Blog: Path of my Life
by Karlin

Morphine and Chronic Pain - The Terrible Toll of Tolerance

Morphine addicted chronic pain people have to deal with growing tolerance, withdrawals, and the unmasking of pains...

Date:   2/9/2009 12:42:10 AM   ( 12 y ) ... viewed 9620 times

Chronic Pain People and Morphine Addiction:

"The Terrible Toll of Tolerance"

This is about the harsh reality of the chronic pain patients who are prescribed morphine, and who have been on it for many years. This isn't about every chronic pain patient, nor is it about most addicts - these are the severe pain cases who have landed on this path because it was their best option.

The main problems are morphine tolerance, withdrawals, and the unmasking of pain that occurs when the morphine runs out. Financial hardship usually becomes part of the story too, but there is no reason for that other than prohibition laws; poppy plants are easy to grow, morphine is easy to make, this could be very cheap medicine, but it isn't.

Chronic pain people have pain every hour of every day, as months go by, as years go by. For many, these pains are more than a distraction, they are often actually "squirming" - as in shifting positions, rubbing the worst spots, and constaly fighting the urge to scream. Living like that will wear on a person. Pain is not without consequences to the spirit... eventually people with chronic pains are ready to try anything to get some pain relief. Most likely, they allready tried so many things, and nothing helped for more than a few minutes - the pain returns soon after a chiropractic treatment, or massage, or accupuncture, and before they get home again they are hurting just as much as when they left. Meditation helps a lot, but it is almost impossible to stay in that state of mind when they are doing something that requires their attention.... who could do meditation all day anyhow?

At some point, usually after several years of the unrelenting pains, the patient and their doctor decide that the time has come to start taking morphine. It is a desperate measure for sure, but when the patient is becoming depresssed and suicidal, there isn't much to lose. It is the humane thing to do, but the morphine has it's own unavoidable problems that government policies and judgemental attitudes makes all that much worse.

The morphine helps, the patient is more active when taking it, the morphine allows them to sleep at night, and they feel more refreshed during the day. They are even getting some physical exersize when the morphine has taken the pains away, and the exersize helps reduce the pains even more. The treatment is a success, it works for several years if the morphine is carefully used. The chronic pain patient can stay on it for years, getting small increases every six months as tolerance develops. And that is where the problems with morphine begins.

Tolerance is where the user's brain stops making the chemicals that works with the morphine to bring pain relief, which means that either the patient has to take larger doses of morphine to get the same effect, or that they just get less pain relief. The standard developed over 100 years ago for morphine prescriptions is that an increase of 30mgs of morphine should be prescribed every six months to keep up to tolerance. Oddly, it seems that 30mgs more makes the difference of the morphine being effective or not even if the previous dose was large or small ; i.e. - whether the patient was taking 100mgs per day, or 300mgs per day, another 30mgs helps.

Interestingly, opiate drugs have no upper limit where they become toxic; breathing can be come suppressed and nausea can occur if a person takes a much larger dose than they are used to, or for the first time, but it is not "toxic" like most other drugs where there is a poisening and the body shuts down from damage to organs. A long time user can work their way up to any amount and not be poisened. You start out at 30mgs, and eventually you could take 3000, or 30,000 mgs, and it will never kill you as long as that is the amount you are used to. Humans, and all other vertebrates, have "Mu-Opiod Receptors" in our brain and spinal columns, and perhaps it is this unique relationship to the poppy plant that allows us to take any amount of the drug derived from it; perhaps we metabolise it well, I have searched and searched and cannot find any more information about why there is "no upper limit" to opiate drugs.

Doctors are discouraged from prescribing more than 300mgs of morphine per day though, and for the patient that has reached that level of tolerance, they are faced with a terrible choice: endure the pain without the relief of enough morphine, or get pain relief by taking more morphine than their prescription allows for, even though doing so will mean that they will run out before it is refilled [refills are usually for one month at a time]. Being tolerant to the amount taken also means that the user will go into withdrawals sooner than when they are taking an effective dose, sometimes within just a few hours.

That is the other special problem for the chronic pain patient who takes morphine - withdrawals. All addicts will experience withdrawals symptoms, but those are especially challenging for the chronic pain patient because some of the withdrawal pains are a lot like their regular "chronic pain pains", and it seems that it is allmost multiplied when chronic pain people go into withdrawals. These pains include muscle cramps, headaches, fatigue, and widespread flu-like aches, and also sweating despite feeling cold, and later on puking, shitting, sneezing, shivering and terrible abdominal pains. Opiate drugs [i.e. morphine, heroin, methadone, etc.] produce the most horrific withdrawal symtpoms - methadone withdrawals were used to torture prisoners by the Germans in WW2, and were often considered to be the most effective of torture techniques.

One theory of chronic pain conditions is that the brain's pain mechanisms are causing "amplified pain", where some of the nerve signals from the body are simply amplified in the brain - things that usually hurt just a little for normal people are interpreted as being severe and urgent and since the pain mechanism's job is to protect the body from danger or damage, and that is what it believes is happening, therefore it will do that by causing severe pains. It is not a matter of the chronic pain person's way of thinking, it is the instinctual part of the pain mechanism that is malfunctioning. And that would explain why withdrawals are worse for the chronic pain patient - those pains are amplified in the brain of the chronic pain patient. Unfortunately, this situation is not widely recognised by doctors, or addiction specialists, and so it probably goes on without any consideration for the addicted chronic pain patient. Most likely, they are scorned for complaining about it - "go through it like everybody else does, you are making it worse that it has to be" [something the chronic pain patient has heard that all their lives, withdrawals or not].

And all that is ON TOP of the chronic pains that the chronic pain patient first took the morphine for. Remember, those original pains were bad enough for the doctor to prescribe morphine for, and now there is withdrawal pains on top of them.

And that brings up the final part of the story of the chronic pain patient on morphine who is going into withdrawals - "unmasking". Those chronic pains are now being "UNMASKED", a term that describes the situation where the pains that were being smothered and kept under control by morphine are now coming through for the first time in a long time, and on top of that they are going into withdrawals. Obviously, this is all getting very complicated and overlapping, and there is no way to know what exactly the chronic pain addict might be feeling, or why. Unmasking plus "amplified withdrawal pains" - am I making my point yet? - this is what hell is, and they are being tortured there, in hell.

All this might be just making a case for more drugs, and every addict does that. It is all a bit theoretical, unresearched. Chronic pain patients on morphine who have reached tolerance to their prescribed doses would surely ask for more, but where does it end? Wouldn't they just ask for more and more, and some would sell some of it, and others would take more than they need, and so on?? How could anyone really know what the motivations of these patients are?? On the other hand, remember that there is no upper toxic limit, and since morphine can be produced quite cheaply, so after 10 years, or 20 years of being on it, would 1000mgs a day really be outside the realm of a reasonable sized prescription? Ahhh, but there he goes again, simply drug seeking.

So who is to know what the right thing to do is? Bringing down the tolerance levels seems like a reasonable solution to this quandry. There are no ulterior motives in doing that, but doctors don't want to discuss ways to bring down tolerance.

If a chronic pain patient who is also an addict seeks help to get through a few days of withdrawals, they just find roadblocks:
- If the chronic pain addict goes to a hospital emergency room during withdrawals, the doctors there might take a look at them and check their blood pressure but then they will be asked to leave, to find their own way home even if they came by ambulance, without getting any help there other than maybe some moderately helpfull pills for the gut pains [just like any other addict is treated].
- Their doctor won't discuss ways to reduce tolerance, they only offer "adjunct therapy", which means antidepressant pills, or off-label uses of Neurontin to help with the pain, which might be a good idea but those pills do nothing to help with the withdrawal symptoms, or with tolerance.
- If the chronic pain addict contacts the addiction specialists, they will tell them to come into a detox centre, but when they get there they are told that "no drugs can be used for a drug problem", even though the patient tells the detox people that they are not there to quit, just to get through the next few days until the prescription is due.

So who is really in denial? The addict who takes more than they are prescribed, and constantly asks for bigger and bigger prescriptions? Or the addiction specialists and doctors who do not know anything about how to avoid tolerance, or how to reverse it, or how to help you through withdrawals? The policy makers - are they in denial, or just ignorant, or are there other motivations for continuing to have prohibition laws? [perhaps you have read about the idea of "alternative reveneuse streams for unsavoury government activities"?].

It is a complicated issue, and everybody but the addicted chronic pain people can just ignore it. At least now, you, dear readers of my blog, at least you know a little more about this hellish reality of some of our fellow human beings.

Some of you might also know why the author has such intimate knowledge of this issue...

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Comments (25 of 238):
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