Pain is an important sensation that adaptively signals our bodies that something is wrong. Fortunately, for most it is brief and when necessary is relatively easily controlled until the inciting condition is resolved. Unlike acute pain, which signals the nervous system that something is wrong or needs attention and is relieved once the cause of pain has been addressed, chronic pain persists.

Chronic pain is defined as pain that persists for more than six months. Often there is a mystery as to the actual cause of chronic pain. For example, two individuals can both have terrible back x-rays, riddled with collapsed vertebrae and arthritis, and one has chronic pain and the other has none. The pathology often does not correlate well with the symptoms. This is very frustrating and discouraging for patients and makes treatment confusing. It’s important for patients to know that chronic pain is a disease, in an of itself, and the pain is real.

Prescribing pain medications for chronic pain, usually opioids (relatives of opium), has become a “quick fix” that, for some, can turn into a nightmare. For these unfortunate individuals the medications actually cause a worsening of the pain, or hyperalgesia, due to hypersensitization of the nervous system. In other words a vicious cycle occurs because the pain meds actually affect the nerves such that there is a lowering of the threshold for pain and an increase in the sensitivity to pain.

Recent data is accumulating regarding this paradoxical physical effect: “the more opiate, the worse it hurts, followed by stronger and stronger medication.” The patient feels trapped and miserable and all they know to do, and frequently all their doctors know to do, is to further increase the pain meds. As this progresses there can be a progressive worsening in function. The patient can become so distraught and confused that it’s hard to differentiate their emotional pain from their physical pain. Eventually they only feel relief when they cannot feel at all.

The mystery of why pain-suppressing medicines that initially offered pain relief, can turn and become part of the problem is not well understood. What is known is that when this happens, and it usually happens quite subtly, the chronic pain patient is trapped within a hopeless cycle of chaos caused by drug dependence, even though they may be taking the medications exactly as prescribed by a pain management specialist. Because of this phenomenon there are many patients under pharmacological management who have poorly controlled pain.

If you receive large doses of opioids with no significant decrease in pain and no improvement in function or things are becoming worse, then you should seek assistance aimed toward carefully stopping the medications. The pain has engulfed your life, and the search for relief has created an addiction to drugs.or at least problematic use of addictive medications.