Rheumatoid Arthritis and opioids for chronic pain relief

Rheumatoid Arthritis and opioids for chronic pain reliefJust a quick word about pain.  And more importantly, pain relief.

The pain of Rheumatoid Arthritis is severe and constant for some people.  People like me.  While I have tried every DMARD and am steadily working my way through the bDMARDs, the pain continues.

The only drug that significantly reduces my inflammation, and therefore my pain, is prednisolone.  However, due to serious side effects, I can no longer take a high enough dose of prednisolone to provide functional pain relief.

So that leaves me with opioids.

Opioids are narcotic pain relievers.  I have tried several. Morphine. Oxycodone. Fentanyl.  Buprenorphine.  I find the combination of ms contin (oral slow release morphine) and Oxynorm (immediate release oxycodone) to be the best combination for me.

In Australia, opioids are not easy to get, but they are available to those with chronic, painful conditions.  Prescriptions are highly regulated and require government authorisation for each script.  You cannot ‘doctor shop’.

This is as it should be, because opioids come with a lot of side effects and the risk of abuse.  They cause nausea, constipation, dizziness, memory problems and drowsiness.  Oh and they make me itch.  But they do reduce the pain enough to allow me to function, most days.

The main concern that doctors have is addiction.  But there is a distinct lack of studies on the long term outcomes of managing chronic pain with opioids.  The statistics on addiction seem unreliable, some quoting addiction rates as high as 30% and others as low as 3%.

As with everything else to do with inflammatory arthritis, patients need to be assessed on a case by case basis.  If you have a prior history of addiction, or alcohol abuse, opioids are probably not a good treatment option.

But, for many people, they are the only viable option. The only potential relief from a life of unending, severe pain.  Should patients be denied these medications because a minority become addicted or abuse the drug?

Almost any drug can be abused.  Opioids are just the current poster child.  Marijuana is becoming more and more accepted as a medical option (thank the stars!) but opioids are being proclaimed as the root of all evil.

But some pain will respond to nothing less. For me, there are many days where I would not be able to get out of bed without my morning narcotics.  30 minutes later, I am still in some pain, but I can function.

Opioid use does need to be closely monitored, however.  I see my GP monthly to refill my scripts and discuss their effectiveness, or otherwise.  If my use is going up, we talk about why.  And it’s a complicated issue, because higher use could represent disease progression, the development of a higher tolerance to the drug, OR it could be the first sign of abuse.  An honest relationship with your doctor is essential.

For me, it represents the first two.  Disease progression I fight with DMARDS, bDMARDs, anti-inflammatories and corticosteroids.  I’m doing everything I can to resolve the root cause of my pain – inflammation. Tolerance we can do little about.   Except be very mindful.  I only take as much as I need. Some days I will take two pain tabs. Some days I need four. It does depend on the day.  Varying the dose helps with tolerance to some degree.

Until I find a drug cocktail that puts me into remission, or at least low disease activity, this is my only chance to have a life.  I understand it’s not the best option, but it’s not as terrible or problematic as some would have us believe.

If use is well managed and monitored, it is possible to live and function well on daily opioid medications.  I have been using opioids daily for around 4 years.  Yes, my dosages have steadily risen.  But I am not addicted.

I do sometimes I crave my pain meds.  But I’m not craving a euphoria induced by the drug.  I am craving the euphoria of feeling the pain subside, at least most of it.

Definitely not the same thing.

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