Chronic Pain Patients Need Effective Pain Management

RA is a painful disease.  It damages joints and often has extra-articular manifestations.  My tendons are greatly affected by my RA.  You see, the tendon sheaths are lined with synovial tissue.  We all know how are immune systems zero in on synovial tissue.  My tendons are swollen and inflamed, and they stay that way.

Consequently, many of us depend on controlled substances to allow us some quality of life.  I wear a Butrans pain patch.  I also have two other medications I can use for break-through pain control.  They are all "controlled substances."  Every time I pick up one of these prescriptions, I show my drivers license and sign my name.  I understand why this is necessary.  Evidently, many people have become addicted to prescription pain medications.

There is a difference between being addicted to a drug and being dependent on a drug.  I am dependent on my pain medications.  Without these drugs, I would have no quality of life.  I would be in bed most days...all day long.   I don't "crave" any of the medications.  They don't even mask all of the pain.  This is probably a good thing.  I have never felt "high" or incapacitated by any of these pain medications.

I had an appointment with my orthopedic doctor a few weeks ago.  I appreciate my orthopedic doctor.  He has treated me for ten years.  When the bursitis in my hips wakes me up at night, he injects steroids. I have also had my shoulders injected, and Synvisc and Orthovisc shots in both knees numerous times.

I was surprised during my last visit to my orthopedic's office. I was asked to provide a urine sample.  The test immediately tells the doctor if there are opioids present in your body.  My orthopedic's NP explained to me that a report is generated a week or two later that shows if the medications are present in therapeutic levels.

I found this perplexing.  I said, "So, this tells you if people are taking their medications properly?"  The NP responded with a story.  She said, "Say a patient comes in here and walks out with a couple of prescriptions.  They come back in a month and we do the test.  We find no medications present.  What does that mean?"

I thought a moment.  My first thought was that the patient was not being compliant.  Then a light bulb appeared over my head.  "Oh, I said.  They are selling the drugs?"  She shook her head in an affirmative manner, and I finally understood.

Chronic pain patients are always being questioned about their pain medications.  Sometimes it is family doing the questioning.  Sometimes, it is friends.  Sometimes, it is a doctor.  I walked out of my doctor's office feeling a bit sad.

I was thinking about all of the people who are addicted to drugs.  I was thinking of all the people who work the "system" for financial gain.  Then I thought of all of the people suffering in pain because of the reckless and illegal behavior of a few. 

I am not unhappy about the urine test.  I think it is a good thing that my doctor knows I am taking the medications just as I am supposed to take them. 

I am unhappy about all of us who must have pain medication to function.  I know several RA patients who have been told by their family members that they just need to eat a different diet, exercise more,  take this or that supplement, and they will be cured.   This kind of unsolicited advice does nothing to help the RA patient who is already living with an invisible disease.

People are always questioning us.  How could we look so well, and yet be sick?  How can we be fine one moment, and suffer intense pain the next.  Why do we require so much rest?

The prescription drug situation is just one more obstacle for chronic pain patients to traverse.  This makes me sad.   I am sad because I have no answer.  I do not know how to make this situation better.  Many RA patients are required to see Pain Management Doctors, and sign contracts that say they will not obtain prescriptions from any other source.  That is an issue if and when one must visit the ER.

I do not know where this is going to lead, or how it will end.  My only wish is that people who truly need pain medication are able to have it.  I am blessed to have a GP who manages my pain.  Many RA patients are denied pain medication until they are in so much pain they are confined to bed.  Some doctors, including rheumatologists, often unjustly label their patients as drug seekers.

If you have a RA and are having difficulty finding a doctor who will provide pain medications, please do not give up.  Advocate for yourself.   Keep a file full of your x-ray, MRI, and CAT scan reports.  Take them to your doctor's appointments with you.  Documented joint damage and swelling could help your doctor understand that you are simply asking for help with pain control.  Without pain control, we have no quality of life.