Wednesday, February 17, 2010

Relevance of an 'Addictive Personality' in an Octogenarian

When I spoke to a close family member a couple of days ago, I was outraged to discover that her doctor had balked initially at the option of giving her any real painkillers but ultimately prescribed a handful of Vicodin with the remark, 'I will do this because you don't seem to me to have an addictive personality'.

The woman she was treating is almost 80 years old, suffered a radical mastectomy in her 30s and as a result has severe lymphedema. Doctors have been willing to POISON her with all sorts of radiation treatment, to butcher her body so that one entire side of her torso is concave, destroying her balance, and change her essential BEING and the workings of her brain and system by prescribing tricyclic antidepressants and neurontin for pain now instead of giving her a simple true painkiller. Note here that tricyclic antidepressants and neurontin have far more negative, even dangerous side-effects than any true analgesic painkiller.

This woman NEVER abused any chemical substance in eight decades and even when prescribed painkillers in the past, always waited until the pain became intolerable before she downed a single half grain of codeine.

To me, this only serves to highlight the absurdity of the negative stereotype of 'drug addiction'. True analgesic painkillers such as codeine or morphine act only on the central nervous system. Is it the puritanical obsession at the foundation of American society that has lain at the heart of the widespread official disapproval of pain medications or is it a real medical concern? I believe it must be the former, as medications that actually damage the human body and mind are approved and promoted again and again in lieu of simple analgesics.

This patient suffered from excruciating 'shingles' recently and it was only after weeks of agony that the doctor finally gave her some Vicodin and Lidoderm patches, with the idiotic comment about her not appearing to have an addictive personality.

What on earh is an addictive personality? All human beings have 'addictive personalities' to some extent. We are addicted to other people, to our relationships, our homes, our daily rituals and our hobbies. We are 'addicted' to some extent to our favourite foods and beverages. Human beings crave discipline and structure and 'addiction' is a misnomer in many cases for that.

If a person lives in severe chronic pain and takes a tablet for it every 6-8 hours, is that a case of addiction, need or simply a way to solve a problem? Moderation in all things should be the standard of measurement where anything, including pharmaceutical substances is concerned. An 'abusive' personality is more to the point when considering whether or not to prescribe a painkiller than an 'addictive' personality.

Finally, it has been the practice in society to treat physicians as Gods and patients as Children. A patient ultimately should be trusted to know what is best for him/her. Why should a doctor be able to control the access and administration of painkillers? Alcohol, a far more damaging and dangerous substance than any pharmaceutical painkiller, is sold WITHOUT prescription to any one who has attained a specific age. Yet codeine, once sold 'over the counter' throughout most of the world, is not available without prescription in the U.S. and obtaining a prescription is a matter of a physician's discretion. Proving legitimate pain NEVER is the sole basis for prescribing a painkiller.

That must change. With the creation of Pain Management, it has changed to some extent, but in order to be accepted into a Pain Management situation, one usually must have exhausted all other possibilities. In other words, Pain Management fundamentally is designated as the last destination for the 'hopeless' and 'incurable' cases. Endless tests, surgical procedures and all of the expense and agony involved are the price one must pay before one is introduced to Pain Management. Again, the patient is not allowed to decide his/her fate at the outset but is treated like a Child and refusal to participate in any course of treatment ordered by a physician carries with it the possible threat of total exile.

The photograph shows the current Queen of England, herself an Octogenarian like the woman who recently was denied legitimate pain relief for a fortnight before a doctor finally deigned to allow her a meagre amount of medication. Although Queen Elizabeth is the ruler of one of the 'great' civilisations of the world, she probably defers to HER physicians where medical treatment is concerned. She is an educated woman of vast experience and considerable power and yet it is doubtful that she would tell her doctors what to do. The woman who is my relation is educated and has held public positions of some influence in the past. Yet we ALL are educated to believe that doctors have the right to dictate to us where our own bodies (and souls in terms of 'mental health') are concerned.

Thursday, December 11, 2008

Painkillers and Choice in Chronic Pain

The popular terminology for medical conditions never ceases to amaze me. In the past few years, 'pain issues' has become the accepted description for anything from migraines to the agony caused by terminal illnesses.

Mention 'pain issues' and society nods its collective head without demanding any gruesome details. Talk about specifics and the magnifying glass comes out...

When I think of my own 'pain issues', I think in terms of the onset of puberty, with its excruciating migraines and cramps, but that actually is NOT accurate. Pain came to me earlier than that, with terrible pains in my left leg that were dismissed simply as 'growing pains'. Were they? Who knows? It really does not matter at this point, although the severity of pain in my left leg is far worse still than the pain in the right leg. If some one had taken an interest then, would my life be different now? Doubtful. In any case, blaming any one or any situation for a severe chronic pain condition is counter-productive. Although I could make a legal case against specific members of the medical profession for my physical condition, to focus to that extent on it would be to make it far too important an aspect of my life. My own philosophy, tested over the years and found to be the best in terms of mental and physical health is: Mitigate the damage and move on.

The only purpose of this extended introduction is to make it clear that I have been familiar with serious pain medication from childhood and my relationship with that medication has varied according to the whims of the medical profession, the 'morality' of society and my own situation from year to year.

All this brings me to a very simple basic premise: When 'heavy' pain medication is available and plentiful and it is the PATIENT'S choice whether or not to take it, one tends to use LESS of it!

I lived through more than a decade when painkillers were dispensed in niggardly fashion, when one had to beg doctors for assistance and then be refused, when one had to create a false persona and playact desperately in order to receive any sort of medication for pain. While famous actors and musicians (and even the spouses of heads of state) managed to procure infinite quantities of pain medication, damning the truly needy by their irresponsible habits, we who lived on a more mundane level had to suffer for THEIR sins. Betty Ford, Nancy Reagan and others of their kind made OUR lives more miserable than we deserved, adding injury to the insult of chronic pain.

Then came a new era with the blessed relief promoted in the philosophy of Pain Management. Those of us who are condemned to a lifetime of relentless pain now have our natural dignity restored to us. Society may continue to shake its head disapprovingly whenever 'morphine', 'methadone', 'codeine' or 'fentanyl' are mentioned, but the powers that be have given us a new lease on life by recognising the fact that pain medication can make the difference between a life lived eternally on the cusp of hell and one that actually can have some elements of normal existence restored to it.

Addiction remains a dirty word, and when an individual mentions any truly effective pain medication, the first response of the ignorant is to warn against 'addiction'. How can these individuals not comprehend the fact that 'addiction' is far less of a danger or threat than the hell of relentless pain??? Those of us who are 'addicted' to life may choose 'addictive' pain medication over less effective options in the interest of restoring the elements of existence that most people hold dear: friends, family, and interest in life and the pursuit of ordinary happiness!

When a patient had to go to the 'Emergency Room' for an injection of morphine, wait three hours sometimes to obtain it, always with the threat of refusal attached to the entire affair, the pain itself would escalate to the point where NO injection truly could 'manage' it properly. Furthermore, all the playacting necessary to procure official acceptance was shameful in nature. You have to show you needed the medication without being desperate. Needy but not too needy, always concerned not to give the appearance of being a lowly 'drug addict'... and so on and so forth. It is difficult for me to forgive all the legislators and 'do-gooders' who placed legitimate pain patients in this predicament for DECADES.

What occurred then was that pain and its 'management' became the centre of existence.
The business of obtaining relief took on far too much significance and importance. It was deprivation that made pain relief into a religion!

Make pain medication easily accessible and the time and energy it requires diminishes vastly, giving one the freedom to truly focus on living.