Many thanks to Laurie Haughton on Facebook’s Endometriosis Support Sisters/ Awareness Group for sharing this article.

Prescription Painkiller Addiction: 7 Myths
Experts Debunk Myths About Prescription Pain Medication Addiction
By Miranda Hitti
Reviewed by Louise Chang, MD
WebMD Feature
 
Prescription pain medicine addiction grabs headlines when it sends celebrities spinning out of control. It also plagues many people out of the spotlight who grapple with painkiller addiction behind closed doors.
 
But although widespread, addiction to prescription painkillers is also widely misunderstood — and those misunderstandings can be dangerous and frightening for patients dealing with pain.
 
Where is the line between appropriate use and addiction to prescription pain medicines? And how can patients stay on the right side of that line, without suffering needlessly?
For answers, WebMD spoke with two pain medicine doctors, an expert from the National Institute on Drug Abuse, and a psychiatrist who treats addictions.
 
 Here are seven myths they identified about addiction to prescription pain medication.
 
1. Myth: If I need higher doses or have withdrawal symptoms when I quit, I’m addicted.

Reality: That might sound like addiction to you, but it’s not how doctors and addiction specialists define addiction.
 
“Everybody can become tolerant and dependent to a medication, and that does not mean that they are addicted,” says Christopher Gharibo, MD, director of pain medicine at the NYU Langone Medical School and NYU Hospital for Joint Diseases.
 
Tolerance and dependence don’t just happen with prescription pain drugs, notes Scott Fishman, MD, professor of anesthesiology and chief of the division of pain medicine at the University of California, Davis School of Medicine.
 
“They occur in drugs that aren’t addictive at all, and they occur in drugs that are addictive. So it’s independent of addiction,” says Fishman, who is the president and chairman of the American Pain Foundation and a past president of the American Academy of Pain Medication.
 
Many people mistakenly use the term “addiction” to refer to physical dependence. That includes doctors. “Probably not a week goes by that I don’t hear from a doctor who wants me to see their patient because they think they’re addicted, but really they’re just physically dependent,” Fishman says.
 
Fishman defines addiction as a “chronic disease … that’s typically defined by causing the compulsive use of a drug that produces harm or dysfunction, and the continued use despite that dysfunction.”
 
For instance, someone who’s addicted might have symptoms such as “having drugs interfere with your ability to function in your role [or] spending most of your time trying to procure a drug and take the drug,” says Susan Weiss, PhD, chief of the science policy branch at the National Institute on Drug Abuse.
 
“Physical dependence, which can include tolerance and withdrawal, is different,” says Weiss. “It’s a part of addiction but it can happen without someone being addicted.”
She adds that if people have withdrawal symptoms when they stop taking their painkiller, “it means that they need to be under a doctor’s care to stop taking the drugs, but not necessarily that they’re addicted.”
 
2. Myth: Everyone gets addicted to pain drugs if they take them long enough.
 
Reality: “The vast majority of people, when prescribed these medications, use them correctly without developing addiction,” says Marvin Seppala, MD, chief medical officer at the Hazelden Foundation, an addiction treatment center in Center City, Minn.
Fishman agrees. “In a program where these prescription drugs are used with responsible management, the signs of addiction or abuse would become evident over time and therefore would be acted on,” says Fishman.
 
Some warning signs, according to Seppala, could include raising your dose without consulting your doctor, or going to several doctors to get prescriptions without telling them about the prescriptions you already have. And as Weiss points out, being addicted means that your drug use is causing problems in your life but you keep doing it anyway.
 
But trying to diagnose early signs of addiction in yourself or a loved one can be tricky.
“Unless you really find out what’s going on, you’d be surprised by the individual facts behind any patient’s behavior. And again, at the end of the day, we’re here to treat suffering,” says Fishman.
 
Likewise, Weiss says it can be “very, very hard” to identify patients who are becoming addicted.
 
“When it comes to people who don’t have chronic pain and they’re addicted, it’s more straightforward because they’re using some of these drugs as party drugs, things like that and the criteria for addiction are pretty clear,” says Weiss.
 
“I think where it gets really complicated is when you’ve got somebody that’s in chronic pain and they wind up needing higher and higher doses, and you don’t know if this is a sign that they’re developing problems of addiction because something is really happening in their brain that’s … getting them more compulsively involved in taking the drug, or if their pain is getting worse because their disease is getting worse, or because they’re developing tolerance to the painkiller,” Weiss says.
 
“We know that drugs have risk, and what we’re good at in medicine is recognizing risk and managing it, as long as we’re willing to rise to that occasion,” says Fishman. “The key is that one has to manage the risks.”
 
3. Myth: Because most people don’t get addicted to painkillers, I can use them as I please.
 
Reality: You need to use prescription painkillers (and any other drug) properly. It’s not something patients should tinker with themselves.

“They definitely have an addiction potential,” says Gharibo. His advice: Use prescription pain medicines as prescribed by your doctor and report your responses — positive and negative — to your doctor.
 
Gharibo also says that he doesn’t encourage using opioids alone, but as part of a plan that also includes other treatment — including other types of drugs, as well as physical therapy and psychotherapy, when needed.
 
Gharibo says he tells patients about drugs’ risks and benefits, and if he thinks an opioid is appropriate for the patient, he prescribes it on a trial basis to see how the patient responds.
 
And although you may find that you need a higher dose, you shouldn’t take matters into your own hands. Overdosing is a risk, so setting your dose isn’t a do-it-yourself task.
 
“I think the escalation of the dosage is key,” says Seppala. “If people find that they just keep adding to the dose, whether it’s legitimate for pain or not, it’s worth taking a look at what’s going on, especially if they’re not talking with the caregiver as they do that.”
 
4. Myth: It’s better to bear the pain than to risk addiction.

Reality: Undertreating pain can cause needless suffering. If you have pain, talk to your doctor about it, and if you’re afraid about addiction, talk with them about that, too.
“People have a right to have their pain addressed,” says Fishman. “When someone’s in pain, there’s no risk-free option, including doing nothing.”
 
Fishman remembers a man who came to his emergency room with pain from prostate cancer that had spread throughout his body. “He was on no pain medicine at all,” Fishman recalls.
 
Fishman wrote the man a prescription for morphine, and the next day, the man was out golfing. “But a week later, he was back in the emergency room with pain out of control,” says Fishman. “He stopped taking his morphine because he thought anyone who took morphine for more than a week was an addict. And he was afraid that he was going to start robbing liquor stores and stealing lottery tickets. So these are very pervasive beliefs.”
 
Weiss, who has seen her mother-in-law resist taking opioids to treat chronic pain, notes that some people suffer pain because they fear addiction, while others are too casual about using painkillers.
 
“We don’t want to make people afraid of taking a medication that they need,” says Weiss. “At the same time, we want people to take these drugs seriously.”
 
5. Myth: All that matters is easing my pain.

Reality: Pain relief is key, but it’s not the only goal.
“We’re focusing on functional restoration when we prescribe analgesics or any intervention to control the patient’s pain,” says Gharibo.
 
He explains that functional restoration means “being autonomous, being able to attend to their activities of daily living, as well as forming friendships and an appropriate social environment.”
 
In other words, pain relief isn’t enough.
 
“If there is pain reduction without improved function, that may not be sufficient to continue opioid pharmacotherapy,” says Gharibo. “If we’re faced with a situation where we continue to increase the doses and we’re not getting any functional improvement, we’re not just going to go up and up on the dose. We’re going to change the plan.”
 
6. Myth: I’m a strong person. I won’t get addicted.

Reality: Addiction isn’t about willpower, and it’s not a moral failure. It’s a chronic disease, and some people are genetically more vulnerable than others, notes Fishman.
“The main risk factor for addiction is genetic predisposition,” Seppala agrees. “Do you have a family history of alcohol or addiction? Or do you have a history yourself and now you’re in recovery from that? That genetic history would potentially place you at higher risk of addiction for any substance, and in particular, you should be careful using the opioids for any length of time.”
 
Seppala says prescription painkiller abuse was “rare” when his career began, but is now second only to marijuana in terms of illicit use.
 
Exactly how many people are addicted to prescription painkillers isn’t clear. But 1.7 million people age 12 and older in the U.S. abused or were addicted to pain relievers in 2007, according to government data.  
 
And in a 2007 government survey, about 57% of people who reported taking pain relievers for “nonmedical” uses in the previous month said they’d gotten pain pills for free from someone they knew; only 18% said they’d gotten it from a doctor.
 
Don’t share prescription pain pills and don’t leave them somewhere that people could help themselves. “These are not something that you should hand out to your friends or relatives or leave around so that people can take a few from you without your even noticing it,” says Weiss.
 
7. Myth: My doctor will steer me clear of addiction.

Reality: Doctors certainly don’t want their patients to get addicted. But they may not have much training in addiction, or in pain management.
 
Most doctors don’t get much training in either topic, says Seppala. “We’ve got a naive physician population providing pain care and not knowing much about addiction. That’s a bad combination.”
 
Fishman agrees and urges patients to educate themselves about their prescriptions and to work with their doctors. “The best relationships are the ones where you’re partnering with your clinicians and exchanging ideas.”

Brain morphological changes associated with cyclic menstrual pain
Published in the journal Pain
Volume 150, Issue 3, September 2010, Pages 462-468
Cheng-Hao Tu, David M. Niddam, Hsiang-Tai Chao, Li-Fen Chen, Yong-Sheng Chen, Yu-Te Wu, Tzu-Chen Yeh, Jiing-Feng Lirng and Jen-Chuen Hsieh

Abstract
Primary dysmenorrhea (PDM) is the most prevalent gynecological disorder for women in the reproductive age. PDM patients suffer from lower abdominal pain that starts with the onset of the menstrual flow.

Prolonged nociceptive input to the central nervous system can induce functional and structural alterations throughout the nervous system.

In PDM, a chronic viscero-nociceptive drive of cyclic nature, indications of central sensitization and altered brain metabolism suggest a substantial central reorganization.

Previously, we hypothesized that disinhibition of orbitofrontal networks could be responsible for increased pain and negative affect in PDM. Here, we further tested this hypothesis. We used an optimized voxel-based morphometry (VBM) approach to compare total and regional gray matter (GM) increases and decreases in 32 PDM patients with 32 healthy age and menstrual cycle matched (peri-ovulatory phase) controls.

Abnormal decreases were found in regions involved in pain transmission, higher level sensory processing, and affect regulation while increases were found in regions involved in pain modulation and in regulation of endocrine function.

Moreover, GM changes in regions involved in top-down pain modulation and in generation of negative affect were related to the severity of the experienced PDM pain.

Our results demonstrate that abnormal GM volume changes are present in PDM patients even in the absence of pain. These changes may underpin a combination of impaired pain inhibition, increased pain facilitation and increased affect. Our findings highlight that longer lasting central changes may occur not only in sustained chronic pain conditions but also in cyclic occurring pain conditions.

Menstrual Cramps May Alter Brain Structure
ScienceDaily (Aug. 11, 2010)

“Primary dysmenorrhea (PDM), or menstrual cramps, is the most common gynecological disorder in women of childbearing age. Lower abdominal pain starts with the onset of menstrual flow and this ongoing pain stimulus can cause alterations throughout the nervous system.

In a study scheduled for publication in the September issue of the journal Pain, researchers report abnormal changes in the structure of the brain in PDM patients, whether or not they are in fact experiencing pain.
Lead investigator, Professor Jen-Chuen Hsieh, MD, PhD, Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan, commented, “Our results demonstrated that abnormal GM [gray matter] changes were present in PDM patients even in absence of pain. This shows that not only sustained pain but also cyclic occurring menstrual pain can result in longer-lasting central changes. Although the functional consequences remain to be established, these results indicate that the adolescent brain is vulnerable to menstrual pain. Longitudinal studies are needed to probe hormonal interaction, fast-changing adaptation (intra-menstrual cycle) and whether such changes are reversible or not.”
32 PDM patients and 32 age- and menstrual-cycle-matched controls participated in the study. MRI scans of each subject were obtained when the PDM patients were not experiencing pain, and maps of gray matter (GM) were created. Both the total GM volume and the GM volume of specific brain areas were determined for both PDM patients and controls.
In these anatomical maps, significant GM volume changes were observed in the PDM patients. Abnormal decreases were found in regions involved in pain transmission, higher level sensory processing, and affect regulation while increases were found in regions involved in pain modulation and in regulation of endocrine function.”

Menstrual cramps may alter women’s brains
Posted 8/13/2010 9:00 AM
By Jenifer Goodwin, HealthDay

“Menstrual cramps are often dismissed as a mere nuisance, but new research suggests the monthly misery may be altering women’s brains.
Researchers in Taiwan used a type of brain scan known as optimized voxel-based morphometry to analyze the anatomy of the brains of 32 young women who reported experiencing moderate to severe menstrual cramps on a regular basis for several years, and 32 young women who did not experience much menstrual pain.

Even when they weren’t experiencing pain, women who had reported having bad cramps had abnormalities in their gray matter (a type of brain tissue), said study author Dr. Jen-Chuen Hsieh, a professor of neuroscience at the Institute of Brain Science at National Yang-Ming University in Taipei, Taiwan.

Those differences included abnormal decreases in volume in regions of the brain believed to be involved in pain processing, higher-level sensory processing and emotional regulation, as well as increases in regions involved in pain modulation and regulation of endocrine function.

Exactly how the changes in the brain could affect women’s experience of pain is unknown, researchers said. But the brain abnormalities suggest that menstrual pain may have similarities with other chronic pain conditions in that over time, repeated bouts of excruciating aches make the brain unusually sensitive to pain — in effect, making the experience of pain worse.

“A long-term bombardment by peripheral pain can elicit plastic changes in the central brain as a reactive adaptation,” Hsieh explained. “It can also be a crucial mechanism that perpetuates the ‘chronification’ of pain” — that is, a mechanism that can turn pain into a lingering affliction.

The study is published in the September issue of PAIN.

Menstrual cramps, or pain in the lower abdomen that occurs when the uterus contracts during menstruation, is the most common gynecological disorder in women of childbearing age, according to background information in the article.

Karen J. Berkley, a professor emeritus of neuroscience and psychology at Florida State University, said menstrual pain is too often not taken seriously.

“This is one of the first groups to call attention to menstrual cramps, the fact that the condition can have an impact on women’s lives, and it’s accompanied by changes in brain anatomy and function,” Berkley said.

Previously, the Taiwanese team reported that women suffering from menstrual cramps also have differences in brain activity as seen by positron emission tomography, another type of brain scan.

“Taken together, those two studies point to the fact that this continual cyclical pain in women is not unimportant,” Berkley said. “”

See, this is why I have my endo sisters. Rikki emailed me to let me know about a site called End Women’s Pain. Check it out!!

Apparently, the End Women’s Pain site was launched back in May, and I did get a Google Alert about it, but I am so far behind on regular updates to this blog that I did not read the email alert. In fact, I have almost 400 Google Alert emails pertaining to chronic pain and endometriosis that I still have not gone through.

Please check out the End Women’s Pain website and then contact Congress and tell them to make positive changes in health care in order to treat us more humanely.

I’d like to share one of the points they make in their analysis and policy recommendations report:

“Due to a lack of basic research on the underlying mechanisms of chronic pain, as well as pain syndromes and their treatment, the causes of these conditions remain a mystery, and evidence-based treatment options are severely limited. Sufferers are forced to experiment with a myriad of therapies, most with unknown benefits and risks, until they find a treatment or combination of treatments to relieve some of their painful symptoms.” – Chronic Pain in Women: Neglect, Dismissal and Discrimination. ANALYSIS AND POLICY RECOMMENDATIONS – May 2010

Also quoted in their report is:

“The overall quality of treatment for pain in the United States remains unacceptable for millions of patients with persistent pain.” -Pain medicine position paper. Pain Med. 2009; 10(6):972-1000

Lastly, please subscribe to the YouTube channel – Campaign To End Chronic Pain In Women, and watch this video:

 

The other day, a fellow endo blogger showed me the story you are about to read below. It affected me deeply, because I have entertained the same thoughts during the past 24-25 years I have suffered with endometriosis. Please read this story. I will be posting more about the topic.

So no one else will suffer
Posted: Thursday, December 10, 2009 1:00 am
By Lisa Fipps managing editor
editor@kokomoperspective.com

Kristi An Rose suffered with endometriosis for 12 years, from 1997 until May 7, 2009 – the day she put a gun to her head and pulled the trigger.

It was a tragic ending of a life that held great promise, a life that is dearly missed, a life that could have been different if more in the medical community knew how debilitating the condition is, knew how much those with it suffer, and knew to take it more seriously, according to her mother, Sherill Rose Hill.

Nightmare begins

In school, Kristi was very outgoing. After graduating from Northwestern High School, she was a workaholic, said Sherill. Kristi worked several jobs and loved it. She always loved art, especially photography. But at the age of 17, she was already having medical problems.

“Kristi had really bad pains in her abdomen during her periods,” Sherill said. “It wasn’t your typical cramps. It was abnormal. I took her to a couple of doctors. They all said, ‘She’s a teenager trying to get attention.’ That wasn’t Kristi at all. I ended up taking her to Indianapolis to Dr. David McLaughlin of Women’s Specialty Health Centers. He said, ‘I think I know what’s wrong.’ He did a laparoscopy on Feb. 12, 1997. He said she had endometriosis. She was so thrilled to know what was going on because everybody had said she was making it up. She knew she wasn’t.”

Endometriosis “occurs when tissue like that which lines the uterus (tissue called the endometrium) is found outside the uterus – usually in the abdomen on the ovaries, fallopian tubes, and ligaments that support the uterus; the area between the vagina and rectum; the outer surface of the uterus; and the lining of the pelvic cavity,” according to the Endometriosis Association.

According to the Cleveland Clinic, symptoms of endometriosis can include but are not limited to the following:

•extremely painful (or disabling) menstrual cramps; pain may get worse over time

•chronic pelvic pain (includes lower back pain and pelvic pain)

•pain during or after sex

•intestinal pain

•painful bowel movements or painful urination during menstrual periods

•heavy menstrual periods

•premenstrual spotting or bleeding between periods

•infertility

A few months later, Kristi had a microlaser laparotomy to vaporize the endometriosis.

For the first time in years, she felt better. The pain was gone. She was happy. So was Sherill. It’s excruciating to watch your child in such pain, Kristi’s mom said.

But then the endometriosis came back.

“The most recent studies have shown that endometriosis recurs at a rate of 20 to 40 percent within five years following surgery,” according to the Cleveland Clinic.

Kristi’s came back in less than a year. She had another surgery to vaporize more of the tissue. It returned again.

In October 2000, Kristi and Sherill flew to Oregon to see a specialist. That doctor performed an oophorectomy, removing her left ovary. They found out that her fallopian tubes were packed with eggs. The endometriosis had prevented them from dropping down to the uterus monthly. Some would ask why Kristi didn’t have a hysterectomy. Doctors were hesitant to do that considering how young she was, Sherill said.

Besides, a hysterectomy is not a cure. Currently, there is no cure for endometriosis. Even having a hysterectomy or removing the ovaries does not guarantee that the endometriosis areas and/or the symptoms of endometriosis will not come back.

After the surgery in Oregon, Kristi was still in pain. “That was a big let down,” Sherill said. “We thought it would be great. We thought it’d be all over.”

Kristi was in constant pain. Her mom searched the Internet trying to find someone who could help. In 2003, Kristi and Sherill headed to Birmingham, Ala., to see a specialist at the Chronic Pelvic Pain Treatment Center.

“When we drove there, we had big hopes,” Sherill said. “By the time we walked out of there, they’d diagnosed her with five different problems – all related to endometriosis.”

Severe pelvic congestive syndrome, vulvar vestibulitis, pelvic floor myalgia, irritable bowel syndrome, and abdominal wall trigger points.

Kristi also suffered from severe interstitial fibrosis of the bladder with chronic interstitial cystitis, a condition that results in recurring discomfort or pain in the bladder and the surrounding pelvic region.

The autopsy report gives a glimpse of just have pervasive the endometriosis was in Kristi’s body. It was on her liver. It was on her bowels. It was on her right kidney. Her right ovary had multiple cysts with large “chocolate cysts” (cysts that form when endometrial tissue invades an ovary), including one that had ruptured right before her death. Her fallopian tubes and right ovary had adhered to her uterus and pelvic wall. There were multiple fibrous pelvic adhesions.

“The doctor who did the autopsy said she had more endometriosis than anyone he’d ever seen,” Sherill said.

To say she was in pain is an understatement.

Kristi gave up. She was tired of doctors. She was tired of hospitals. She was tired of the pain.

In 2006, Sherill’s husband, Kristi’s stepfather, Mike Hill, developed cancer. Sherill was torn between helping her daughter who was suffering and her husband who was suffering.

“I told her, ‘We’re going to find something for you,’ ” Sherill said. She pleaded with her daughter to hang in there until they found someone who could help. By then Kristi had no insurance. Her mom and stepdad helped pay for her medical expenses. Kristi hated that. She was independent. She wanted to take care of herself.

On April 16, 2009, Mike Hill died.

“Kristi said, ‘Look at him. He’s at peace. I would love to be at peace,” Sherill said.

She began to worry about her daughter. She was sinking deeper and deeper into depression. A letter Kristi wrote on April 4 details her thoughts: “I am so tired of the pain. It is enough to drive someone crazy. Having constant pain all the time is enough to want to give up. Enough to want to put my fragile body to rest. My body can’t take any more. My brain is past the breaking point. My heart is broken. God, my heart is broken.”

“She was having grand mal seizures and pretty much bed-ridden then,” Sherill said of her daughter. “I got an uneasy feeling,” Sherill said. “So I hid the gun we kept in the house. Three days prior to her dying, she said, ‘I don’t want this anymore. They can’t fix me.’ I begged her. I said, ‘Please, let me see what I can find out. We’ll find something. She said no. ‘You’re not going to take me to another doctor, who will just take your money and say, ‘Well, we don’t know what else to do for her.’ ”

On May 7, 2009, Sherill was on her way home from a short trip to Kentucky and called her daughter.

“I told her I was almost home,” Sherill said, tears flowing down her cheeks. “She said, ‘I want you to remember one thing.’ I said, ‘What?’ She said, ‘I love you very, very, very, very, very, very, very, very, very, very much, Mom, and she just kept saying it. And I said I love you very, very, very much, too.’ ”

As Sherill drove home, Kristi searched the house and found the gun. She went outside to the back yard. She put the gun to her head. She pulled the trigger.

“When I got home, the police were in the yard,” Sherill said, sobbing. “I couldn’t pull into the driveway. My son, Tom, was there. I have another son, Michael. Tom had been in the house, and the neighbors came and got him. They said, ‘Your sister’s lying in the backyard.’ My son went out and got her. That’s just been very hard for him. He said, ‘I held her and she wasn’t talking.’ He said he kept thinking, ‘I gotta get this fixed before mom gets home.’ When I pulled up in the yard, as soon as I got out of the car, Tom grabbed a hold of me so tightly I could hardly breathe. He said, ‘Kristi shot herself.’ He held me so tight and he wouldn’t let go. I said, ‘Is she alive?’ He said, ‘Yes. They’re trying to get her stable.’ They wouldn’t let me go to the back yard. It seemed like forever and then they brought her to the front and put her in the ambulance. I yelled at her to fight like hell, and then we were on our way to the hospital. It wasn’t very long before they came out and said she didn’t make it. I said, ‘Can I see her?’ They let me see her, and when I looked at her I knew it was over for her. She suffered so much pain. Pain was a daily thing. The doctors didn’t take it as seriously as they could or should have.”

There was no funeral. Kristi had always said she wanted to be cremated. “I was with her every step of the way, I wasn’t going to let her go through that by herself,” Sherill said. “I’m not going to let her down now. I went down to Greenwood where they do it. I kissed her. I talked to her and then I watched as they took care of her.”

Sherill broke down in tears.

Her daughter killed herself 20 days after her husband died. Twenty days after her daughter’s suicide, Sherill had a dream. In it, Kristi was smiling, running, happy, free.

“That’s the one thing that’s kept me going because I know she’s not in pain anymore,” Sherill said, crying. “I’m just crying for myself now. I’m just so lonely I don’t know what to do with myself. I just don’t know what to do.”

What she has done, with her from her two sons, is have a fundraiser in Kristi’s memory, with the proceeds going to the Endometriosis Research Center.

“I wanted to help somebody else,” Sherill said. “So no one else has to live that way. I just want everybody to know how much pain she went through, how much she suffered, so this doesn’t happen to anybody else.”

To contact Sherill about the fundraiser, send an e-mail to endokristi [at] yahoo [dot] com.