by Dale J. Ross M.D.
Pain is a unique signal in our human system. It is intended as a signal for harm to our bodies. It is a mechanism to give us an awareness of what could create further harm. A sprained ankle swells up to try and stabilize the joint and to increase tension and accentuate the neural signaling (pain signals) in the area to help stave off more damage by continued use. We elevate the foot to reduce swelling and pressure, which reduces pain. We place ice on the foot to reduce swelling and pressure, to reduce pain. We apply compression to reduce swelling and pressure, and hope pain has lowered enough to make it tolerable to stand on. We take NSAIDs such as ibuprofen to reduce swelling and pressure, as well as to decrease pain signals. If these steps allow function, you can properly use the signals to adjust activity and keep the injury safe while you see what you can tolerate without further harm. Once the injury is known, we can take precautions to protect the area, prevent exacerbation, and promote healing.
This is not the usual case that I have seen followed through properly in many cases, but it is the correct understanding of the process. Often, we subvert the body’s stabilization as above, place an external splinting apparatus, then patients often seek enough pain modifying drug to resume activities that the body is screaming at you to not do because it continues re-traumatizing the injury. Why do we work against the natural process when we injure ourselves?
Years ago, aspirin was potent pain medicine. When it was absolutely horrendous pain the doctor would instruct the patient to take “two” aspirin; this was big medicine. Take two aspirin and call your doctor in the morning was pretty potent stuff. A major intervention was used and your doctor wanted to hear directly from you in the next 12-24 hours. Jump to the next millennium, literally; starting around the year 2000 a transition in the concept of care was just beginning to establish itself. As of the late ‘90s and early 2000, hydrocodone use started to become commonplace outside of the immediate post-operative setting.
Hydrocodone only works to cover up pain; it does not have any role in improving healing or function of injured tissue and joints. If you had an acute appendicitis, you would not expect to receive a prescription for a bunch of hydrocodone and have nothing else done. You would rightly expect the problem, the thing that is wrong, to be addressed. Mankind is pressing for the immediate fulfillment and control of every aspect of comfort and discomfort; be it physical, mental, or spiritual. Without a proper understanding of the context, just using drugs cannot be expected to fix anything and will more likely add to the harms.
Over the years industrialized America has accelerated the role of pharmacologic management – the use of drugs for pain modification as well as other issues. Hydrocodone is one of the most common prescription drugs used for pain modification today. It is converted in the body to active compounds that have the exact same effect as morphine and is the same as morphine in what the body uses and understands; it is not just another aspirin. The United States consumes greater than 99% of all worldwide production of hydrocodone. No other country uses this drug to this extent. Canada still uses codeine products such as Tylenol #3 for the far majority of all post-surgical prescriptions. Codeine is also an opiate, but is considered an “inferior” drug by most chronic pain drug users and known drug abusers because it takes more to get the same effect. Oxycodone, dilaudid, morphine and other drugs are pushing hydrocodone to the point of becoming seen as obsolete as aspirin today, when it is in fact an extremely bioactive and potent drug. The people of the United States are quickly forcing an escalating vicious cycle of building drug dependence upon themselves rather than looking to and working for healthier functional approaches.
Take the sprained ankle example again. A sprain is medically understood to be ligamentous injury, tears, to the support structures of a joint. Instead of limiting activity that harms the ligaments further, opioid use covers up the innate pain signals and allows “work as usual.” This is a common point of concern for patients, “How can I go to work if you don’t give me more pain pills?” Usually the patient is fully comfortable and without pain resting and protecting the injury. It is only with inappropriate use that the pain increases and they “need” something stronger than ibuprofen for the pain. The point is not to cover up the symptoms so much that you can act as if you have no injury. Doing so allows harm and further damage. If the pain is so bad that it takes morphine to stop the hurting to allow you to just walk on the foot, there is real danger of long-standing harm. This also starts to speak to the use of regular daily opioids for chronic pain.
Our bodies were created for greatness; it is a gift we should appreciate. We have a role of stewardship and responsibility for our bodies. We also do not get another one when we tear it apart by good intent, unpredicted happenstance, or poor choice.
Our bodies were created to function without all of these drugs and making the decision backed up by effort to live life differently enough to maximize the health that you should have is not an easy path; until you decide that it is what you really want!
Be sure to read part two of this series: Pain and Prescriptions – Part II