Lessons I’ve Learned from Taking Prescription Painkillers (Part 1)

**Note- these are my personal experiences and should not be taken as medical advice. All prescription medications that I refer to are drugs that I was prescribed by a doctor for orthopedic and neuropathic knee pain following two different surgeries within a three-year period. **

My Personal Drug Story

Isn’t it funny how our society polarizes drugs into “good” and “bad” categories as if they possess purely benevolent or malicious intentions? I remember taking D.A.R.E. (Drug Abuse Resistance Education) classes when I was in middle school and we learned about all of the illegal drugs not to take: heroin, marijuana, methamphetamine, MDMA…I knew that these illegal drugs were bad (sarcasm, sarcasm, cynicism, cynicism…) but I was also raised in a family that eschewed the use of drugs in almost all cases. I don’t think I took cough syrup or cold medicine until I was in my late 20’s. Even then, I felt guilty every time I did!

So, I learned at an early age, drugs = bad. This brief context of my socialization surrounding drugs, will hopefully set the stage for the following account of my experiments with a long list of analgesic (i.e., pain relieving) drugs to treat knee pain. I do not view drug taking (no matter the legality or purported “safety” of the drug) lightly. I tried all of these different drugs as a very serious attempt to alleviate pain and, believe me, drugs were not the first thing that I tried! That being said, I hope to also communicate some of my newfound appreciation for drugs when used as one tool in a broader treatment plan and not a be-all-end-all-cure-for-what-ails-you.

Keeping in mind that before three years ago, I rarely used drugs: I’d take Advil or cough medicine maybe twice a year for a bad headache or cold. Since the injury to my knee three years ago, I’ve tried all of the following prescription drugs for pain relief or anti-inflammatory properties and some for months at a time! Seems crazy, right?!: Diclofenac (topical gel) (Brand Name: Voltaren), Duloxetine (Brand Name: Cymbalta, among others), Hydrocodone, Lidocaine (topical patches) (aka: xylocaine or lignocaine), Naproxen (Brand Names: Aleve, Naprosyn, among others), Piroxicam (Brand Name: Feldene, among others), Pregabalin (Brand Name: Lyrica, among others), Sertraline (Brand Name: Zoloft, among others), Tramadol (Brand Name: Ultram, among others).

Top 5 Lessons I’ve Learned from Taking Prescription Painkillers:

1-Drugs do not have just one effect (and thus, no drug is “safe”)

I don’t believe that any drug is “safe,” though some are clearly worse than others. All drugs have “side effects,” or additional effects to the desired one. The most common side effects that I experienced were: head aches, insomnia/nightmares/sleep disturbances, foggy headedness/inability to concentrate, constipation, and skin issues (irritation, rashes). It is common to experience gastrointestinal (GI) symptoms from ingested drugs and skin irritation from topical drugs¹. For some of these drugs, the list of side effects is probably scarier than what they claim to treat!

*Please note, though I believe that drugs are not, “Safe,” sometimes drug taking is a calculated risk that makes sense (see #5)*

2- Doctors (MDs) have a limited understanding of the drugs that they prescribe

First of all, let’s get this elephant out in the open right away: randomized controlled trials (RCTs) are only as good as the sample size that they include, which is….drumroll please…predominately Caucasian males. So, in a system that idolizes the RCT for medication use and effectiveness, this should be a HUGE red flag if you are NOT a Caucasian male. For a good discussion of this issue as it pertains to women specifically, see: Alyson McGregor TED Talk.

This just reinforces the idea that each person reacts differently to drugs and is one reason why people get frustrated: clinical symptoms and disease presentation are often very different from the information gathered in RCTs. Also, there is still much we don’t know or that hasn’t been studied. But, that being said, this great unknown is also part of the hope that seems to buoy you as a patient, who has not experienced relief: maybe there is a drug (or something) that I haven’t tried that can help me!

Furthermore, doctors are human and so their recommendations are based on many factors OTHER THAN the patient’s well-being (e.g., personal preferences/biases, drug company lobbies, political pressures, reimbursement rules, bias against herbal/alternative remedies, bias towards RCT knowledge and away from experiential knowledge, fear about litigation, ignorance of alternative effective treatments, pressure to prescribe, etc.). Not all doctors are up to date on their knowledge of the biology of pain and effective approaches to treating pain (even those who claim to be pain “specialists”!)².

3- Drug taking behavior is NOT rational

When you are in pain that is severe in magnitude or duration, the mindset is often, “I will take (or do) anything to get out of pain.” This includes swallowing whatever pill the newest specialist or doctor prescribes no matter how long the side effect list is or how much it will cost after your insurance pays their portion. The coercion and seduction of a pill, a drug, a “silver-bullet” is very strong in itself, but becomes near impossible to resist when you are experiencing the raw desperation of sustained pain (i.e., chronic pain states: Making A Difference in Chronic Pain).

Drug taking can be as much about fear of symptoms as prevention of symptoms. It is a tricky psychological situation when you are in the midst of experiencing raw pain. Any pain you already, “know” is better than a feared, “unknown,” pain. Maybe, this is our inherent negativity bias speaking: I know I can put up with what I’ve already been able to tolerate, but not if it got worse…

At one point, I was experimenting with different doses of Tylenol, Advil, and Tramadol to help with my bouts of intermittent nerve pain. I finally settled on taking one Advil in the morning and one Tramadol and two Tylenol at night to help me sleep. The only reasoning that I had for this particular number of pills, combination of drugs, and timing is that I had what I thought was a, “better” day and night of sleep one day that I did this so this became my routine. I didn’t want to change it for fear of making my pain worse, and indeed I continued this regimen for the better part of three months! I won’t pretend that there was much logic to these drug taking decisions of mine.

4- It is often hard to tell whether a drug is helping

This was especially true when I was taking multiple medications concurrently (should be obvious, I know). But, even without that complication, it is often difficult to assess if a drug is helping. There are so many factors that play into one’s experience of pain or any other symptom that is the target of a drug: strength of stimulus, sensitization of nervous system, context or environment of stimulus, diet, exercise, sleep, perceived self-efficacy to cope, perceived social support, work/disability/compensation issues, comorbidities with psychological illness (e.g., depression, anxiety), etc.

It is almost impossible to be a good scientist when it comes to yourself.

5- Drugs are useful in treating pain (…in some cases)

Complete avoidance of drugs is just as dangerous a position as over-reliance on drugs. There is some evidence that appropriate use of analgesics post-surgically or even prophylactically can potentially prevent the development of chronic pain³. As the author of this study notes, “…the one factor that’s most often been shown to predict chronic pain is pain itself — pain predicts pain. At the present time we don’t know whether acute pain causes chronic pain, or if acute pain is simply correlated with long-term pain, and this is really important, because if it is causal, aggressively managing acute post-surgical pain may reduce the risk that it becomes chronic.”³. Once you’ve had pain for a while, you’re brain gets sensitized, and it’s harder to get rid of (your brain learns how to be in pain)⁴.

Drugs should be used in certain situations. I repeat: drugs were helpful to me. Despite all that I’ve written here about the negatives of drug treatment for pain, I do believe a few of them served a key place in helping with my recovery. However, they were only one component to many that it took to help me get on the path to recovery. Over-reliance on drugs is just as dangerous as under-reliance.

Just because you have tried a drug for your pain, doesn’t mean you have tried the right drug. Now, I know I just spent a lot of time talking you out of taking drugs, but let me be clear that my main objection is that these drugs are not necessarily prescribed intelligently and there is much misinformation out there. For example, the orthopedist who gave me the diagnosis of CRPS would not prescribe me a neuropathic pain drug. CRPS and other neuropathic conditions can respond to certain drugs (neuropathic drugs) and the drugs that I was asking for were the ones that research trials supported using as first line treatments⁵.

There are many different drugs designed to treat pain and there are different types of pain. This topic is a Pandora’s box of information, but suffice it to say that finding an effective treatment for your pain probably depends on if it is orthopedic/structurally related, neuropathic, intermittent/constant…you get the idea. Pain is not just pain.

So, that begs the question: when are drugs necessary? I am going to harken back to a psychology definition that I tend to like: To answer the question of whether behavior falls into the realm of psychopathology (i.e., mental illness), you must answer the next set of questions: Do the behaviors negatively impact your quality of life to a great degree? Do these behaviors/thoughts negatively affect your ability to do your job or fulfill your responsibilities? Likewise, do the problems that you are experiencing (e.g., pain) impact your life to this great of a degree and have you tried safer alternatives? If the answers to these questions are: YES, then taking drugs might make sense. Ultimately, this was the decision that I came to for myself.

I hope that my experiences as someone suffering from chronic pain as well as a student within the healthcare field may help you or someone that you know to at least be mindful of the decisions that you are making regarding taking drugs (mostly applicable to analgesics). Also, check out PART 2 where I discuss the specific medications that I tried and what I personally experienced with each.

**Note- these are my personal experiences and should not be taken as medical advice. All prescription medications that I refer to are drugs that I was prescribed by a doctor for orthopedic and neuropathic knee pain following two different surgeries within a three-year period. **

References

1. Ratini, M. (2014): http://www.webmd.com/a-to-z-guides/drug-side-effects-explained
2. Moseley, G.L., Butler, D.S., Beames, T.B., and Giles, T.J. (2012). The graded motor imagery handbook. Adelaide, Australia: NoiGroup Publications.
3. Katz, J. (2016): http://www.bodyinmind.org/managing-pain-after-surgery/
4. Butler, D.S. & Moseley, G. L. (2003). Explain pain. Adelaide, Australia: Noigroup Publications.
5. Finnerup, N.B., et al. (2015). Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurology, 14 (2), pgs. 162-173.