Sunday, December 16, 2007

Are you "Chemically dependent or "Addicted"?

Two of the most misunderstood terms in taking opiate or opiate-like drugs is Addiction vs. Chemical Dependency. Doctors, especially the News Media and even Chronic Pain patients themselves often misuse the terms. As a Chronic pain patient you have a duty to educate yourself on these things. Its not fair to you and it is certainly not fair to other Chronic Pain patients who are "fighting for our rights." So educate yourself!!

In writing this blog I want to be fair and present the other side. I just wish the "News Media" would do the same. If you take powerful Opiates or Opiods because you live with a level of Chronic Pain that is intolerable, sooner or later you will become chemically dependent on them. This is normal and if at some point you feel you no longer need them, slowely start reducing your dosage until you are completely off of the drug. I would suggest consulting with your Doctor and make sure he is aware of what you are doing. He will probably advise you at what rate you should reduce the medication. If you continue to take them after you no longer need to and make no effort to get off of the pain medications then you have become Addicted. At that point it is time to seek out an Addiction medicine specialist.

When opiates are prescribed by a physician for the treatment of pain and are taken in the prescribed dosage, they are safe and there is little chance of addiction. However, when opiates are abused and taken in excessive doses, addiction can result.

The brain itself produces endorphins that have an important role in the relief or modulation of pain. Sometimes, though, particularly when pain is severe, the brain does not produce enough endorphins to provide pain relief. Fortunately, opiates, such as morphine are very powerful pain relieving medications. When used properly under the care of a physician, opiates can relieve severe pain without causing addiction.

Feelings of pain are produced when specialized nerves are activated by trauma to some part of the body, either through injury or illness. These specialized nerves, which are located throughout the body, carry the pain message to the spinal cord. After reaching the spinal cord, the message is relayed to other neurons, some of which carry it to the brain. Opiates help to relieve pain by acting in both the spinal cord and brain. At the level of the spinal cord, opiates interfere with the transmission of the pain messages between neurons and therefore prevent them from reaching the brain. This blockade of pain messages protects a person from experiencing too much pain. This is known as analgesia.

Opiates also act in the brain to help relieve pain, but the way in which they accomplish this is different than in the spinal cord.

There are several areas in the brain that are involved in interpreting pain messages and in subjective responses to pain. These brain regions are what allow a person to know he or she is experiencing pain and that it is unpleasant. Opiates also act in these brain regions, but they don't block the pain messages themselves. Rather, they change the subjective experience of the pain. This is why a person receiving morphine for pain may say that they still feel the pain but that it doesn't bother them anymore.

Although endorphins are not always adequate to relieve pain, they are very important for survival. If an animal or person is injured and needs to escape a harmful situation, it would be difficult to do so while experiencing severe pain. However, endorphins that are released immediately following an injury can provide enough pain relief to allow escape from a harmful situation. Later, when it is safe, the endorphin levels decrease and intense pain may be felt. This also is important for survival. If the endorphins continued to blunt the pain, it would be easy to ignore an injury and then not seek medical care.

There are several types of opiate receptors, including the delta, mu, and kappa receptors. Each of these three receptors is involved in controlling different brain functions. For example, opiates and endorphins are able to block pain signals by binding to the mu receptor site. The powerful new technology of cloning has enabled scientists to copy the genes that make each of these receptors. This in turn is allowing researchers to conduct laboratory studies to better understand how opiates act in the brain and, more specifically, how opiates interact with each opiate receptor to produce their effects. I just hope it is soon, because personally I hate taking opiods or any medication for that matter. I, like most people in chronic pain just want a life.

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