Myth Buster: Do Painkillers Reduce Your Pain Threshold?
By Anthony Perardi, Chief Physician Assistant
At APC, we take great care to be sure we’re setting our patients up for long-term pain relief with advanced pain management. Medications can be an important part of addressing chronic pain, but we know you have questions about painkillers – and for good reason.
Data provided by the Centers for Disease Control and Prevention shows that, between 2000 and 2017, prescription opioid drug users had a higher overdose mortality rate than heroin users.
The overdose death rates for both those populations dropped in 2018 (though synthetic opioid overdose deaths increased). The good news is that the opioid crisis is making the medical community more thoughtful about how painkillers of all kinds are prescribed.
Fortunately, at APC our focus has always been to find effective pain care solutions that are safe and sustainable for patients.
Does Advanced Pain Care Prescribe Painkillers?
While we do prescribe painkillers, we don’t consider opioids an effective long-term solution.
Studies have shown detrimental effects on the body affiliated with long-term prescription opioid use. In short, you can end up in more pain, not less. Here’s how that happens:
Your body builds up a tolerance to pain medicine. The longer you’re on opioids, the more tolerance you build. That means you have to take more of them over time to achieve any sense of pain relief.
As you increase your intake, you fill up your body’s opiate receptor cells in your nervous system. Overwhelming those receptors make your body more sensitive to painful stimuli. It’s called hyperalgesia.
I’ve seen patients in this state of increased pain and they haven’t been able to get out of pain until we help them reduce their medications.
Because of the opioid epidemic, reducing opioid painkiller prescriptions is no longer a goal, it’s a regulation. We know that in order for you to be healthier, and safer, we have to reduce those types of painkillers.
How Does APC Create a Plan for Me?
At APC, your pain care plan is always tailored to your needs. There’s no one size fits all approach at APC.
That’s why an initial consultation in the office is so important to us — we want to hear your story before deciding how to treat you.
It’s that level of personal attention and care for your long-term, pain-free lifestyle that has made me proud to be a part of APC for nine years.
In your initial consultation with a physician, they will listen to your pain history, perform a clinical exam, and design a personalized pain treatment plan for you.
Our team of physician assistants and nurse practitioners typically handle the follow-up visit to continue your treatment plan.
If you’ve never had pain medicine before, or have never taken an opioid before, you might be wary about medication. But don’t worry, we see plenty of patients like you.
We also see chronic pain patients who have been on long-term pain medications before transferring to us.
If you’re one of those patients, a physician will set-up some guidelines for us to follow. We track your daily intake of milligrams per morphine, or MME. We like to keep your MME low or at goals set by Advanced Pain Care physicians.
What Are Some Pain Management Options?
There are plenty of effective, non-opioid medication options, as well as other interventional therapies to manage pain.
When we’re considering prescribing you pain medicine or changing your existing medications, we’re thinking about:
- how much you’re currently taking on a daily basis
- what your history is
- how compliant you’ve been to the medication dosage
- whether you’ve tried any physical therapy or interventional procedures that are alternatives to help with pain
Prescription painkillers that we typically prescribe include nonsteroidal anti-inflammatory drugs (NSAIDs), and neurological agents like Neurontin or Lyrica to help with nerve pain.
We also treat migraines and headaches, which can be very debilitating to patients, with different calcitonin gene-related peptides (CGRPs).
Coping with chronic pain can take a toll on your mental health, so we also utilize antidepressants that help not only with the mental side of depression but also help with the pain.
If other measures are not sufficient, and we determine that you do need an opioid medication, we may prescribe an opioid that is tailored toward each individual based on their health and pain response. Examples of these medications might include Tramadol, Tylenol with codeine, or Hydrocodone.
Our goal is to get you back to a functional lifestyle without suffering. That’s why we’ll consider other interventions, like the spinal cord stimulator, NSAIDs, physical therapy, and interventional injections.
Cervical, Lumbar, and joint injections with steroids can be very therapeutic to help with chronic pain or injuries. These techniques are offered to the patient throughout their visits with APC in order to help make the patient more functional and to help reduce suffering. The advantage that Advanced Pain Care offers to patients is an in-house surgery center to offer these treatment plans so that patients do not have to deal with a hospital. This has been a very convenient and safe option during the COVID-19 pandemic.
Medial branch nerve blocks are a great non-steroid technique for patients with arthritis in the back. It’s a numbing agent that serves us in a diagnostic way. Even though it only provides eight to 12 hours of relief, it can show us whether that spot is the source of your arthritis pain.
From there, we can do what’s called a radio frequency or a radio ablation, which involves heating up a little nerve that runs through that joint.
That procedure can provide pain relief that lasts from eight to 12 months. You can go out, exercise, and do activities that a painkiller would prevent you from doing.
Painkillers can depress your energy levels. Our main goal at APC is to keep you active and enjoying life.
What if My Pain Meds Aren’t Working?
You don’t have to feel discouraged if your existing pain medication plan isn’t working. We’re here to help you find the right solution.
We can create compounds of medications that are tailored to you. Low-dose naltrexone is an example of a compound we can create to treat pain and fibromyalgia.
About three years ago, we were able to do genetic studies on patients to see how their bodies were metabolizing pain medication.
I had a patient who was taking 12 Norcos a day — it was a lot of medication and it wasn’t helping him. We did a genetic study and found out that he didn’t metabolize hydrocodone. It just went straight through his body.
So, we put him on Percocet which was shown to metabolize better by his body and it worked. He had less pain and it totally changed his life. It can take some trial and error with medication, but that’s just one example of an option we can consider.
I Feel Judged When I Ask for Pain Medication
You might feel a sense of stigma when it comes to asking for pain medication. The opioid crisis has likely contributed to that stigma.
I know the majority of my patients don’t want to be dependent on pain medication. They don’t want to keep taking pills. They don’t want to be at home. They don’t want to be non-functional.
It’s not your fault that you got in an accident, or got hurt.
It can be hard to talk about, but that’s what I’m here to do: to talk to you and listen.
If you’re scared of addiction, I understand that fear. I’ve seen the horror side of addiction, what it does to people, relationships, families, and kids. Advanced Pain Care provides in-house behavioral therapy treatment plans that are coordinated with a patient’s pain plan. This department offers therapy and behavioral treatment techniques to help deal with the depression side of chronic pain.
So, if there’s anything I can do to prevent that from happening, that’s my ultimate goal. At Advanced Pain Care, we truly believe that pain is inevitable and suffering is optional.
Keep Reading: What to Expect at a Pain Management Clinic