Tag Archives: pain

The problem with painkillers

July 28, 2014
HEATH LEDGER
HEATH LEDGER

With chronic pain such a big problem as our population ages, Australia’s seen a big rise in the prescribing of strong painkillers, commonly known as Endone and OxyContin. These provide relief from severe pain to tens of thousands of Australians. But because the active ingredient of both drugs is oxycodone, an opioid (or painkiller) that’s related to morphine, Australia’s high consumption has been ringing alarm bells. Australians rank as the third highest consumers of oxycodone per head in the world. The evidence has grown that these prescription painkillers are contributing to addiction, over-doses and deaths.

The Australian actor Heath Ledger died in 2008 from the acute effects of oxycodone in combination with sleeping pills and anti-anxiety drugs. And the American actor Philip Seymour Hoffman, who died earlier this year from an accidental drug overdose, was known to have fought a long battle with addiction to prescription painkillers. So it’s little wonder some doctors here are urging their colleagues to think twice before prescribing Endone or OxyContin, or at least to limit the number of pills their patients get at any one time. “It’s an enormous problem in Australia,” Sydney anaesthetist and pain specialist, Dr Jennifer Stevens, told me. “There’s an increasing number of deaths in Australia where Endone or OxyContin was one of the drugs found in people’s bloodstreams.”

A concern is that young people are getting access to left-over painkillers that have been prescribed to their parents or grandparents. Young people can crush, snort or inject them to get what’s been described to me as a “lovely warm high.” These prescription painkillers can be addictive, lead to ever-bigger doses, and be mixed with other drugs with sometimes fatal consequences. Allegations that pensioners have been selling their Endone and OxyContin to young drug users to supplement their income have been discredited by a recent study. But more drug users are getting their hands on the prescription painkillers one way or another. A survey of Australians who regularly inject drugs found almost one-third were injecting oxycodone in 2013 compared to just 17 per cent in 2005.

Dr Stevens urges older Australians to clean out their medicine cabinets and return their unused Endone or OxyContin to the chemist. The more that’s in the community the greater likelihood of problems. Older people are at risk of addiction and even death if they hoard their painkillers and use too many when the pain gets on top of them. Between 2001-9 there were 465 oxycodone related deaths, and in half the cases the deceased person had had a history of pain or a chronic medical condition. A 2011 Victorian coroner’s report showed deaths where oxycodone was present increased from four in 2000 to 97 in 2009.

Last month Dr Stevens circulated a letter to all junior doctors at St Vincent’s Hospital warning against inappropriate prescribing of oxycodone to patients being discharged. “While no patient should be discharged without adequate analgesia we should all be aware of the potential for hoarding and diversion of these drugs,” she wrote. Prescriptions for Endone for patients being discharged from St Vincent’s had trebled in the seven years to 2012, Dr Stevens wrote. But an audit had shown as much as 30 per cent of the prescribing was inappropriate. Endone and OxyContin were useful drugs to alleviate post-operative pain, cancer pain and in palliative care. But the evidence they lessened chronic pain, such as back pain, was much less clear. Instead they were associated with unintentional overdose and addiction, Dr Stevens said in her letter.

Last year Dr Stevens co-authored a paper with Dr Ngaroma Steele titled Where oh where has your Endone script gone? The oxycodone epidemic. Published in the journal Australasia Anaesthesia, the paper questioned whether some of the Endone and OxyContin was “ending up in the nightclub district of Kings Cross” – up the road from the hospital – “or handed out and swallowed at a party?”

“Prescriptions are done out of the best intentions,” Dr Stevens told me. “Junior doctors who do the paperwork when patients are discharged don’t want patients to have a lot of pain when they go home. To make sure, they give patients a box of 20 when what they need is two or three tablets.”

Some of the growth in Australia’s oxycodone consumption from 92kg in 1998 to 2058kg in 2011 is undoubtedly related to the dawning acknowledgement that being pain-free is a human-right. So how to strike the balance between two legitimate problems – too many people suffering pain, and risks of addiction, over-doses, and death? Professor Louisa Degenhardt, of the National Drug and Alcohol Research Centre, at UNSW, is undertaking a study of 1500 people, average age 58, who are taking prescribed oxycodone. Despite the medication, many people’s lives are bleak. Half suffer moderate or severe depression, one-quarter an anxiety disorder, and half have thought of killing themselves. On average they’ve suffered pain for 10 years. Their lives could be worse off drugs. But drugs alone don’t seem the answer. “With chronic pain, it’s about managing it, accepting the reality they may have to live with it for the rest of their lives, and working out strategies that help people regain quality of life,” Professor Degenhardt said.

As I’ve written previously this is where people need teams of experts to help, including perhaps physiotherapists, meditation teachers, and exercise physiologists. Pills alone, it seems, just aren’t enough, and in some cases, can be dangerous, not only to individuals but the wider community.

What’s your experience/view on prescription pain killers? Please leave a comment.

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Trapped in a world of pain

July 14, 2014
pain1

The two most painful operations a body can undergo, according to my anaesthetist, are knee replacement surgery and a lobectomy. And I’ve recently undergone the lobectomy. This is when a lobe of your lung is removed. To get at your lung, the surgeon must cut a big hole in the side of your chest, and spread your ribs apart. The muscles between the ribs are torn, other muscle is cut through, and sometimes, as happened with me, a rib is broken. I’d been warned the after-effects were painful. But when the anaesthetist popped his head round the hospital room door, I chided him about the pain. I know a sick person must ingratiate herself with the health professionals so they’ll like you. So I chided ever so gently: I’d had two babies without a whiff of pain relief, I said. I was no wuss. But I was now in unacceptable pain. “I thought hospitals were better at this pain management thing,” I said. That’s when he told me a lobectomy was one of the two most painful operations you can have. I, of course, was curious to know the other one. Hmmm. I won’t be getting a knee replacement in a hurry.

My doctors say I’m very lucky, and as I lay in pain, watching the play of winter sunlight on the grey walls, I tried to see it their way. I’ve joined the small but growing band of life-long non-smokers, the majority women, who’ve been diagnosed with lung cancer. They say lightning doesn’t strike twice. But it’s struck me twice. Seventeen years ago I was diagnosed with breast cancer. I’m lucky this lung cancer is a primary, unrelated to the breast cancer. And I’m lucky it was found, quite by accident, as a result of my regular ultra-sound/mammogram which led to other tests. The cancer was so small I had no symptoms (typically a long-standing cough, or coughing up blood). I’ve often boasted my lungs are the best part about me: I never get colds, flu, bronchitis, or asthma. Don’t be alarmed on my behalf by the awful statistics for lung cancer survival. With the cancer I have, its early detection, and the lobectomy by a top surgeon, the odds of my reaching old age are fairly good. I’m seeking advice on whether chemo-therapy can further improve my chances.

What I wanted to tell you about was pain, and the need for pain management specialists to be accorded status like heart surgeons. I feel I’ve visited another country, where you don’t want to go, but where a significant minority of Australians are stuck. My pain, hopefully, will not turn into the chronic suffering that affects one in five Australians, or one in three over the age of 65.  Back troubles, arthritis, neurological…the causes are many and the personal and economic costs huge. Too many are stoic and silent, or believe pain is inevitable as you age. The truth is it’s best headed off before it gets too severe. Three weeks after my operation, and with the right medication, my pain is manageable and declining. But I won’t easily forget the Nights of the Long Knives. Each night as the pain surged in, it felt as if a thick-bladed, stainless steel kitchen knife was wedged deep into my left lower back; and as if a clamp was pressed, like some medieval torture implement, to my ribs. The medication just didn’t touch the sides of it. I found myself thinking, in those lonely hours, of everyone I’d ever known who’d suffered terrible pain.

When I started this blog nearly 18 months ago, I determined to write little about health issues because, let’s face it, the list of ailments is endless at our age. It can get tiresome, and also, there are many good health websites run by experts. But with my new insight, I want to convey the need to elevate pain management as a national health priority. It’s crucial the millions of Australians who live with severe pain get better access to public pain clinics. It’s only relatively recently that pain and its consequences have been taken seriously, and that pain management has emerged as a medical specialty. In my case, it was when a doctor from the hospital’s pain management team saw me at my request that my situation improved. A change of medications and dosages wrought a miracle. I was returned to myself.

At a recent count there were only 275 pain medicine specialists in Australia, inadequate for an ageing population. Australians who live with severe pain can face long waiting times of five months or more to access public pain clinics. Lesley Brydon, the dynamic chief executive of advocacy group Pain Australia, said in the past two years some state governments had provided extra funding for regional pain services and GP education. “NSW has been outstanding and is the model for what should happen nationally,” she said. “And in parts of WA two-year waiting times have been cut to two months.” So there’s progress but still enormous unmet need.

Dr Jennifer Stevens, a pain medicine specialist at St Vincent’s Hospital, Sydney, told me: “We’re at the beginning of treating pain better. There’s so much we still don’t know.” What is being learnt is that opiates (strong pain drugs derived from, or mimicking, opium) are not the entire answer. Managing chronic pain involves psychological and life-style changes, exercise, and multi-discipline teams. I’ve tasted severe, ongoing pain. Mine’s diminished. My heart goes out to all those who live in chronic pain.

(And thank you to all who sent good wishes.)

What’s your experience with chronic pain and what’s helped? Please Comment.

Coming of Age is updated every Monday. Click ‘Subscribe for free’ to have it emailed to you.