and the development of dependence and addiction. The side effects of opioids may include cloudy thinking, drowsiness, depression, and sleep disturbance. In women, opioids and chronic pain can lower estrogen levels, even leading to early menopause and osteoporosis.
In some cases, increasing the dose of opioids can actually cause more pain, a phenomenon known as opioid-induced hyperalgesia (OIH) that occurs in some people who are on long-term opioids. The proper treatment of OIH is to discontinue opioid medications under medical supervision so the brain can “reset” and eliminate the hyperalgesic effect of the drugs.
It may amaze you to know that there are no scientifically reliable studies that justify the use of opioids for longer than three months, even though use of that length is standard operating procedure for treatment of chronic pain. There are a number of reasons for this disparity, but probably the best explanation is that opioids offer temporary relief to a permanent problem that is complex and difficult to treat. Doctors and drug companies have created an industry that promotes these powerful drugs for chronic pain, even though for many that is not the best course. Many people say they would never have started taking prescribed pain medication if they had known how much havoc it could wreak in their lives.
Additionally, as in Amy’s case, painkillers are frequently prescribed in conjunction with other habit-forming medications, such as muscle relaxants (specifically Soma), stimulants used for sleepiness caused by the opioids, antianxiety drugs, and sleeping pills. The use of medications to treat the effects of other medications can be extremely frustrating for people with chronic pain and their families. Amy ended up on so many medications that her quality of life was severely compromised, and she still had significant pain. As a nurse, Mary certainly knew that Jim was no longer benefiting from his medications, but felt helpless to change anything. After all, “he’s in pain and can’t stop them,” or so Jim told her whenever she brought it up.
Many medications are not habit-forming and may be prescribed as part of a pain management plan; these include muscle relaxants, antiseizure medicines, and antidepressants. Pain management also often includes invasive procedures such as injections (epidurals, facet blocks, and others) and surgeries, as well as nonmedication and nonsurgical techniques such as acupuncture, chiropractic, physical therapy, massage, and hydrotherapy.
Prescription Pain Medications
We’ve described potential problems with taking opioids for chronic pain. Here are the names of medications in this class and other classes of drugs with habit-forming potential:
Table 1.1a
There are a number of nonopioid medications that are used to decrease pain. Here’s a partial list:
Table 1.1b
{exercise} 1.5
_______________’s Pain Management Experience _________________
List the medications that have been prescribed for _______________, as well as those he or she is using that are not prescribed (put a P next to those prescribed and an N next to those not prescribed). You can refer to the list in Tables 1.1(a) and 1.1(b).
Now list any substances _______________ has used in addition to medications.
Include alcohol, over-the-counter products, cigarettes, caffeine, and illegal drugs.
Finally, list any treatment modalities or procedures _______________ has used or undergone for pain management. Indicate “+” or “–” as to whether they were helpful or not.
As you read this chapter, your mind may be churning with frustration, fear, anger, and confusion. How did you get here, and what do you do now? Is there a way out? Indeed there is, so read on and get ready to work. In the next chapter, you will see more clearly how your life has become based on the well-being of your person with pain. And you will begin to see how you can move toward balancing your own life, regardless of how _______________ is doing.
2 How Families React to Chronic Pain
After Jim’s injury, he was laid up in the hospital for a while, then came home and hadn’t worked since—over four years ago. He couldn’t sit up or concentrate long enough even to do therapy. He was severely depressed and in pain twenty-four/seven. Two surgeries and countless epidural injections had left him no better, and, in fact, worse after the last surgery; now he had burning and tingling down his right leg that kept him from resting, so he was up and down all night. Mary nursed Jim in the hospital and at home for as long as she could, but finally money was running out and she was compelled to return to work. At the time, she still had one of her kids at home, whom she felt she was abandoning because she had to leave to work nights as a nurse at a local hospital. It was actually a relief to be out of the house (though she hated herself for feeling it). At least she could care for people who got better. And she didn’t have to live with them—with their pain, their complaining, their depression, and their anger. At home, that’s mostly what dominated her life and the life of her family. Jim tried his best, but it seemed like his best wasn’t nearly enough. The pain was getting the best of him, and driving them both, not to mention the kids, crazy!
Thankfully, Mandi was out of the house, recently graduating from college and going on to graduate school. She wanted to help, even offering to quit school and return home, but Mary categorically refused. The last thing she wanted was for her successful daughter to get sucked into the downward spiral that had become their life. Ross had become more sullen and withdrawn lately. Mary was sure he was missing his dad. They were both subject to Jim’s moodiness—one minute shouting, the next crying. Mary knew it was taking its toll on her teenaged son and didn’t know where to turn.
When chronic pain is introduced into the family, everything changes. Along with these changes, a variety of confusing and negative emotions often develop as the whole family is thrown off balance by role reversals, medical concerns, financial and legal worries, and other lifestyle shifts. It can be difficult for even a well-functioning family to adapt in a positive way; in fact, it is uncommon to see a healthy adjustment to such a trauma.
While every family’s experience is unique, there tends to be a pattern to how families respond to chronic pain, which may occur rapidly or over a long period of time. When a member of the family becomes disabled by chronic pain, the rest of the family
