Because of the recent hysteria about the “opioid epidemic” there have been some discussions by doctors and the CDC about how patients in chronic pain should get over their pain by using “nonpharmacologic therapy” such as massage, physical therapy, etc. Unfortunately their suggestions don’t take into account the cost of such therapy, most of which is not covered by insurance. This often leaves people in chronic pain with no treatment, and the effects of the lack of treatment for long term chronic pain are not something that doctors and the CDC ever address.
For me this is the most frustrating side effect. I can live with a lot of things, but the loss of cognitive ability has massively affected my life. I used to be smart. I graduated from college and always planned to get a masters degree, but now that is no longer a possibility. I look at things that I wrote in college and I don’t understand how I could ever have written them. Back then I took my ability to concentrate and write a cohesive sentence for granted. Nowadays I lose my train of thought in the middle of a sentence, I can’t complete basic math problems, I forget something the minute I hear it unless I write it down, I can’t remember names, I can’t remember words, and on my best days I can barely write a coherent blog post. I miss being able to think.
Last night I was in agonizing pain because I’ve exercised too much this week. I couldn’t go to sleep because I was in so much pain. This is what we chronic pain patients call Painsomnia. It’s a terrible cycle of:
pain –> no sleep –> more pain–> definitely no sleep –> even more pain
The cycle just keeps going and going until you’re in such a massive flare that you can barely function. If I want to live my life like a semi normal person I have to stop the cycle before it starts, and that’s impossible to do without pain medication. My usual coping techniques (yoga, epsom salts bath, heating pad etc.) are not enough to stop the cycle they only help me cope.
Reduced social life
When you don’t feel well the majority of the time you learn to make priorities and usually those priorities are based on survival. When I’m not feeling well I drop off the map. I don’t make phone calls, I don’t initiate texts, and I definitely don’t participate in anything social. If I disappear it’s because I don’t have the physical energy to be interact with other human beings. Not being social reduces my stress levels and preserves my energy for basic tasks that aren’t optional, but it also makes me feel lonely and isolated.
Changes in mood
This is a complicated side effect that has an abundance of interesting science I’m not qualified to decode. However, here’s what I do know about how chronic pain can affect mood:
Chronic pain impairs the hippocampus which is the part of the brain that regulates learning, memory, and emotional processing. Additionally, when you spend a prolonged period of time in pain the brain rewires itself to anticipate future pain, which makes you constantly wary and causes anxiety. You live always waiting for the other shoe to drop, and not surprisingly this can make you cranky and emotional. It also makes it difficult to deal with even small hiccups that wouldn’t normally be a big deal.
It’s not easy to live while you’re constantly waiting for the shoe to drop. I’ve noticed that I rarely look forward to things anymore because I never know if I’m going to be able to do them. Last year every time I tried to make a commitment I would have a kidney stone, so I stopped getting excited about anything. I reasoned that there was no reason to get excited because I’d probably get a kidney stone anyway. This absolutely took a toll on my quality of life, but while I was in it I had a hard time finding a way to change the pattern.
Loss of energy
This is another complicated side effect because it can stem from a number of things all related to pain. Insomnia caused by pain, depression caused by pain, inflammation, non restorative sleep, or just because after a while pain wears a person down draining their energy and sapping their motivation. Pain also wears down your immune system and changes your sleep habits which can lead to long term fatigue and there’s no easy fix.
Doctors often pretend that pain is a mind over matter kind of thing, but the truth is that being in constant pain wears on your body no matter how much “nonpharmacologic therapy” you try. If we’re really going to have a productive discussion about opioids and chronic pain the long term side effects of chronic pain need to be part of it.