Chronic Pain and Painkillers Detox FAQs
How does Chronic Pain affect my body?
Chronic Pain is different from acute pain. In acute pain there are pain receptors (nociceptors) which are designed to detect a painful situation (for example if we put our hand on a hot stove) and then relay that information to the brain. Our brain feels the pain and the signals quickly make it to our consciousness, and we take appropriate action. But in a chronic pain situation a number of changes take place, some of which are not helpful. One of the worst things to happen is that the nociceptors become more sensitive to pain signals. They fire off at lower levels, so that patients actually feel more pain than there really is. Narcotic pain medicines make this situation worse.
Why do Narcotics make Chronic Pain worse?
Narcotic Medicines (Opiates) cause a number of changes in the body when they are taken. Narcotics attach to the body's natural endorphin receptors and stimulate them to produce pain relief, energy, a sense of well being and even euphoria. Unfortunately though, once a patient has been taking Narcotics the brain decreases the production of its own natural painkillers - the endorphins. Without natural endorphins the patient has to take narcotics just to avoid withdrawal and feel normal. And of course medicines always wear off, so in some ways the patient is frequently in some state of withdrawal. In addition to this, once a patient starts on narcotics, they seem to lose the ability to discriminate which nerve signals are truly painful and which are not. Normally our brains receive signals all day long and at a subconscious level our brain decides which are painful and need attention and which ones can be ignored. Once a patient take narcotics they seem to lose some of this ability, so that many nerve signals feel more painful and seem to cause more alarm. In this way patients suffer more with physical pain but also with emotional stress. In addition to this, narcotic medicines have serious side effects. They decrease restful sleep, alter people's memory and judgment, cause constipation and sexual problems, along with many other side effects.
How will stopping narcotics actually improve my pain?
As we can see, taking narcotics for chronic pain leads to a number of problems:
- Patients receive more pain signals than they normally would from overactive nociceptors.
- Patients interpret more of these signals as serious pain and therefore feel the pain more intensely.
- Patients are unable to make their own painkillers (endorphins).
- The narcotics are always being eliminated from the body so patients are often having withdrawal symptoms.
- Patients develop tolerance so they need more and more medicine just to get the same amount of pain relief.
- The medicines cause serious side effects which get worse as the dose gets higher.
Stopping the narcotics allows the brain and the body to return to a normal state. This can take some time, but in our experience our patients almost always report that their pain is reduced within 1 to 2 weeks after they detoxify off their narcotic medicine.
What is the best way to Detoxify off Narcotics?
We usually recommend an outpatient Accelerated Opiate Detoxification (AOD) method because it is so comfortable, safe and quick. The usual way to detoxify off narcotics is to slowly wean them down, but this usually takes three months or more. During this time patients are having withdrawal symptoms all the time and they are quite miserable. Usually they are not able to complete the detoxification because they are too uncomfortable. The Accelerated Opiate Detoxification is a completely outpatient program that is completed in 3 to 5 days. The patient comes to the office daily. They are kept under supervision and take sedatives that make the detoxification process safe and comfortable. Our success with this detoxification is over 99%.
What is the Naltrexone implant?
This is a special formulation of Naltrexone, which is designed to release slowly over a 6-12 week period. It is placed under the patient's skin and so it is effective and does not allow the patient to forget or skip their medicine. A licensed pharmacist compounds the implants for us. While the Naltrexone implant has not yet been submitted to the FDA for approval, the medications it contains are fully approved by the FDA and the compounding process is fully approved by the FDA.
Why use the Naltrexone Implant?
We have found that it is very important to use the Naltrexone implant. When they have an implant, our patients report that their pain is reduced and they usually lose their desire to take any more pain medicines. This may be because the Naltrexone is filling up their endorphin receptors so the receptors are no longer wanting opiates. It may be that the patients stop obsessing over whether they should take any pain medicines because they know that it is no longer an option. Either way, we see that patients are much more successful when they get an implant. We recommend implants for at least 6 months.
What do I do if my pain gets worse or I develop a new pain?
It is always an option to remove the implant if this is needed. Over the years we have had this happen very rarely. If it is necessary to remove the implant then patients can usually use narcotics within about 6 to 12 hours.
Are there any risks and side effects?
As with any medical procedure there are some risks and potential problems. The outpatient Accelerated Opiate Detoxification is very safe but sometimes patients feel some discomfort or too much sedation. Very rarely patients need to complete their detoxification in a hospital. The Naltrexone Implant has been very well tolerated, but sometimes there can be some bruising or inflammation, and there is a very small risk of an infection. As mentioned, it is very rarely necessary to remove the implant, if for example the patient is in a car accident and requires narcotics for acute pain. If patients abuse narcotics they can have an overdose, especially after any period of abstinence. After the implant wears off the risk of overdose can be high if patients abuse narcotics.