More Pain Meds is Not Necessarily More Pain Relief!!

Pain is an ambivalent symptom. It is ‘great’ in a sense because it lets us know there is an underlying abnormality, but it is evil because it is annoying and no normal human being can deal with it. In pain medicine, especially in the field of medication management, two main breakthroughs took place. The first is the discovery of opium and eventually its derivatives. The Second is Aspirin. Although reports of opium growth dates back to 3,400 B.C. in Mesopotamia by the Sumerians and later by the Arab Empires, it was not until 1803 when morphine was extracted from opium resin and was viewed as a magic and miraculous drug. Aspirin, or acetylsalicylic acid, was discovered by the German company Bayer by Felix Hoffmann. Aspirin discovery eventually gave rise to Non-Steroidal Anti-Inflammatory Drugs (NSAIDS). Initially, it was thought that the more pain medication such as morphine is given the better the pain control. More recently, there is data to suggest that accumulation of metabolites of morphine, such as M3G and M6G can lead to hyperalgesia (Increased pain sensitivity) rather than analgesia (pain control). These metabolites act on the brain and spinal cord and give the patient serious side effects including neurotoxicity, myoclonus (jerking of muscles), poor concentration, hallucinations (tactile, auditory, and visual), sedation, constipation, and many other symptoms. When the patient presents to his/her health care provider and the latter is not familiar with this, it is treated as if the patient is over-medicated, in withdrawal, or even under effect of other chemicals. Providers fail to ask the key questions and fail to rotate the pain medication from one to another after certain time period. These un-noticed symptoms can cause severe distress to the patient and his loved ones and providers may perceive it as drug-seeking “weird” behavior. My Opinion: always express yourself, talk about your symptoms, demand to be evaluated, and be heard. You may be right and your provider may be wrong…