Pain medication tolerance ( it is not what you think, read on)

[sandee1818]

I learned something today from my PM doctor.
He said that as far as tolerance your body becomes tolerant to the meds after a couple months. Therefore the need for a raise in meds due to tolerance is simply bunk. Your body gets adjusted to the meds and the tolerance after two months and when the meds stop working as well as they used to it is because your body ( pain) has simply become worse.
Now I am like you and have always heard that after taking a medication for too long it becomes ineffective. But he says he has the research to back this up and is currently getting me copies to post here as I explained that no one would believe this because we have been told that tolerance is a huge issue when taking narcotics.
I had been explaining that I needed an adjustment because the dose I am on and have been on for years and years just isn't cutting it anymore. Well I had my annual MRI and he showed me on the scan results where indeed I am definitely worse off than when I had my last MRI last year. Anyone with degenerative disease knows it gets worse over time just as injuries to our back does.
So tolerance has to do with our bodies and injuries getting worse and the meds are effectively working just as they did we just got worse.
I will post the results and research when I get it. It does make sense to me and although it also makes sense that the meds lose its effectiveness after time. But My PM doctor is one of the best in the country, he actually got into pain management because he broke his neck and never got sufficient relief. He invented the blood transfusion machine years ago and is very up on anything to do with pain management. So I trust he knows what he is talking about. Something to think about in any case. We are not getting tolerant to our meds we are just getting worse. Not to scare anyone though:)

[TigerLily17]

Wow, I just can't wrap my head around this. I would have never imagined something like this and it is raising so many questions in me that I never would have thought of as I'm sure it is in everyone. I look forward to reading more about this.

Lily

[opus88]

hi everyone I just found this discussion in the archives...very interesting, Sandee,  is there somewhere I can find the research that was done on this tolerance vs. condition..I would be very interested in reading it.
It was explained to me that the body 'remembers' the pain whether it still exists or not re: neuropathic pain...and apparently the most difficult to treat!
the remembered pain is most apparent in 'phantom pain' after an amputation.

[fpainestam]

Hi again, everybody.  What an amazing high level discussion this is.  I, too, am looking forward to reading the promised research...fpainestam

[Tuckamore]

Welcome to our forum. You have offered additional good information on the topic of tolerance. I beleive we all know that we need pain. It is our bodies way of signalling us that something is not right. It is a challenging and difficult task to juggle medications that effectively treat chronic pain and still allow our bodies to interpret "good" pain signals. And yes I agree there is "good" pain. That pain that signals, hello, something is going on here, something is not functioning correctly, look at me. The good pain must be differentiated from the chronic pain and it is often a challenging task.

Chronic Pain is a very complex issue and varies with each of us. The definition of Neural Plasticity is the ability of the brain and/or certain parts of the nervous system to adapt to new conditions, such as an injury. The research by various medical facilities and medical research groups is even more complex. Results and focus of these research studies vary. This is a very exciting time in the area of Chronic Pain Research.

The classification spectrum regarding "chronic pain" is immense. Terminal cancer pain is considered chronic pain, yet the patient certainly has great reason for pain. Fibromyalgia is also considered chronic pain and no one here would disagree with the statement that it is real pain. In my opinion chronic pain has become a catch all term for all causes of pain that last longer than thirty days. Again, in my opinion there are degrees and variances of pain principles and causation that need to be addressed on an individual basis.  

I am hopeful that advancements and concrete results in CP research will be forthcoming. Our quest will be to get the slow-to-accept-change medical community on boards with any new conclusive approaches. Currently ideas, opinions, treatments and approaches to CP vary widely from state to state, city to city and often clinic to clinic.

I am sorry that your search for a restful night of sleep has not ended. Many of us face that issue and understand your plight. I wish you a good nights sleep and welcome you to our community. I am hopeful you will continue to join in our discussions and add your comments to our threads.

Peace, Tuck

[CareerLady]

Hi folks,

I just joined and am enjoying the thoughtful discussion. I believe I am having tolerance issues, so I am trying to stay calm and inform myself. I have to say I believe both things can be true, - that we can develop tolerance to pain meds + much of our change in medication needs may be due to worsening of physical damage. Pain is a complex phenomenon, and is caused by different amounts of tissue injury and signalling function, depending on who you are neurologically, and what has befallen your body, injury or illness-wise. Also, I don't think that 2 months is a magic number. There is probably a variance based on individuals responses. Anyway, here are some things I am thinking about.

First, the scary thing is that people NEED pain. It helps prevent us from doing further injury to ourselves. People who are congenitally unable to feel pain risk a lot of bad stuff, because they can't tell when they are seriously injuring themselves.  I know the idea of pain being necessary sounds cruel for people who have long-term pain from debilitating conditions like arthritis or some of the things you have mentioned. But in a sense, pain is like the warning track in a baseball stadium. It's trying to prevent us from crashing into the wall at full speed. It's adaptive in general, even though it's such a bear when you have chronic injury and damage.

Anything that gets in the way of feeling pain can be perceived by our bodies as an infringement on the warning system. That is, our bodies will try to restore "normal" perception of pain so that we will be properly advised as to what is going on with our skin, joints, muscles, tendon, ligaments, bones, etc. We can't afford to suppress pain very much or for very long; our bodies will respond by resetting the pain mechanism to report even more forcefully on smaller pain experiences.

What this is all a demonstration of is something called neural plasticity. The message of neural plasticity is that tolerance is an almost unavoidable response to the use of pain medications. Our central nervous system is trying desperately to keep us in touch with reality, and will continually renew  and in most cases, "upregulate", the way sensory experiences are processed. If your doctor doesn't talk about this, then perhaps its because this is all being researched more thoroughly now, and medicine is a conservative profession that doesn't go jumping on bandwagons. This is all part of a larger field of study called epigenetics that deals with the way that environmental causes interact with genetic endowment to change expression of genes involved in everyday function and behavior.

The only place where tolerance doesn't seem to be inevitable is something called central sensitization, which is what causes pain in a susceptible group of people. It has been implicated in some cases of fibromyalgia, pain from shingles, pain from diabetic neurpathy, and some types of back pain that linger after damage has been repaired. (But not all types...) Central sensitization is a hypersensitivity that is caused only by a neurological change (changes in neurochemical signalling), and is not caused by ongoing damage in the skin, joints, muscles, tendons, ligaments, bones, etc. That is why some people get almost miraculous pain relief from some of the newer drugs (such as gabapentin and pregabalin) and often don't even have any recurrence. It's because they were having pain for no good reason, and this type of pain can be eliminated by "down-regulating" the pain system.

I am not sure if this helps anyone, but I just wanted to add this to the discussion. As I said, I just realized I am having tolerance issues. I thought meds were going to solve my long-standing sleep disruption issues. After a few blessed nights of restful sleep, I am back to my usual state of exhaustion (and it took a lot less than 2 months!). I was SO hopeful. Like all of you, all I want is a normal life. The really nice thing is that researching all these medications and research has helped me see how hard scientists and practitioners are working to get us help. Here's to medical science! Good luck to you all in having comfortable, productive and fulfilling lives.

[Mollyrae]

I can agree with that....That both our tolorance and increased pain levels play a role in the need for an increase. When thinking about it, I guess it has to be a combination of both  playing it's own roll in the course of things.

Thank's for the information, it's been helpful.

Take care.

Molly