ON THE COVER Dr Sarah Jarvis
My Weekly’s favourite GP from TV and radio writes for you
Nobody wants to live in pain, and fortunately these days we have effective treatments for most of the many different types of pain. However many of them carry a risk of addiction if you take them for too long. So, how do you know if you’re addicted, and what can you do?
Headache, backache, osteoarthritis, stomach ache – your body is very good at telling you when you’re in pain, and your nervous system is responsible. Your brain is connected to every bit of your body via a complex network of nerves: below the neck, all these messages travel through your spinal cord. Motor nerves carry messages from your brain telling each muscle to move, while sensory nerves carry messages back from your skin, limbs and body organs, telling your brain about touch, heat and pain. Most parts of our body have pain sensors at one end of these “sensory nerves”. Without them, you wouldn’t move your hand away from a burning flame, or seek help if you had tummy ache. The aim of most painkillers is to damp down the signals your brain gets, or to reduce inflammation. Complicated pathways in your body result in chemicals being released if there’s inflammation or damage in any part of your body. Pain signals from muscles and joints, as well as cancer pain, usually respond well to stronger opioid painkillers like codeine or tramadol, or medicines that work on the nervous system, like pregabalin and gabapentin. Diamorphine, the medical term for heroin, has been the
FOR BACK PAIN, EPIDURAL ANAESTHETICS OR STEROID INJECTIONS INTO THE MOST PAINFUL AREA CAN PROVIDE A MEDIUMTERM SOLUTION
standard treatment for the pain of heart attack for decades, and heroin is part of the opioid family. Hence the risk of addiction. Even more worrying, some painkillers may make your body more sensitive to pain. If you’re taking painkillers and you get pain, your instinct is to take more painkillers, which can end up feeding the addiction.
Antiinflammatory medicines can cause severe stomach inflammation and damage your heart or kidneys if you take them for too long. So more and more people are being switched away from antiinflammatories to opioids or nerve-damping gabapentin and pregabalin. Risk of these conditions increases with age and obesity, and the UK population is living longer (and fatter) than ever.
So it’s hardly surprising the number of prescriptions issued in the UK for opioids has doubled in a decade, from 12 million to 24 million a year. It’s thought that up to 192,000 people could be addicted.
Don’t stop painkillers immediately if taking them for a long term condition. But do ask yourself some serious questions if you’re on regular doses of strong painkillers. Firstly, have you been taking it for over 3 months? If so, do you know exactly how many painkillers you take a day? Have you ever been tempted to take more? Do you run out of medicine before your prescription is due for renewal? Do you “borrow” tablets from other people or your partner, because you run short? Do you pace the floor until your next dose?
Dealing with pain and painkiller addiction, is not easy, but it is possible. If you’ve answered “yes” to any of these questions, speak to your doctor. They will understand and want to help. Options include pain clinics, pain group work, physiotherapy and possibly counselling. Next Week: Do you need a second opinion?
MOST HOSPITALS RUN PAIN MANAGEMENT SERVICES, WHICH INCLUDE GROUP SESSIONS TO HELP YOU DEAL WITH THE IMPACT OF PAIN