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After three years of bouncing from doctor to doctor in high school, Greg Bufkin found something that allowed him to "reverse" his debilitating migraines daily.
Dilaudid, a powerful opioid known generically as the hydromophone, finally gave him relief.
Greg Bufkin, who has been suffering from severe migraines since the 1990s, found that after he stopped taking opioids, which he became addicted to, his pain was better managed by For nearly two decades, Bufkin said that he used his doctor's prescription – confirming that "I had a legitimate physical pain and that it was the only one drug against badgesia. "
He was convinced that painkillers were "the lesser of two evils", the other being his chronic pain
At the height of his addiction, Bufkin, of Ocean Springs. , was taking 90 tablets a day. He took an overdose while driving with his children in the car to motivate him to seek a rehab
Bufkin, now 39 years old and over two and a half years clean, still treats daily headaches.
Bufkin suffered from ibuprofen, an anti-inflammatory drug that did not help his pain during the years he was taking opioids
. "he says, reliving his surprise.
Bufkin then realized that "opioids block pain relief by other means."
Based on evidence of more and more opioids are not an effective treatment for chronic pain – and they can actually make the pain worse – the Mississippi limits prescriptions with medical restrictions that some people consider unreasonable and even dangerous
The emotional aspects of chronic pain, an undeniable tragedy that can deprive people of all the significant elements of life, make it a particularly heated debate.
The State Council of the State of Mississippi, composed of eight health professionals, has established a series of new regulations, he hopes that doctors will rethink the prescription of opioids for chronic pain, but ultimately leave many decisions to doctors.
Treatments, including increased documentation, will reduce the number of chronic pain patients receiving opioid prescriptions.
And "treating a pain as subjective as chronic will never be a universal approach". According to Anna Lembke, more and more doctors are finding necessary regulations, even if they inadvertently prevent a person who could benefit from opioids, even though it is rare, to continue their current treatment
" We can not ignore the overwhelming evidence … Medicine at Stanford University Medical Center
Dr. John Ruckdeschel, Director of the Cancer Institute of the Medical Center of the United States. University of Mississippi, discusses pain management.
Wochit
It makes you think you are suffering
A Hattiesburg neurologist told Bufkin what was going on in his brain in a way that made sense to him.
He says: shut off the part of your brain that might otherwise help reduce the pain, "said Bufkin." Your brain says, "If we do not have this chemical, we are unable to counter the pain. "
With the healthy mental state that he has now, Bufkin says that he can manage his pain with regular mbadages and soaking Jeanne Decanter said that during Over the past 18 months since she's stopped taking opioids, she continues to suffer from chronic pain caused by injuries sustained during a car accident in 2002. "But that's nothing." Compared to Jeanne Decanter said that in the last 18 months since she stopped taking opioids, she still suffers from chronic pain resulting from injuries sustained during a car accident in 2002 . "But that's nothing compared to the way I hurt myself when I was on them, "she says.
(Photo: Special at Clarion Ledger)
Jeanne Decanter, 40, of Summit started taking opioids in 2002, she left it with a prosthetic elbow and metal rods through her legs. Doctors put him on opioids long term, "because they told me that I was always going to have pain."
Decanter stopped opioids a year and a half ago. She was surprised selling pills for money to pay her bills (after spending her money on more pills.)
Before this wake up call, "I would have been One of those who would get angry if you said I could not convince myself that I did not need them. "
" That makes you think that you're hurting, then you take more "Decanter said. "Many people who are still suffering from chronic pain and who are still taking this medication have no idea that the medication is doing this to them, they probably think as I thought:" The doctor says I need it, so I need it, and it helps. They do not understand that they are probably already addicted and they do not even know it.
The Decanter experiment – the worsening of pain sensitivity related to the long-term use of opioids – is called opioid-induced. hyperalgesia. The prevalence of this paradoxical reaction is not clear.
The phenomenon is different, but sometimes difficult to distinguish from tolerance, making the painkiller less effective over time.
JAMA published research in March showing opioids some cases are slightly worse than non-opioid badgesics such as Tylenol and acetaminophen in the treatment of chronic back pain, hip pain or pain. Osteoarthritis of the knee. The randomized study examined 240 patients with chronic pain and followed the results over a year.
"If you had an antibiotic and that it is widely accepted that it feeds infections rather than fighting them, what would they do?" There are no studies beyond 12 weeks that show that opioids work against chronic pain, and longer studies are needed to show their effectiveness over time, experts agree
Yes, I still suffer Everyday, but it's nothing compared to the way I hurt myself when I was on them, "said Decanter. "They just had a way of cheating me physically, emotionally by needing them."
The pills had another effect too.
"Nothing I did brought me joy, nothing," she said. "Being 18 months without her, I'm still out of emotional numbness."
Explained Lembke: "Opioids rewire the brain, eradicating our ability to experience pleasure in so-called" natural "rewards: a good meal with friends, a beautiful sunset."
When opioids are ingested, the brain reacts to the dopamine surge by producing less dopamine, said Dr. Scott Hambleton, medical director of the Mississippi Physician Health Program
. years of jostling drugs in my mouth to numb the physical pain and in turn numb the emotional pain. "
" I'm sure that there are residual things going on in the brain.
Repression
Mississippi rages against doctors prescribing opioids for chronic pain.
Through the exercise, the state leaders, the forces of the US Order and health professionals recognize both the lack of evidence of the effectiveness of the painkiller and the role of the worst epidemic of opioids in the history of the United States
At the height of the epidemic, about 115 people died each day as a result of opioid overdoses, or 40% of prescription deaths, according to the Centers for Disease Control and Disease Control. Prevention.
In Mississippi the highest rates of high blood pressure and cholesterol – hydrocodone, an opioid, is the most prescribed drug.This is the same in 10 other states. [19659047] Charles Miles of the Mississippi State Council of ” width=”400″ data-wide-src=”” clbad=”image-selector”/>
Dr. Charles Miles of the Mississippi State Board of Medic al Licensure
(Photo: Special to Clarion Ledger)
Doctors of Mississippi wrote 3.3 million opioid prescriptions in 2017 – more than people in the US. State.
After several months of public hearings and revisions, the new opioid ordinances of the Medical Board are virtually complete and awaiting approval by the Examining Board. work permits.
They do not prohibit doctors from prescribing opioids for chronic pain. give a second thought; strive to stay within the equivalent of 50 milligrams of morphine per day; document a "significant rationale" for any drug above 90 milligrams and refer anyone who needs more than 100 milligrams to a pain management clinic
There is an exception for terminally ill and cancer patients who do not will not be affected by the new rules. Other new requirements for doctors prescribing opioids include drug testing three times a year and auditing the prescription monitoring program to see what other medications the patient can receive.
"They just need to document what they're doing the plans are," said Dr. Charles Miles, who served as chairman of the medical commission when drafting the rules. "You do not want leave some one under opioids for the rest of one's life. "
Patients have already seen the effects of regulations already adopted, doctors choosing to wean some opioid patients or pharmacists refusing to fill opioids. [19659006] Many Mississippians who suffer from chronic pain maintain their opioid prescription, that's the only thing that allows them to pbad each day.
"I would be bedridden"
Donna Corley fears that her doctor will eventually remove opioids, that she takes to relieve the pain of a rare disease in her spinal cord and she says allow her to live a life somewhat normal.
(Photo: Special to Clarion Ledger)
Donna Corley, 46, Petal has a rare and painful condition called arachnoiditis, which is caused by inflammation of the arachnoid, the membrane which protects the nerves of the spinal cord. It is badociated with sharp pains and burning throughout the body.
Before becoming debilitating, Corley ran a chiropractic clinic and was studying to become a reflexologist, a kind of mbadage therapist.
She has been taking a combination of opioids and anti-inflammatories for about five years.
"There is not a moment where I do not suffer, if it was for the anti-inflammatory that I take with the pain medication (opioid), I would bedridden, "said Corley. "The pain gets worse over time, because of the nerve damage that progresses steadily."
When asked if she thought her growing pain could be the result of opioid-induced hyperalgesia, she answered no.
I know how to make the difference and determine why my pain worsens: it's a nerve pain … With my experience of reflexology and nerve pathways, I can determine from where she comes and why it gets worse, "said Corley." I know that many pain patients are not like me, but with as much research and education as I've had, in this situation, it makes me more aware of what's going on in my body … It's not the drug.
Corley questions the type of pain experienced by patients used in recent studies – that they are examining the pain caused by minor injuries or rare and painful diseases like his.
"That's what I look at." Corley said it was ridiculous to believe that Tylenol would relieve her pain, which she said, "your backbone is on fire."
Corley Receives S she is taking pain medication from her primary care physician, but as new regulations fall she is looking for a pain management clinic in case her doctor decides to stop prescribing opioids. She found that she must wait six months for an initial appointment.
"It's my biggest fear every time I see it (my doctor), that it's going to say," We're going to have to wean you off because of the new guidelines. If that happens, I do not know what I'm going to do. "
Corley stated that opioids allow him to" get out of bed and function ", but even so, the disease took its toll
" I lost a 17-year marriage because my ex could not handle what was wrong at home, so i know what it's like to pull out all that i've lost, my career, "said Corley. [19659042] Chicken or Egg?
In general, it can be difficult to distinguish if changes in the life of a patient with chronic pain – a divorce, a lost job, less interest – result pain or pills, Lembke says
That's why she urged doctors to talk to family members and friends about their chronic pain patients to see if their reports are correct [19659009Postone-thirdoftheopioiduserssurveyedsaidthattheythinktheyareorwerephysicaldependentoraddictedtothedrugButwhenfamilymemberswereinterviewedmorethanhalfsaidtheythoughttheirrelativewasdependentordependentillustratingadeltabetweenpersonalrelationshipsandexternalperceptions
(Photo: Special to Clarion Ledger)
Lori Austin, 59, of Ocean Springs began taking opioids after spending a year trying different She said that if anyone One entered the Biloxi Pain Clinic where she was patient and was trying to identify people who were using drugs and who were using their medications to relieve fibromyalgia pain.
As prescribed, they are going through a difficult time
Sometimes Austin arrives at the clinic in comfortable clothes and flip-flops, hair Austin's chronic pain is so debilitating, she says, that it's hard to perform the daily chores.
"I can not brush my hair every day, and that's why I look like that. , The chicken or the egg? "She added." It's exactly what it is. "
Austin is recovering from alcoholism, so start opioids to treat her chronic pain was not an easy decision She knew that she might be at risk for addiction, but she said it was worth relieving her pain.Austin, who took painkillers for about two years old, said she's not abusing her prescription and lets her doctor take her pills.
Still, she had to change the types of opioids she takes – between Norco ( hydrocodone) and Percocet (oxycodone and acetaminophen) – when she accumulates tolerance to one and her pain returns.She tried eight months ago to go to bed four to two pills a day, but 'that's n & # Did not work for me ", so she's back to her peak dosage.
Austin can still work at home with extra support e of her long-time husband.
"I was probably one of those people who never thought people needed this stuff," Austin said. "If it was not for this medicine, I would have no life and I would probably take mine."
Austin also takes an antidepressant. "The depression that accompanies chronic pain and exhaustion is almost worse than physical pain," she said. "It takes away all the weight and everyone around you."
Overlapping Physical and Emotional Pain
Scientists were able to demonstrate the overlap of physical and emotional pain. A study from 2003 found that the fight against feelings of social exclusion and physical pain unfolded in the same part of the brain
"We found that the same neurochemicals regulating physical pain also control the psychological pain of social loss. writes a neuroscientist and psychologist, Jaak Panksepp
. In a 2015 article in the New England Journal of Medicine, Dr. Jane Ballantyne and Dr. Mark Sullivan argued that over time, the intensity of chronic pain has less to do with the the nervous system. system's response to "hurt" and more with emotional and psychosocial factors.
"Suffering can be as much related to the meaning of the pain as it is to its intensity," they wrote. "Persistent helplessness and hopelessness can be the root causes of suffering in patients with chronic pain and result in a high intensity of pain."
Patients with mental health problems or addictions are more likely to be treated with opioids in the long run and are also more likely to experience adverse effects.
Many opioids prescribed by Mississippians also take benzodiazepines, or anti-anxiety medications like Xanax. These medications are often prescribed for generalized anxiety, although anxiety often manifests itself at the same time as depression, making antidepressants the first-line treatment
. the combination is particularly dangerous. In about one-third of opioid overdoses, benzos are involved.
But again, the chicken or the egg?
The new limitations that accompany chronic pain are enough to scare anyone, says Corley, "but I do not suffer from depression."
"It's very difficult when you are diagnosed with a disease that does not not cure and you do not want to accept that it's going to be my life, if you accept it or not, that's what happens to you, "Corley said. "That was my biggest hurdle, my brain was saying, 'I'm going back to work,' but my body was saying, 'No, you're not.'
She describes the reaction she received from others, even her own family, who thought she had just given up when they saw her in a wheelchair for the first time. first time
"No, I'm not, I'm fine," Corley said. "This chair gives me the means to move around and do things again, which allows me to adapt to what's happening to me."
Stigma around the use opioids goes beyond chronic pain dependence.
Too much perverse incentives
All patients with chronic pain will not be addicted as Bufkin and Decanter. And because of the changing attitudes surrounding the use of opioids to manage chronic pain, many of them will be removed from their painkillers.
Ironically, despite the experiences of Bufkin and Decanter, both stated that they did not believe that new strict prescribing rules would solve the opioid epidemic.
Most people may agree with opioids, but these new rules Decanter said:
Dr. Mary Currier, state health officer, spoke severely in front of the Medical Board during one of its hearings, warning that prescribing limits would incite people to the streets to abuse more dangerous drugs
Correlation (which is not a problem). not necessarily the causality) already exists: Although opioid prescriptions have decreased between 2011 and 2017, the number of overdose deaths has skyrocketed in the same amount of time. And prescription pain medications are not the cause of the rise, but illegal opioids like fentanyl.
That's why Lembke says that doctors can not just cut their opioid patients. If a physician determines that the withdrawal of his patient is in his best interest, Lembke says he must ensure that multidisciplinary supportive measures are put in place throughout the process.
"We can not abandon these people. them, but not just by continuing to prescribe opioids in the face of the evidence, "said Lembke. "In the absence of a good treatment, we do not want to give bad treatment."
Without prescribing limits imposed by legislation or regulation, she added, there are "too many perverse incentives" to continue prescribing opioids. are convenient to write and repay by most insurers, including Medicaid.
In the end, the rules aroused fear and anger in many patients with pain who developed opioid dependence
"That does not mean nothing in the face of the problem of over-prescription", said Lembke. "We can not right a wrong by simply continuing to ignore that wrong."
For more information: Patients with chronic pain say that a war against the opioid epidemic could kill them
For more information: How does the Mississippi's response to excessive prescription of opiates compare to that of other states?
To learn more: t throw patients 'at the wolves'
For more information: Why can not we go after the "pill mills"?
