Jun 2, 2016

Interview Transcript

Interviewer: Your painkillers don't work for you anymore. Is this normal? We'll find out next on The Scope.

Announcer: Questions every woman wonders about her health, body and mind. This is "Am I Normal?" on The Scope.

Interviewer: We're talking today with Dr. Kirtly Parker Jones. She's the expert on all things woman. Dr. Kirtly Jones, a lot of women have been emailing us lately for various reasons of pain and they've been saying that painkillers just don't work for them anymore. Is this normal? Can you grow a tolerance to painkillers?

Dr. Jones: This is a great question and, in fact, yes, this is normal. Now, let's talk a bit about what we're talking about painkillers here. I'm assuming our questioners are asking about narcotics.

Interviewer: Let's assume yes.

Dr. Jones: So we'll make that assumption. What we do know is that narcotics are opioids and these would be drugs like hydrocodone, and oxycodone, and morphine, Demerol, drugs like that, are actually pretty good for acute pain, meaning they work when the pain is acute onset. Let's say you just had surgery or you just had a cesarean section, it can be really great for a couple days. However, two things happen if you take it for longer than a week or so. Number one, we have very good evidence that narcotics do not work for chronic pain.

Interviewer: Doesn't do them any good.

Dr. Jones: Doesn't do them any good. For two reasons. Number one, it doesn't work for chronic pain and, in fact, narcotics can sensitize people to pain so they actually feel more pain.

Interviewer: So now, what classifies as chronic pain to you?

Dr. Jones: Well, chronic pain is pain that goes on longer for a week or two.

Interviewer: Okay.

Dr. Jones: So that's chronic pain. So acute pain, we've all had it. You break your leg, you sprain your ankle, you've just got an abscess in your finger or you just had an operation.

Interviewer: Something that's going to go away.

Dr. Jones: Something that's going to go away cause you're going to heal.

Interviewer: Okay.

Dr. Jones: But during that going away time, narcotics can be very useful.

Interviewer: Like a toothache. My dentist gives me painkillers when I go and have my wisdom tooth taken out.

Dr. Jones: Yeah, right. So that's a good thing because it's going to hurt for a couple days and narcotics work for that. But over time, narcotics don't work. Now, let's talk about those two reasons. One is that narcotics can actually sensitize you to pain so you feel it more.

So the other issue is that when you've taken narcotics for a while, the same dose doesn't give you the same effect. So that's where you get used to the narcotic effect. What then happens is that people start taking more narcotics and then you get into this vicious circle of taking more narcotics and then it not working as well and then maybe sensitizing you to pain so your pain actually feels more. So you take more narcotics and then the difficulty is are you really needing those narcotics or are you addicted? What is the behavior around getting those?

So more and more, we've understood that chronic pain . . . now, there is a kind of chronic pain, meaning longer than a couple weeks, in which narcotics can be very helpful and that's the pain associated with cancer. So cancer pain tends to come and it gets worse and worse as the cancer spreads. So in reality, it's almost like acute pain that keeps happening over and over as the cancer spreads to a new area.

So the goal for pain is that acute pain should be treated with the least amount of drugs that does the job well for someone so that they can get up and move around. We never can make all the pain go away for someone, we'll say, after surgery. So our goal is to make it tolerable for people to get up and move around because getting up and moving around is really important to make the pain feel less. So moving is important for most kinds of pain to make you feel better.

If our listeners ask, "My painkiller isn't working as well as it used to," then the answer is right, how long have you been taking it and what have you been taking it for?

Particularly for things that are chronic like low back pain, or people who have pelvic pain that's chronic, not just like the acute pain that comes with a bad period or with an ovarian cyst that ruptures or something like that. So people who use pain on an everyday basis, their pain medicines are not going to work as well and they're going to need more and they might become addicted and it doesn't work for chronic pain in the first place.

So what are you supposed to do? If your pain pills aren't doing for you what you want, should you get a higher dose? Should you get a stronger narcotic? I think most pain specialists would say this is the time for a reevaluation of your pain and looking at other options for pain management.

So other options at pain management actually include cognitive behavioral therapy. In other words, helping you deal with how you appreciate that pain, how you respond to that pain. Exercise can be helpful. Physiotherapy can be helpful. Yoga can be helpful. Mindfulness therapy can be helpful. But we really need to take another approach to people with chronic pain than giving people narcotics because the consequences of giving people narcotics for chronic pain have led to essentially a rise in the rate of deaths of young people and middle-aged people in this country.

We now see an actual drop in the lifespan in this country, probably related to suicides and narcotic overdoses, which is a pretty sad thing. So if you have chronic pain, it's not about narcotics, it's about other therapies. If you have acute pain, that tooth, go to your dentist and you can take it for a couple days, but be careful about taking it for longer.

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