Is it really pain management?

I had a difficult time getting to sleep last night and it seems that I have developed a tolerance to the pain meds as the pain over the last 3 days while low, has been about a 4-5 even with the meds. This morning I have already had to take the breakthrough meds just to get comfortable and even sitting in the recliner is not helping much.

The numbness and pins and needles returned to my leg and foot last night. The throbbing goes from mid thigh all the way down to my Achilles tendon where it blend in with the pins and needles across the bottom of my foot. I about took a spill coming down the stairs to let the dog out this morning because I had a difficult time telling when my foot was firmly on the stairs. With such a steep staircase that would have sucked big time.

I decided to look up and read more about tolerance since it seems I am indeed developing it towards my meds.

Tolerance

Overview
Tolerance occurs when the repeated use of a chemical substance, taken to improve mood, has a diminished effect, and more is needed to create the same mood improvement. This change, which is the brains response to repeated substance use, is caused by the brains ability to adapt to or compensate for the presence of a chemical.

Because tolerance develops when a person uses drugs or alcohol repeatedly, tolerance can be an early sign that the person is developing an addiction. Unfortunately, physicians rarely ask about tolerance and regularly miss the opportunity to identify early addiction. Even if a physician questions a patient about tolerance, an early diagnosis of addiction is difficult if a patient is in denial and answers dishonestly.

Some substances cause tolerance to develop more rapidly than others. When narcotics are used regularly, tolerance develops in just a few weeks, and higher doses are needed to have the same effect. The body accommodates to increased amounts of narcotics. If the narcotic is withdrawn, the body's altered chemistry is imbalanced, creating physical discomfort known as narcotic withdrawal syndrome.

According to the above it can be as little as a few weeks to develop, so I decided to see what Web MD had to say and came across this chat transcript in which the guest speaker was Dr. Allen Lebovits. The transcript goes for several pages so I will not cut and paste the whole thing, just the opening. It is an interesting read and he discusses some of the myth behind the use and prescription of oxycontin in chronic pain situations. He points that the use of opiods like oxy and MS-contin are probably better alternatives for pain management versus drugs like darvocet and hydrocodone.

He also discusses the under-treatment of pain due to the myth of addiction, which not only patients need to overcome but so do my doctors as well as the method of removing one pain medication while adding another by tapering off one and slowly adding the other at the same time.

Addiction is the behavioral phenomenon and addiction can be defined as compulsive use of a substance. It's also characterized by lack of control, so you lose control over yourself; you tend to focus very much on the drug. In fact, your whole life becomes the drug, obtaining the drug, and when are you going to get it next. You become preoccupied with obtaining the drug. This happens even when you are harming yourself.
Physical dependence refers to developing withdrawal symptoms during abstinence. In other words, if you're taking a certain drug, and we're talking here about opioid drugs, and you suddenly stop it, it is normal for you to go through withdrawal. That simply means you have developed a physical dependence.
Tolerance , once again, is a normal physiological process and it refers to the need for an increased dosage in order to produce the desired effect. So what this would refer to in pain is when a patient needs more of an opioid in order to obtain the same degree of pain relief they've had on a lower dosage.
Now I'm referring to opioid and narcotics as interchangeable terms. In the medical setting we prefer to refer to it as opioids, rather than narcotics. I'd like to explain one more term, and that is something called pseudo addiction . That refers to when a patient is not getting enough of an opioid, in other words they are undertreated for their pain. They will develop symptoms similar to addiction, so they will require more of the drug and may even engage in some addictive behaviors, but the reason for that is that their pain has been undertreated.

This is an interesting read with some great questions I think we have all asked or wondered about. Armed with information like this, it is easier to help the doctors determine what is the best method of pain management and how to proceed. Of course in order for your doctor to help you, you must be totally honest with him/her and get over the fear of discussing certain issues with them. They are health care providers and have seen and heard it all, they will not embarrass you nor will they think ill of you. I have had to reveal things that I would normally only discuss with my wife to my doc (who is a women BTW) in order to determine the best possible path.

I think the doctors take on being cared for by your PCP versus a pain clinic though might be off base a bit. I have been to a pain management clinic and it was because of my time there that I have arachnoiditis. My time in pain management clinics taught me that ALL pain management docs I saw like to stick you with things. Like I said above, talk candidly with your PCP and if they are a competent doctor you should not have a problem.