by Terri L. Schreiber (Colorado Medical Society Article)
My entry into opioids began innocently enough. I sought medical attention for facet joint damage, a fractured spine and three torn discs weeks before starting a PhD program. The injury happened during labor and delivery when pain was considered a fifth vital sign. Opioid prescriptions were plentiful and I was a model pain patient with no history of taking opioids except following dental procedures and a minor back injury. I took the medication as prescribed and adhered to doctor requirements that I use one pharmacy and never fill a prescription early. Little did I know that the initial prescriptions would lead to 10 years of increasing opioid tolerance and opioid-induced hyperalgesia, disability, gaining 50 pounds, hopelessness and withdrawal from PhD studies. The good news is that this article is possible because I tapered off all opioid medications and reclaimed my life. This is intended to be a cautionary tale as to why daily opioids are not always a long-term solution to chronic pain.
My pain management story began after obtaining an MRI to determine if a lumbar fusion was warranted. For years, massage and chiropractic care were sufficient to treat a preexisting whiplash injury from a car accident. Benzodiazepines to manage chronic insomnia kept the neck pain manageable. Despite evidence of spine disease, the surgeon gave me sage advice. There was a 30 percent probability that lumbar fusion would eliminate my pain and not create additional problems. The odds were not inspiring so I opted out of the potential surgery and was referred to a physiatrist who oversaw my care for the next eight years.
From the earliest days working with the physiatrist, I was naïve about how dependent on the opioids I would become. Initially, they felt like a panacea. I had answers to why I felt so much daily pain and could finally explain the loss of 40 pounds within weeks of delivering my daughter. Further, I thought the medicine would tide me over as we explored a range of viable treatment options. I believed I was doing everything right. What I did not fully appreciate was the longer I took the medicine, the less connected I would become to my body’s signals. Nor did I understand that my acuity and memory were slowly eroding.
I tried to trace how my treatment plan became harmful. From the outset, the medications were intended to be an interim solution until the benefits of radiofrequency ablation could be realized. Time passed and I went forward with the procedure, but did not enjoy the intended benefits. Instead, pain levels increased. From that day forward, my response to almost all procedures was atypical. In addition, and unexpectedly, by taking the medication as prescribed, I became more susceptible to the risk of opioid dependence. By being compliant, I had a seemingly limitless supply of opioids or what I came to believe is “heroin in a pill.” Medication refills continued uninterrupted for 10 years. Yes, interspersed with the prescriptions were efforts to reduce pain. I had a discogram to diagnose the location of my pain and periodic spine injections. I also investigated the viability of a neurostimulator implant. My allergic response to nickel and other materials ruled this out. Medication alternatives were limited. So, it seemed reasonable that I was advised to treat my pain and daily medications as analogous to a diabetic needing insulin. For years, I believed this was my best choice and could not see the hole I was digging.
And then a miracle happened. Two events set me on a path to finding a long-term solution. The first was that my treating doctor closed his practice without warning. In the weeks following the closure, by attempting to stop taking the medicine without medical oversight, I learned I was dependent. Then, months into tapering, I had a minor slip and fall. My pain was out of control. I could barely walk. I could not read and my memory was shot. So, I made a choice to taper off all medicine and became emboldened to understand the cause of my immobility. I was terrified. Sure, the MRIs showed multiple spine diseases: bone spurs up and down my spine, degenerative disc disease, facet joint problems, spondylolistheses and stenosis. Surprisingly, the data no longer held the power to overwhelm. Instead, I started to read literature, recalled my 1993 treatment options following my whiplash injury, and reconsidered any and all non-opioid treatments. Anti-inflammatory foods, chiropractic adjustments, embracing a sugar free and gluten free diet, hypnosis, massage, meditation, neurokinetic therapy, physical therapy, Pilates and spine injections all became treatment modalities to explore. I took drastic measures. I withdrew from my PhD program with the goal of reclaiming my health. After six months of physical therapy, I could walk without a limp. Ice, heat and peppermint oil replaced diclofenac patches and a TENS unit. The new diet, hypnosis, meditation, naproxen and Tylenol made it possible to significantly reduce my pain levels.
Today, I am no longer dependent on anything. I still keep a small amount of pain pills and muscle relaxants for extreme pain, but take them rarely and with caution. There are days when I am bedridden and need an occasional spine injection, but my cognitive function has been restored. One can attain quality of life after opioids and two spine injuries. Learning to live with tolerable pain and minimal medication not only allows full use of one’s brain, but provides an opportunity for medical providers to identify the true cause of pain and not a hyper-exaggerated response. What remains essential is for the patient to take an active role in treatment. The system is designed to find quick solutions and mine was not. Yes, opioids were effective for acute pain, but in my case, to maximize quality of life, chronic pain required a more holistic treatment plan. It is hard work finding more permanent lifestyle solutions, but whoever said the goal should be a pain-free life? When I lost the capacity to understand my body’s response to injury, I lost much more. I lost the ability to live, affirming the comment I once heard that if you cannot feel pain, you cannot feel anything else either.
Terri L. Schreiber is a community volunteer for the Colorado Consortium for Prescription Drug Abuse and a parent coordinator for Drug Prevention at the Challenge School in Cherry Creek School District.