep. It worked and 12 hours later I was able to go home with some endone tablets, brufen and panadole to keep on top of the pain. I think I probably would of gone out of y mind with the pain that followed that hospital stay for another 5 days if it wasnt for the tablets. I have a very high level or threshold for pain as I was born with this and until this incident had not really ever had pain medication to assist me with the Arthritis but even this was beyond my threshold. My main issue is long term, what do the pain killers do to your organs? Short term yes, they clearly helped me and I have been back at work for a week, but what are the long term consequences of taking these medications?
    Geminiwoman
    13th Aug 2018
    1:06pm
    Wow. I agree with you all. I have had arthritis from neck to (and including) knees for many many years. I have taken a number of different opioids over the years and I am currently on Targin. Yes, I did get addicted to one of the pain killers (Tramal), but the benefits really outweigh the risks. Since there has been so much publicity lately re opioids, I have talked to my Doctor and we have decided together to try to wean me off the opioids, but I'll be honest, I am really worried about how I will cope and at 68 yrs, I don't want to spend the rest of my days in pain. I am going to a specialist pain clinic at our local hospital (when I can get an appointment) to see if they can teach me some exercises to help. Time will tell, but at this point, anything is worth a try.
    Maggie
    13th Aug 2018
    6:44pm
    Gemini woman I feel for you. You may be one of the unlucky people who really only get pain relief from opiates/opiodes. This is absolutely nothing to be ashamed of or frightened about. Your GP will of course be only too willing to go along with your wishes to be weaned off them because obviously if you can get pain relief without them that is a good thing, but also GPs are now being watched in connection with the amount of these drugs they prescribe and have to account for this.
    I have tried just about every possible treatment and nothing else works. The pain specialist I see is much aware of this and has acknowledged it, and was happy to write to my GP who is now more comfortable about prescribing for me.
    If you can exercise and get to a class it is wonderful to get out of the house and meet with lovely people in the same boat.
    If the pain makes you depressed there will be something to help with that and these things make life more pleasant. Good luck to you.
    Ed
    13th Aug 2018
    3:01pm
    One of the best pain control meds around is ' Pyseptone' (Methadone) lasts 24 hours and did wonders for my poor old Mum who was on them for over 10 years,her Dr. was very progressive,she had to go to hospital and the Dr's there didn't like it so they put her on Endone and Morphine,which she wasn't comfortable with and complained on death ears,she died not last long and died at 92,as far as I can ascertain it was just the stigma attached to that drug and addicts being the reason they stopped it. She was fine with it and functioned well.
    HarrysOpinion
    13th Aug 2018
    3:29pm
    I will accept medically prescribed pain killers only when pain gets beyond my level of tolerance, as was in recent case of severe lumbago. I do not fear becoming addicted because my mentality of control towards prescribed medication has always been with a strong attitude
    -"use it only up to the point of recovery"-.
    Maggie
    13th Aug 2018
    6:34pm
    I am so pleased to hear that you do not have chronic daily pain and that medication can help you over lumbago or whatever may unfortunately strike you.
    Chronic severe pain is a pain which reduces one's quality of life to the point where many pain-stricken people wonder if life is worth living at all.
    Sadly for many people opiates are sometimes the ONLY thing that helps. Yes, you do become tolerant of them, yes you do need bigger and bigger doses over time to get relief. However, if your pain specialist thinks it will help you, you may be sent for a Ketamine or Lignocaine infusion. I know almost nothing about the latter, but I have had a ketamine infusion which is a treatment which can reduce pain for several months if one is lucky, or happily reset the body so that lower doses of medication work as well as they did in the beginning of treatment.
    If opiates are prescribed for you and they help, there is nothing to be ashamed of. I think that quality of life is paramount - after all what is the point of being alive al all if you are so handicapped that you can get no pleasure out of it any more.
    micko
    13th Aug 2018
    4:43pm
    Pain destroys your quality of life and I’d have no qualms at all of taking the drugs necessary to alleviate pain regardless of any addiction concerns. Laying around in pain concerns me far more. Have suffered sciatic pain in the past.
    ROB
    14th Aug 2018
    11:56am
    Well, maybe they prolong life but will also shorten it considerably a give a horrible quality of life with all the harmful side effects. ALL drugs, supplements and even herbs can produce negative side effects, so why not use something already proven extremely effective with nothing induced or ingested and with NO harmful side effects?


    Tags: health, wellbeing, pain,

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