As someone who suffers from chronic pain, I was wondering what are the long term effects of my pain medication? At this point in time Lyrica is not available to me and SSRIs, like Cymbalta, have horrible side-effects with me. So, my doctor in all his wisdom prescribes me Vicodin to control my pain. So, what are the long-term effects of it’s usage?

During my research I found very little on the long term effects. Most of what I found dealt with addiction to opioids and opioid-mix drugs. Currently, very few people become addicted to drugs like Vicodin and Percocet, though they do become physically dependent– which is not the same as addicted (explained further below). Some of what I found also dealt with the effects of overdose on opiods mixed with acetaminophen, such as liver and kidney damage that could ultimately lead to death (which is the case with any drug that contains acetaminophen).

Here are some of the facts regarding addiction and physical dependency to opioid/opioid-mix drugs from WebMD:

Addiction Myths¹ :
Addiction: Hospice patients worry about becoming addicted to opioids. With hospice, however, it is rarely an issue. People with chronic pain also worry about addiction, but it turns out that for most adults, if they do not already have a substance (alcohol or drug) abuse problem, addiction is not much of an issue even when opioids are used on a long-term basis.

• A study was done in which 12,000 nonaddicted people who needed opioids were followed up to see if they had become addicted. Four out of 12,000 showed addictive behavior (less than one tenth of 1%).
• Generally, the only people who develop addictive behavior after being given opioids had an addiction problem before the opioids were given for pain. Most people take opioids until the pain goes away. Then they stop taking them because they do not want to feel dizzy or drowsy. Once the pain goes away, the toxic side effects of dizziness and drowsiness come back.
• Anyone who takes any medication just to “get high” is already showing addictive behavior and needs to stop taking addictive substances, including opioids, other addictive drugs, and alcohol, immediately.
• Some people with actual painful illnesses are addicted to mind-altering substances. They get prescriptions because of their actual illnesses. Here’s how the patient or the family can tell the difference between someone who needs opioids for pain and someone who is abusing opioids. Normally, the dose of opioids is arrived at by the patient telling the doctor how they are doing with the pain and by participating in their activities of daily living. A chronic pain patient who is not addicted to medication will tell the doctor the truth about his or her ability to function and do what needs to be done in daily life.
• Addicts will lie about performing activities of daily living. The addict will claim that the pain is so severe that they need a higher dose until they get to a dose that causes them to be asleep most of the time. Then, they will tell the doctor that they are doing fine and are able to do all the activities that they need to do.
• Selling the medicine to others is a federal crime that could get the seller a very long jail sentence and could lead to government seizure of your car or your house.
• Family members must let the doctor know what is actually happening in this sort of situation. When an addicted person actually has a painful syndrome, the doctor, with the help of the family, may have to decide what the dose of medication should be, without reference to the dose the pain patient thinks would be best. Sometimes, in severely addicted people, the opioids should not be used at all. Some addicted people can be treated with opioids if necessary as long as they cooperate carefully with the treatment plan.

The physical dependency of my Vicodin is well documented, but I’m glad to know that the kind of addiction exhibited in such shows as “House” is so rare. Still, I worry about the damage my body will have due to long-term use. The WebMD article tells me that opiod/acetaminophen and opioid/NSAID (ibuprophen, naproxen) aren’t recommended for long-term use by chronic pain sufferers simply because over time they can damage the liver, kidneys and stomach (NSAIDs). However, an article from the Mayo Clinic states²:

No evidence indicates that long-term use of single-agent opioid analgesic preparations results in end-organ failure, as may be seen with other analgesics (eg, NSAIDs), or with certain combination opioid analgesics

And the WebMD states:

Strong opioid medications are slightly different in this regard, and this is fortunate for people who suffer from severe pain. With strong opioids, the dose depends on the amount of pain. These medications should not mixed with acetaminophen or other non-opioid drugs when used to treat chronic pain. People with intense pain can take very high doses of opioids without getting side effects. Some people with intense pain get such high doses that the same dose would be fatal if taken by someone who was not suffering from pain. In the pain patient, that same high dose can control the pain and still allow the person to be wide awake enough to do his or her activities of daily living.

• Long-acting opioid: The best way to treat chronic, severe pain is by keeping it under control all the time. Your doctor can do this by using a long-acting opioid to keep the pain under control and a short-acting opioid to deal with those few times during the day when the pain breaks through. So, if you are on morphine, you would get a slow-release tablet that would keep your pain under control most of the time, and a short-acting tablet or liquid for those times when your pain breaks through.
• Bad opioids: Some opioids are not recommended for chronic pain.
  • Demerol (meperidine), which is used often for acute pain after surgery, is a poor drug for chronic pain. It is not absorbed well when taken by mouth, and it causes dysphoria (feeling truly lousy) and seizures if used for more than a few days.
  • Talwin (pentazocine) is also bad for chronic pain. It has a ceiling effect. There is a maximum dose after which raising the dose gives no further pain relief. It also causes withdrawal symptoms when given to someone who is also taking another opioid.
  • The opioid/acetaminophen or opioid/NSAID combination drugs are fine for short-term use, but acetaminophen is poisonous to the kidneys and liver when used for a long time or in high doses. Many NSAIDs are toxic to the kidneys and stomach when taken for a long time or in high doses.

Doctor’s Argoff and Silverstein, writing the article located on the Mayo Clinic Proceedings, clearly states that “single agent” opioids show no long-term effect leading to organ failure, but combined with acetaminophen or NSAIDs can have dire results as shown by WebMD. So, am I to take from this that I should find another way to manage my chronic pain? I’m thinking that over the long haul I will be forced to go back to Amitriptyline and possibly try Lyrica– after I talk to my doc about this new drug.

Yesterday, while I was doing my research for this post, the FDA was busy approving a new, long-acting opioid for moderate to severe chronic pain.

The US Food and Drug Administration (FDA) has approved morphine sulfate/naltrexone hydrochloride (Embeda), an extended-release oral opioid analgesic for the management of moderate to severe pain when a continuous, around-the-clock opioid analgesic is needed for an extended period of time. This Schedule II agent is the first FDA-approved long-acting opioid that is designed to reduce drug liking and euphoria when tampered with by crushing or chewing.

Does this drug count as a “single agent opioid” and will it be safer to use than Vicodin (mixed with acetamenophin) or Percocet (mixed with NSAIDs)? Can this be something that will have fewer adverse long-term effects for chronic pain sufferers? As I’m not a doctor, I can’t really answer those questions– but they will be posed by me to my own doctor. It’s something I’m genuinely interested in. I have chronic noncancer pain and want relief from that without having to wonder if I know anyone close who would be willing to donate part of their liver later on in my life³. This is something that I’ve been thinking about for quite some time and I believe it’s time to review my options and sit down with my doctors again.

A note on physical dependency:
Physical dependency is different than addiction in that addiction causes people to seek the drugs anyway that they can get them, including lying to their doctors about their pain and daily activities. Physical dependency cause the withdrawal symptoms when people stop taking the drugs as well as heightened tolerance over time. That means that people suffering from chronic pain are likely to take more of the medication to get relief– which is what can lead to the most damage. This is why it’s so important to talk to your doctor honestly about the need to increase your dose of medications if and/or when that happens.

One more note: One of the side-effects of Vicodin is intense itching all over. I’ve recently discovered this in my research (having developed this recently and wondering what is going on). It’s normal and you should make sure to tell your doctor if you experience. I was under the impression that this was an effect of long-term use of the medication, but I’m wrong. It’s normal and can occur in people that have just started taking it.

1. WebMD: Chronic Pain Guide: http://www.webmd.com/pain-management/guide/narcotic-pain-medications
2. Contemporary Clinical Opioid Use: Opportunities and Challenges * W. L. Lanier and E. D. Kharasch
   Mayo Clin Proc. July 1, 2009 84(7):572-575
3. That statement is only half tongue-in-cheek, by the way.

There’s a lot of talk about women’s issues this election cycle. Thanks to Hillary Clinton, and now Sarah Palin, we’re back in the spotlight. In that vein, Congress is pressing for a revote on the Lilly Ledbetter Fair Pay Act, which failed to pass previously. McCain has come out again it:

“I am all in favor of pay equity for women, but this kind of legislation, as is typical of what’s being proposed by my friends on the other side of the aisle, opens us up to lawsuits for all kinds of problems,” the expected GOP presidential nominee told reporters. “This is government playing a much, much greater role in the business of a private enterprise system.”

I’ve recently engaged in a half-hearted IT job search – in anticipation of my eventual graduation from the Tech program. There seems to be a little available, but I’ve heard that women are not treated favorably in the IT industry. It would please me, and thousands of other women, tremendously if this actually became law. Would I know that my male counterparts were making more than me? Probably not. But this act would give me recourse should I find out about a pay discrepancy after the fact. As a woman hoping to work in a male-dominated field, I would feel just a little better knowing I had a safety net.

There was some talk that this law isn’t necessary. I beg to differ. I worked with a company (unrelated to the tech field) that cut me a mystery check. When I inquired to what the purpose of the check was, I was told that it was to make up for a pay difference between me and my male counterparts. I had no idea that the men were making that much more per hour than I was, but there was a lawsuit and the settlement agreement was that this company would pay the hourly difference to each female for whatever period of time they agreed to (I think it was 3 months, even though I’d been there for over a year at that point). I left that company not long afterward, but my eyes had been opened. The reasoning for the lower pay was that women are mothers and so are prone to miss work because of their sick children. Men, on the other hand, are more reliable and should be rewarded. Really?

At a time when a major political party has nominated a self-proclaimed “hockey mom” to be vice president, there should be no more “she should get less because she’s a mom”. This woman is seeking a job while parenting 5 children (and potentially helping parent a grandchild) so the reason listed above would apply to her and her pay should be cut significantly. Right? No. Wrong. Her husband will be able to tend to the children while she runs for office and he can tend to the children while she continues to govern Alaska (except that he’s got a full-time job plus an extra job on the side in the summer, but that’s not this issue). It’s only fair that the rest of American women enjoy the same equality in pay as the women who govern them.

I am so beyond tired. I don’t think the best Starbucks coffee in town could keep my weary eyes open and my yawns suppressed. I’ve been given a lot of extra responsibility lately and I’ve still not adjusted.

Pee Wee has another job (I’ve mentioned this?) and as an effort to help her be more responsible as far as money is concerned, I’ve agreed to watch KJ while she’s working. This does not include when she wants to go hang out. I think for that she can pay and I don’t think that’s at all unreasonable. Lately though she’s been handing him off to me more and more. She’s having some trouble coping with his increased activity, but limited mobility. Children his age can get really frustrated sometimes and they need a certain amount of “in your face” entertainment. Then, of course, there are the evening fussy periods. I’ve tried to explain different ways of dealing with the stressful situations, but I don’t think it’s working. When he won’t calm down for her she almost immediately yells “Mom!”

I urge her to work on her parenting skills, because parenting as a teenager isn’t all cute clothes and adoring coos. Shoot, it’s not all that when you’re an adult with a partner who can help with the workload! But somewhere between being pregnant and now she’s finally come to the realization that babies really aren’t cute all the time and, honestly, I think she resents her life choice.

Grump and I were thinking of taking custody of him for a while when she graduates high school. She’s making some decisions regarding her future and it might just be better for them both if she did that alone. I don’t want to take away her parenting rights, but if he’s with us- two people that are already settled and have some stability in our lives- they’ll both be better off. She’ll be able to mature into a person that won’t resent her child and he’ll be in a nurturing environment without going from sitter to sitter as his mom struggles to feed him.

Some people, of course, think this is the wrong choice for us. They think that we’re giving her too much leeway and that we should just throw her to the wolves. The “she made her bed” crap. I thought about that and you know what? The only person that will really suffer is KJ. I know how long it took me to get my bearings as a young, single mother. And Pee Wee suffered for it (she won’t admit it, of course, but I live with the guilt of what my choices wrought on her). I don’t want that cycle to continue.

Add all of this to classes starting soon along with my responsibility to Mags and, well, I’m worn out right now. Luckily I’ve found momentary release online from time to time, but when I’m not at the computer there are so many other things to deal with. I’ll be glad when I’ve adjusted to the new routine.

Speaking of routines and classes, I’ll be taking a full course load this fall. That means 4 classes instead of 3. For a minute I was stressing out because of the potential for epic fail, but then I realized it’s just one more class. I’m pretty sure I can handle it. Hopefully not only will I be able to handle it, but I’ll be able to use my lessons as jumping off points for future posts.