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Can Painkillers Cause More Harm By Masking Pain?

Ben’s story in When Is a Pain Doctor a Drug Pusher?, the NY Times Magazine article I wrote about yesterday, brought up something I’d never thought through: Opioids don’t correct the problem that causes pain; they just mask the pain. Couldn’t this cause more harm than good?

Ben, a farmer for whom “. . . years of pushing 800-pound bales of hay wore out his back,” said:

β€œThey [opioids] helped my pain. I could get out and work, use the bulldozer. I was working a 250-head cattle herd. I was doing everything relatively pain-free because of the drugs. They gave me my life back.”

When there is a physical cause of pain, won’t doing activities that the injury made impossible cause further degradation in the damaged area? The same areas of the body are stressed as were before, but the body’s warning system can’t do its job.

Even when pain can’t be traced to a direct physical cause, as with headache disorders and migraine, masking the pain may still be harmful.

Say I have enough pain relief to return to my previous levels of activity. The “lifestyle management” tools I use now — regular sleep, exercise, minimizing triggers, etc. — would no longer seem as important. I’d probably let them slide. Why worry about triggers if they don’t affect my daily life?

But I’d still have chronic daily headaches and migraines, I just wouldn’t feel the pain of them. Getting rid of pain would not keep chronic daily headache and migraine from doing harm in my body and brain. The potential for long-term damage remains. Also, migraine has many symptoms other than pain that a painkiller can’t treat.

On the contrary, some argue that the brain learns to be pain and gets stuck in a rut. If something no longer causes pain, then the pressure on this mechanism could let up and allow the brain climb out of it’s pain rut. If this is the case, opioids make sense.

I’m not arguing that opioids shouldn’t be available for patients who need them. (My stance is the opposite.) However, treating an illness and treating pain caused by the illness require different approaches. Getting closer to the source of the problem when possible seems the logical place to start.

Addiction is the problem child in the realm of opioids. Sometimes the quieter kid really needs the attention.

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7 Responses to Can Painkillers Cause More Harm By Masking Pain?

  1. Daniel Newby says:

    “Opioids don’t correct the problem that causes pain; …”

    What about people with defective or disrupted opioid signaling?

    *********
    That’s a great point and something I hadn’t thought of. Thanks for bringing it up.

    Kerrie

  2. Anonymous says:

    When there is a physical cause of pain, won’t doing activities that the injury made impossible cause further degradation in the damaged area? The same areas of the body are stressed as were before, but the body’s warning system can’t do its job.

    It’s a common misconception that taking opioids takes away all of your pain. It just doesn’t do that. It reduces your pain level to a level that allows you to be a more functional person in the world. You do still feel pain, and when your migraines get worse, they feel worse. When I get an acute migraine (as opposed to the daily chronic one that doesn’t go away-I have both) I still feel the acute migraine-full intensity. For those I use triptans unless I’ve maxed out on them for the week. If so I take breakthrough (short-acting) opioid medication. The purpose of the long-acting opioids however is to reduce the level of daily chronic pain I live with.

    When my pain level or number/frequency/intensity of acute migraines starts to increase and I have no logical reason for it (pms etc) I discuss it with my doctor.

    I honestly don’t know anything about back injuries so I can’t comment on that and how much activity people can do with pain management. I know that regarding migraines, for me, I have to pace myself. I can’t take on too much. If I do I pay for it. I had to take the skytrain to the city for a Drs appt today. 2hrs there, 2hr appt, 2hrs to get home. My migraine was building by the time I arrived at the appt and on the way home way too many people were wearing way too much perfume. It was crowded and hot…I hadn’t eaten…remembered my gravol at least for the ride…needless to say I’m still sick and I got home at around 6pm. The last appt I had in the city was like this as well and I had to inject my Imitrex on the train on the way home-it got so bad so quickly. I was shaking and sweating…at least I didn’t have a repeat of that. ugh.

    My triggers are still exactly the same and the opioids have not affected them one iota. annoyingly πŸ˜‰

    Bottom line: I still have to be careful and take care of myself. I’m able to get up and take a walk with my dog almost every day though, and before being on these meds I just could not. Literally.

    For others it may be a slightly different experience-I don’t know if many other people only experience the chronic component of chronic daily headache/migraine and do not also experience the acute migraines as well.

    ********
    Thanks for all the information. I don’t have personal experience to rely on (opioids don’t work for me), so I really appreciate hearing others people’s perspectives.

    I hope I didn’t offend you. This post is really just a bunch of random musings, mostly in response to farmer Ben’s story.

    Take care,
    Kerrie

  3. katy says:

    Hey Kerrie

    sorry-that last comment was from me! It posted without asking me to sign in…oops!

    *******
    No worries!

    Kerrie

  4. Joanna says:

    Congratulations, Kerrie, on being honored by MyMigraineConnection.com ! πŸ™‚ You definitely have been doing a great job, keep it up!!!

    ********
    Thanks!

    Kerrie

  5. Migraineur says:

    Kerrie – I wish I had a reference for you, but it seems to me that I read a while ago that pain medications fall into two broad categories. There are analgesics, which mask the pain; and there is another category in which the mechanism that causes the pain is disrupted. I’m probably not explaining this well…. I just sort of wondered if you’d heard of this distinction and if you thought it had any application to the issue at hand. It seems to me in an injury situation, the distinction could be moot. Whether you’re masking the pain or disrupting it, you’re still setting yourself up for further injury. But with other types of chronic pain, such as migraine and CDH, I wonder if anyone has done any research into whether the illness is nothing more than a pain mechanism not caused by any other condition. In that case, I wonder if disrupting the mechanism might be not only a good thing, but absolutely the right thing. All speculation on my part, of course.

    On the whole, I have always been really impatient with the idea that suffering is good for the soul, and I felt this way long before the end of my 19-year migraine remission. (I don’t mean to suggest that you believe suffering is good for you – quite the contrary, I think you agree with me.) Personally, I think the best thing for the soul is happiness. I’m into my fourth migraine-free week, thanks to inderal, and I can tell you that everything in my life is better.

    *********
    I’m so glad Inderal is working so well for you.

    All I really know about “disrupters” is that that’s what nerve stimulation is supposed to do. Once the signal is disrupted, the brain can go back to being “normal.”

    Not only is suffering bad, it’s not good for your body or, in the case of migraine and headache, brain.

    Take care,
    Kerrie

  6. Angel says:

    I definitely think you’ve brought up an important issue (as always ::grin::). I guess though it’s ironic that Western medicine is very big on treating the symptoms and not the cause of many illnesses–but they come down hard on chronic pain patients.

    I agree not feeling pain could lead a person to do further injury, but to those (not you) who would say live with it–some people just can’t. I can’t be productive, or a good mom, wife, or even *me* when I’m in chronic pain–even if that pain isn’t an 8 all the time. Being at a 4 every day, all day, is draining.

    So far, no one really wants to deal with my neck (what I think is part of my problem with CDH). And triptans are out (they only make me feel worse). So for the meantime, I’m grateful for my vicodin (and listening for more info on that potential new migraine med).

    ********
    This is an excellent point: “. . . it’s ironic that Western medicine is very big on treating the symptoms and not the cause of many illnesses–but they come down hard on chronic pain patients.”

    Thanks for reassuring me that you don’t feel judged. I know people come here for support and don’t want anyone to feel like I’m saying that what they do is wrong.

    Take care,
    Kerrie

  7. deborah says:

    Congratulations, Kerrie. Keep up the great work your doing.

    Deborah

    *******
    Thanks!

    Kerrie

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