The IWALLK Essays - 4. The Pain Buffet

When you walk through the door you may be impressed and depressed by its high costs. The variety of excruciation offered can be staggering, and the chef never ceases to serve up surprises for you by adding new and creative recipes; some, you may need to Google in order to truly appreciate. But it's all there for you! It's “all you can take” at the Pain Buffet!

And, if you're me (or a million other people) and you need adequate pain relief for a temporary amount of time, you may find yourself spending most of that time seated there. Even if, on the other hand, your pain is chronic and not temporary, you will probably similarly be forced to endure spending much of your life there going up for seconds, thirds, fourths...

Metaphors aside, pain is a natural part of life. Here in the material world accidents happen--imperfection rules. Human animals have adapted naturally to a world where broken bones and bloody wounds catch us when we least expect them. But we usually heal. We don't always stay pretty as we accumulate the scars of space and time, but we do nearly always keep soldiering on, wiser than before. 

Pain is the hardest aspect to come to terms with though, because it always sucks. And the sucking is not just electro chemical signals registering physical discomfort in the brain. The much more painful aspect of pain is not what happens in the brain, it is what happens in the mind, not helped by the policies of a primitive society. 

For me, this is why not having adequate amounts of serious pain medication – specifically opioids – can be so unhealthy. Without enough of this kind of medication, stress increases, clenching unnecessarily tightens vulnerable muscles and tendons, and the normal resumption of daily activities can be unreasonably delayed. While waiting for my new Primary Physician some weeks ago I caught sight of a brochure that I didn't want to see. The gist of its message was that just about anything (acupressure and music therapy have been suggested) would be used now at the Internal Medicine section of Franklin Memorial Hospital in Farmington, in lieu of opioids for moderate to sever pain management. This isn't based on logic or historical wisdom, but rather on the recent media-enhanced, trendiness of the anti-opioid hysteria that is sweeping the nation. 

Big Pharma companies like Johnson and Johnson pushed doctors to over prescribe these medications. Then there was an inevitable reversion to the street use of dangerous and unregulated black market narcotics after these prescriptions ran out. The recent introduction of extremely powerful analogues, turning common heroin into unstable admixtures which include fentanyl and its sister analgesics, like carfentanil, have turned the needle into a loaded gun ready for Russian roulette. But, we must bear in mind that it is not the drugs, but rather the socially retarded policies around them, that are causing overdose deaths to rise dramatically. In 2017, 47,000 Americans died as a result of opioid overdoses—an incredible 9.6% increase from the year before. 

Yet, cooler minds are examining the situation and coming up with a more truthful assessment. According to a recent Peter Wall (no relation) Institute of Advanced Studies (University of British Columbia) lecture called, “Drug Use for Grown Ups,” given by Carl Hart – a neuropsychopharmacologist and distinguished Columbia University (New York City, NY) professor – over 90% of people who use drugs classically thought of as “addictive” or “hard drugs” never experience uncontrollable dependence upon these substances. The hype about the danger posed by “drugs” (the inaccurate catchall phrase) to the general population is entirely based upon propaganda. Many other thinking people are beginning to realize how unreasonable drug policy has been, especially since the advent of cannabis law reform and the coming days of probable federal legalization. Fear based prohibition has of course also been reinforced by the ignorant hyper-moralization of religious groups, racist politics of elected leaders and the erroneous emphasis on law enforcement over medical treatment.

It is this last category – emphasis on law enforcement over medical treatment – that limited the amount of necessary pain medication I myself received after my quadruple bypass surgery. In that kind of surgical procedure the sternum is sawed in half and cracked apart to access the heart. 

The post surgical pain of the healing process after the rib cage is wired back together is (as you might imagine) nearly intolerable at first, slowly diminishing over about a six week period. In the hospital I asked for something stronger than oxycodone (one or two 5 mg tabs, every four to six hours), because it just didn't touch the pain. They were required by law to do a Drug Enforcement Agency (DEA) background and criminal search on me before bumping the class of meds up to hydromorphone (aka Dilaudid, one to two 2 mg tabs, every four hours). This helped tremendously. Although I had to deal with a slightly more fuzzy head, I was able to get my mind off the pain enough to think about other things.

I was only in the hospital for four days including the day of surgery. They try to get patients out into the big ole world again as soon as possible—which is very reasonable and a good policy. Unfortunately not much thought was given to tapering the pain medication. So I went from 6 to 10 hydromorphone a day in the hospital, back to a prescription for 24 oxycodone tabs to take home, meaning I was rescheduled to take only 1 to 2 tabs every six hours—a significant reduction in efficacy by lessening the type of medication, and increasing the hours in between taking it. 

This was a huge jump and fired back up the amount of daily pain again to the point where I was not able to sleep well or think about anything else. I felt I had to skip doses at certain times of the day in order to hoard enough for night use. This was a ridiculously unnecessary subjugation, and limited the use of the oxycodone to a maximum of six days (out of a six WEEK recovery). 

When I was running low and still experiencing the same amount of pain, I called my surgeon's nurse and basically begged for a refill. After 10 minutes of groveling, she relented and approved a second refill. Of course, that was to last only another 6 days—maximum. During that time I was practically overdosing on acetaminophen (aka Tylenol), using 1000 milligrams every 4 to 6 hours, trying in vain to replace some of my doses of oxycodone, so that I could reserve them for extra painful episodes. When I got close to the end of my refill, I was suffering tremendously still, mostly at night (lying on my side in bed was an exercise in teeth clenching torment). Mercifully, I was also prescribed Lorazepam (a benzodiazapine 0.5 mg, for anxiety and to help with sleep). This made things a little bit easier to handle, in that I would be able to eventually fall asleep, but in the morning would be suffering intensely from lying in one position all night.

Although tolerance is a problem when someone is trying to get extra relief over the prescribed amount, ironically, NOT using enough medication can weaken even the normal dose. Opioids must also be “stacked.” In other words, it takes a pill or two for the body to recognize the efficacy of normal use when doses are skipped. If you cut it down to nothing, where you had formerly taken a dose, then take only one pill, it does not have the same power as the continued use on a regular schedule. This can be a maddening cycle of inadequacy.

When I had tapered down to taking one oxcodone a day, trying to deal with almost the same amount of pain as I had after surgery (made worse by a cough), I decided to try getting something else from the surgeon's nurse. It was on a weekend and the physician on call was much more amenable to helping me out. He offered Tramadol (thirty 50 mg tabs, a synthetic and weaker narcotic to be taken 1 to two times every six hours). And, I continued using up to 6,000 mgs of acetaminophen per day, despite the danger of liver damage. Thankfully, by this time (the third week at home) normal daily pain had lessened quite a bit. The difference of having the Tramadol, where I had been stretching out the oxycone was very effective and helped tremendously at first. I had used Tramadol in the past and not gained much pain relief. But now it seemed to be doing the trick. 

I discovered that a recurring cough was due to a psychological response to being around a person I have a difficult time dealing with. When this person was around, my blood pressure also ran dangerously high and I experienced profuse sweating. Although the stress of dealing with this person had been recognizable before surgery, now, the psychosomatic response was much stronger. I don't know why, but apparently the phenomenon of anxiety, re-manifested as physical discomfort, is common after heart surgery for some people. Just a new thing to have to deal with. To rationally continue my treatment of normal chest pain and escape the deleterious psychosomatic effects of this other issue, I have simply been trying to avoid interacting with the person as much as possible while I heal up. I think I will be able to overcome the physical reactions more easily once the sternum is fully healed. At least then, developing the psychosomatic cough won't ALSO be an exercise in physical agony. 

As with most things, overcoming all of this is simply a matter of time. In IWALLK terms it is just another “long distance walk.” I endure it until I get to my destination. While time may “heal all wounds” conscious effort is the true key to controlling pain in all of its manifestations. As I said earlier, it is the mind that ultimately takes control. Only the mind can find the hallway to the shining Exit at the Pain Buffet. I am so thankful to only be stopping by there for appetizers this week; just passing through on my way to a new life. 

Knowing now the full extent of the struggle for finding relief, I have a fresh appreciation for the struggles of the chronically pain-afflicted. I genuinely pray for them and feel for them. I can truly say that what is left of my heart breaks for those who are trapped among the cold, rotting service trays, dirty dishes, unfair policies, and darkened tables of the Pain Buffet. 

When all substances are finally decriminalized and/or legalized, the taxes on their sales are redirected toward the treatment of abuse disorder for the rare 10% who need it, and rationality breaks through the prejudicial and purposefully blinding policies of pandering politicians – handing back the control of health decisions to patients and doctors and away from subsidy-seeking law enforcement agencies – not only will individuals find the relief they need, but society itself will be freed from an ignorance that has only served to unnecessarily amplify its own problems. I would love to live long enough to see a closed sign in the window of the Pain Buffet. But it will take more than the detailed recounting of my story. It will take YOUR acceptance and efforts too. 

Together we can close the place down for good!