NYT: Pain Pills perpetuate back pain?

Here's an article I saw this morning in the New York Times regarding over-prescription of narcotic pain killers for common so-called job related injuries like back pain:

http://www.nytimes.com/2012/06/03/h...nd-delays-to-workplace-injuries.html?_r=1&hpw

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It seems to indicate that prescribing pain killers actually delays workers returning to their jobs. Sounds to me at least like one more bit of evidence that treating back pain as a structural disorder is way off the mark. Just wondering what any of you have to add to my conclusion?

 

Interesting. The article doesn't really get into why these people have longer recoveries with pain meds...if the medications are just not working/making people more sensitive to pain, or if they're being prescribed instead of some other treatment that would be more effective.

 

What the article implies, if seems to me, is that pain killers are being used indiscriminately to treat the symptoms of back pain without actually addressing the real cause of those symptoms, which Drs. Sarno, Schubiner et al. would insist is really emotional and psychological (i.e. TMS). I have heard, anecdotally of course, that the creeks draining major metropolitan areas in the US are so full of NSAIDs and other pain medications as to become toxic to fish and other wildlife! Obviously, there's a spreading pain epidemic out there that isn't being fixed so much as wall-papered over.

 

Forest, not that I'm a ranting behaviorist, but I wonder how much overusing pain medication relates to secondary gain theory? Does the so-called 'pain patient' actually re-enforce secondary gain by taking painkillers? By taking higher doses and enjoying the intoxication they produce, does the pain patient reinforce his symptoms? IOWs: It may be that by getting 'high' with the pain drug each and every time he/she experiences pain, the patient actually keeps having the pain because it allows him/her to keep dosing themselves and getting a pleasant sensation in return. Sounds like a good way to get locked into a cycle of pain and addiction! I've heard of retired professional athletes who are constantly popping pills and drinking martinis at the Country Club bar to deal with aches and pains they claim they acquired during their former careers in professional sport. Sounds to me as if they miss all the fame and adulation associated with being a star and now they're filling up their empty lives with either aches and pains or pain killers. I guess the chicken or the egg arguments about addiction run on and on in an endless circle.

 

Yes, Forest, using physical means to cure spiritual (i.e. emotional/psychological) ailments is definitely going about things backward. I know I pop a couple of Ibuprofens before I take a long bike ride, but temporarily eliminating the TMS pain allows me to expand my pain-free range of motion while I'm engaging in the activity. Seems to carry over later on too. However, I don't get up in the morning and take two Ibuprofens and then take some more after exercising. I'm very careful not to reinforce the pain cycle that way. My real improvement seems to be due to meditation, breathing exercises and doing the journaling inside Howard Schubiner's Unlearn Your Pain book. That holistic long-term stuff. The Ibus are only a temporary fix, not a real solution.

 

MorComm to quote you: using physical means to cure spiritual (i.e. emotional/psychological) ailments is definitely going about things backward
Absolutely agree with your statement.

When Dr. Sarno first mentioned 2ndary gain it didn't click, but some time later it did.

 

Ouch! I take pain medication to get through my day. I've been really sensitive about this - but have been on them a long time. I don't get a "pleasant high" anymore, but can simply get through my day - which are typically pretty crazy. I know what MorComm is saying is true. I want to get off of these, but the time hasn't been right. And is there ever a good time? Believe me. These are questions I have asked myself over and over.

BG

 

I know that when I had a so-called "herniated disk" in 2001-2002 my doctor prescribed Ultracet and I must have taken those pills for about 9 months. But when the pain faded away, I was really glad to stop taking them because they seemed to make my lips crack. When I finally did stop, I remember it was like a new sun was rising on a new day. Never wanted to go back there again. But if I had known about TMS back then, I know I would have gotten out of PT as quickly as possible so as not to reinforce the structural diagnosis. Also, would have never gotten into popping Ultracets after the first 8 weeks of back symptoms either. I'm sure now that the whole doctor-pill-PT scenario set me up for having a relapse in 2008 when I foolishly returned to pain meds and PT. One nice thing about knowing about TMS theory is that you won't get fooled again with purely structural diagnoses and approaches to recovery.

 

On a similar note: http://www.psychologytoday.com/blog...chronic-pain-better-and-they-may-make-it-wors

And I found this line very relevant to TMS:

 

Haven't we been through this one before, in the 19th century in China when the Western powers attempted (and succeeded) in addicting a huge portion of the Chinese population to opium? They called them the Opium or Gun-Boat Wars where the British and the French and Portuguese used military force to compel the weak central Chinese government to allow the free-flow of opioids to an addicted population. Another thing about the over-prescription and use of opioids, like oyxcodone, is that they are making there way into the adolescent recreational drug-user group, many of whom are becoming addicted. Kind of a slop-over effect of the over-use of opioids for the treatment of chronic pain. Certainly an alarming situation.

 

I'll propose another mechanism to explain the longer recovery period. If the subconscious is using pain to distract you from emotions and you decrease/suppress the pain through pills then the logical thing for the subconscious to do is ... increase the pain.

 

I think all the explanations offered here are viable (as to why opioid pain killers may be related to worsening of pain). There is also the fact that any substance which induces a more relaxed state (as opioids do) is likely to lead to more time resting and being sedentary. Research clearly shows that the quicker people can get back to levels of activity again after the onset of back pain, the higher are their chances of recovery- the more rest people engage in, the slower they are to recover. While some people will use opioids in order to be able to be active, others will use them and just become more and more inactive- and this will increase the amount pain, levels of disability and the duration of the problem.

 

I'm always surprised by the folks on this forum who know more about tms than anyone and rationalize taking any medications to take the edge off the pain. And then give advice to others.

 

I think Dr Sarno even prescribes a strong narcotic pain reliever during the first phase of an acute attack of TMS. But one of Sarno's criteria for a successful TMS cure is NOT taking any pain medication at all. Likewise, no physical therapy, chiropractic, acupuncture, or massage either. No physical or structural treatment modalities at all. One thing you definitely do not want to get into is a pain flareup - pill popping cycle that runs on and on ad infinitum. Becoming addicted to pain pills is just not the same thing as curing TMS through meditation, journaling and knowledge lectures.

Despite my rather impressive new title, "TMS Guru", I'm just like you, Barry, working my way toward healing my TMS by a series of hit and miss successes and failures. Sure, I've read a lot of the theoretical literature, but there aren't any hard and fast rules about a treatment program. Guys like Alan Gordon, Howard Schubiner, and, of course, Dr Sarno not only have the theory down by tons of clinical experience based on many, many patients. I'm not here to diagnose and prescribe only offer advice based on my own experience. I do notice that as I work my way through the mental exercises in the SEP, my TMS pain did go down without using any pain medications. What you don't want to do is program yourself so that you associate taking the pain medication with the reduction in symptoms, like the guy who wakes up every night at 3 am in intense pain and then pops a pill so that the pill popping and the pain become part and parcel of the same programmed pattern.