Living with Chronic Pain: The Complex Reality of Opioid Use

It’s a struggle. For those of us trapped in the grip of relentless pain and looking for ways to just function, finding relief is an ongoing battle. Opioid medications have long been prescribed as a primary treatment option, but their use is controversial and often stigmatized. However, from the perspective of chronic pain patients like myself, the reality is complex and nuanced.

Chronic pain is not just a physical sensation; it permeates every aspect of life. It can lead to reduced mobility, decreased quality of life, and increased risk of mental health issues. For many patients, traditional pain management techniques such as physical therapy, non-opioid medications, and alternative therapies may offer partial relief but fall short in providing the necessary comfort to lead a functional life.

Opioids, including medications like oxycodone, hydrocodone, and morphine, can be effective in managing severe pain for some people. Opioids work by binding to opioid receptors in the brain and spinal cord, which blocks the transmission of pain signals. While these medications can bring much-needed relief, their potential for addiction and overdose has raised concerns among medical professionals and the public alike.

The opioid epidemic, which emerged in the late 1990s, brought increased scrutiny to the use of these medications. And rightfully so! Rampant misuse, overprescribing, and illicit manufacturing contributed to a rise in addiction rates and overdose deaths. As a result, there has been a push to restrict opioid prescriptions and implement stricter regulations. However, this has inadvertently led to the stigmatization of chronic pain patients who legitimately require opioids for pain management.

As a personal example of this going too far, I had a liver tumor removed in 2019. The procedure was at a large, influential health system that has been pushing hard for reducing opioid prescriptions and use. The morning after my liver resection, the nurse decided I had enough painkillers despite my having orders in my chart from my surgeon. When I told her my pain was 10/10, so bad I couldn’t breathe and thought I might pass out, she didn’t seem to care. She told me I just needed to walk around some. While I very much agree with active recovery (ahem…this entire blog really), I couldn’t breathe, let alone walk. Eventually it got so bad, that I contacted the charge nurse and on-call surgeon, who helped me get the pain back under control over the course of several hours. By this point, however, my recovery was significantly set back, and I had to spend an extra day in the hospital. Clearly, patient harm like I experienced was unacceptable. But it’s the type of environment we’re building here.

Chronic pain patients often face significant challenges in accessing opioids due to the tightening of regulations and the reluctance of healthcare providers to prescribe them. From a providers’ viewpoint, this makes sense as many face litigation should something go terribly wrong. It’s completely understandable, and I am in no way blaming the majority of providers. However, as a result, patients may endure long waiting periods, unnecessary bureaucratic hurdles, and even outright denial of necessary medications. This lack of access not only prolongs their suffering but also compromises the ability to function in daily life. This JAMA article does a great job of summarizing this argument from the viewpoint of several physicians.

Living with chronic pain takes an enormous emotional toll on individuals and their loved ones. The constant struggle to find effective treatment, the fear of being labeled as an addict, and the frustration of being misunderstood can lead to feelings of isolation, anxiety, and depression. Chronic pain patients require empathy and support from society to help combat the emotional burden they carry.

Most chronic pain patients who rely on opioids are acutely aware of the potential risks associated with their use. Responsible medication management, regular check-ups, and open communication with healthcare providers is second nature. Many patients actively engage in risk mitigation strategies, such as participating in pain management programs, incorporating complementary therapies, and setting strict dosage limits to minimize the chance of addiction or overdose.

For chronic pain patients, the decision of whether or not to use opioids is a personal–and often difficult–one. There is no right or wrong answer. The best way to make a decision is to talk to your doctor about your individual situation. Personally, I do not regularly use opioids. As I’ve shared in other posts, I rely heavily on mindfulness techniques, an occasional mix of ibuprofen/acetaminophen, and cannabis (more on that last one in the future). More on my methods here.

Here are some things to consider when making a decision about opioid use

If you decide to use opioids, it is important to follow your doctor’s instructions carefully. This includes taking the medication as prescribed, not sharing the medication with others, and disposing of unused medication properly.

It is also important to be aware of the signs of addiction and overdose. If you experience any of these symptoms, call your doctor immediately:

If you are struggling with addiction or overdose, there is help available. There are many resources available to help you get treatment and recover. You can find more information on the CDC website or by calling the National Drug Helpline at 1-800-662-HELP (4357).

The opioid crisis has had a profound impact on the lives of chronic pain patients. While efforts to curb addiction and overdose rates are crucial, it is equally important to recognize the needs of those who depend on opioids for pain management. Addressing the opioid issue should not come at the expense of stigmatizing and marginalizing individuals who are legitimately suffering. Instead, a balanced approach that focuses on responsible prescribing, improved access to comprehensive pain management strategies, and increased support for patients is necessary to ensure that those with chronic pain can lead dignified and fulfilling lives. I haven’t seen nor heard many chronic pain patients being included in the conversation at a national level. That must change.