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Getting Off Painkillers

Getting off painkillers for chronic pain managementGetting off painkillers is not easy for anyone who suffers chronic pain. But while giving up these drugs can give you a significantly better quality of life, to successfully leave these drugs behind, you need a definitive plan and a concrete strategy.

Chronic Pain

From headaches to arthritis to back pain, chronically recurring pain is all too real for those who suffer. Early in my career as a physician, I did not understand the serious distress of ongoing pain until I endured a long recovery from my own major abdominal surgery (total proctocolectomy). I endured six long weeks of serious pain until it subsided enough to be controllable with just ibuprofen.

However, many people’s chronic pain has no clear cause. Through my years in medical practice in Utah dealing with many patients hooked on narcotic pain relievers, I’ve discovered that chronic pain is a complex puzzle. Myriad thoughts and feelings contribute to pain perception. Psychological factors complicate the situation. And the thoughts and feelings associated with chronic pain can become blurred in the addiction and side effects of the drugs used to control the pain, which worsens the perception of pain. Without doubt, chronic pain is exacerbated by depression, anxiety, fear and similar negative emotions. Sometimes, the pain is the negative emotion itself, and pain relievers help numb those emotions.

Chronic Pain Relievers

In the medical profession, we are always careful to identify patients who are on addictive pain relievers for too long. After a while, these drugs distort pain perception, increasing sensitivity. Consequently, as you become more pain-sensitive, you grow more dependent on these drugs. They also lead to depressed mood and poor sleep. That’s why I always ask patients whether they want to get off of them and whether they want some guidance. Usually they say no because they just don’t understand how their life can improve.

The most common medications that cause long-term problems are the narcotic pain relievers like codeine, hydrocodone, oxycodone, hydromorphone, meperidine, etc. These drugs act on the brain to blunt pain perception. At the same time, they also cause an alluring high that soon yields to a distressing letdown when the pharmaceutical wears off.

After continual use of these drugs for longer than three weeks, getting off the drugs becomes a problem. You will likely feel withdrawal symptoms if you go off them abruptly, and the withdrawal effects are worse the longer you have been on these drugs.

The withdrawal symptoms create the opposite feelings of the drugs’ effects. So, instead of pain relief, you feel more pain. Instead of constipation, you get diarrhea. Instead of soothing emotions, you feel down in the dumps. Instead of being relaxed and calm, you feel anxious and worried. Instead of enjoying heavenly reassurances, you suffer hellish punishment. There’s no way around it: Getting off these drugs causes distress.

You have to expect these types of opposing symptoms whenever you come off of centrally acting drugs, whether they are pain relievers (narcotics such as codeine), stress relievers (benzodiazepines such as Xanax®) or recreational street drugs like methamphetamine. Any drugs that make you high when you take them will make you feel very low when you stop.

Getting Off Meds

In planning to get off a drug, you have to assemble a strong social-support team. Don’t go it alone, or you’ll struggle and probably fail. You must have someone who can talk to you often, guide you through your emotional struggles and assist you with cleansing and healthy food preparation. The process may take from one to several months, depending on the dosage you’ve been on and for how long.

You will need to establish a plan for sleeping well. You can use many herbs to improve sleep such as valerian root, passion flower, kava and even the supplement melatonin. A good sleep habits review is found at http://www.helpguide.org/life/sleep_tips.htm.

You’ll also need a daily exercise program that you can perform without exacerbating your current pain symptoms. You may need a professional to guide you with this, such as a physical therapist to teach you stretching and flexibility movements. Your exercise must be enjoyable and mood elevating. This can be walking, swimming, stretching, dancing (such as Zumba Fitness®; watch at http://www.youtube.com/watch?v=Vf0q6qtThF4), or anything that gets you moving your body.

Stress reduction is huge key to success. (And don’t forget that stress is often a major cause for chronic pain.) So whether you relieve stress with massage therapy, love making, fun movies or an enjoyable hobby, you must be able to feel passion and bliss. Feelings of passion for an activity, excitement or enjoyment in social groups cause healing endorphins to surge in the body, which partially overcomes pain. Such feelings assist in rerouting the brain’s pain neuro-pathways so that pain perception decreases.

Nutrition Assistance

You also have to put a nutrition plan in place. A liquid cleanse for three to five days, followed by many days of fresh juicing assists you in detoxifying and cleansing your body of all the medications you have stored in your body fat and organs. Then, by making your food consumption predominately raw and cooked whole foods instead of refined and processed foods, sugars and oils, you nourish your body and mind. This alone helps decrease chronic pain.

Before you start your long, slow taper off narcotics over weeks to months, experiment with other medications for pain control. These can be ibuprofen, tramadol and even the slow-acting benzodiazepine drug chlordiazepoxide which helps to take away withdrawal symptoms for a few weeks. The use of methadone and buprenorphine (Suboxone®) is needed only for high-dose drug withdrawal cases. Remember, your goal should be to stay psychologically and emotionally on the path of getting off the addictive drugs, while overcoming the pain’s causes. Then, natural, milder pain relievers can be used until you can get completely off these, too.

Natural Pain Relief

Herbs and supplements that can effectively ease pain include: berberine, boswellia, bromelain, capsicum, Chinese skullcap, curcumin, holy basil, quercetin and willow bark. Some of these are known to offset pain by acting as Cox-2 inhibitors, restricting enzymatic action (like the prescription drugs Bextra® and Celebrex®), that can otherwise cause pain.

Other supplements knows to lower pain are fish oil, MSM (methylsulfonylmethane), SAM-e (S-Adenosyl methionine) and GABA (gamma-Aminobutyric acid).

The key to getting off addictive chronic pain relievers is more than finding a perfect pain reliever in natural form to use as a replacement. Instead, you need to shift your lifestyle to decrease your need for pain relievers. A big step toward this goal is down-regulating your sensitivity to pain (getting off the drugs that increase pain sensitivity). Also, you must increase your physical activity, mental focus and passion for life. In these ways, the neuronal pathways of pain and the need for the narcotic drug diminish.

Even with extensive knowledge of how to get off pain relievers, the process still often requires professional assistance. These include facilities with comprehensive programs that work in coordination with medical doctors familiar with chronic pain and drug rehabilitation. I’ll discuss this in more detail next week.

To your continuous health and happiness,

Michael Cutler, M.D.
Author, Easy Health Digest

Dr. Michael Cutler

is a graduate of Brigham Young University, Tulane Medical School and Natividad Medical Center Family Practice Residency in Salinas, Calif. Dr. Cutler is a board-certified family physician with more than 20 years of experience. He serves as a medical liaison to alternative and traditional practicing physicians. His practice focuses on an integrative solution to health problems. Dr. Cutler is a sought-after speaker and lecturer on experiencing optimum health through natural medicines and founder and editor of Easy Health Options™ newsletter — a leading health advisory service on natural healing therapies and nutrients.

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