Last night I was watching Dr Eva Orsmond’s documentary on RTE 1, Medication Nation. I sat on my sofa with a heat wrap around my neck, debating whether or not I’ll get one for my lower back. I’m in pain. I’m moving around as needed, as I can’t sit still for too long or my back starts to seize. It’s on the back of my mind to remember my tablets before bed, as I have to do every night. I’m listening to medication being called “the easier way out” and I can feel my (currently low, thankfully) blood pressure rising. I live with chronic pain and depression, and medication makes my life easier, yes. That doesn’t mean I’m taking the easy way out.
Ireland has an issue with overmedication, that much isn’t news to anyone who has been paying attention. We’re at risk of making antibiotics ineffective, such is our overuse. Codeine has been an illicit drug of choice for years. For the last few years, it’s been dependent on your pharmacist and how strict they are. We’re all aware of the stories of people starting the day with a Solpadeine as a regular habit. For me, codeine is a staple of my pain management regime. Since it’s predecessors included various opiates including Oxycodone and Fentanyl, for me it’s not something which instantly stood out as a bad thing. While my common sense knows that it’s an addictive drug, in comparison it seemed like nothing. Mine is given on prescription, and has been since the start.
It’s not that I don’t feel the addictive quality of it. Believe me, I wasn’t expecting to. The previous meds had been prescribed in times of sheer desperation. I’ve cried in pain more times than I can remember. I’ve managed to come off those super-strong medications with no ill effects, which shocked me. It shocked me more that I’ve felt withdrawals from Solpadeine and not from the stronger ones. But withdrawals aside, I’m worse off without them, because they allow me to function and get on with my life.
I’ve been dealing with chronic pain for three years now. For the most part I’ve made my peace with it being my everyday. There are days where it makes me angry. I’m angry and resentful that this is my life. It affects my life with my son, my partner, the activities I can do with friends. I do not want to be medicated. I don’t want to have to take numerous tablets every single day. I’ve suffered with angry eczema, dizziness, hot flashes, headaches and at one stage swelled up like the Elephant Man in my search for something that will work to take the pain away enough to be manageable.
In my search for a cure, I’ve tried physiotherapy, physical therapy, acupuncture, pilates, hydrotherapy. I’ve undergone four sets of six corticosteroid injections into my lower facet joints, with more to be administered. The newest addition to the table is a rhizotomy – we’re planning on burning the nerve endings in my lower back. It’s shit, but it’s doing something.
Dr Eva’s documentary made me feel guilty about taking my painkillers last night. It made me doubt my routine of what I put in my body to get by. Having spoken to others who suffer with chronic pain disorders, I was not the only one to feel this way. These are medications carefully thought through between myself, my doctor, my pain management consultant and my psychiatrist. Defining them as the easier solution is a dangerous road to go down – often they are the only solution within a certain time period.
It’s fantastic to advise that alternative therapies and that old nugget exercise are the cure for all. I agree, they definitely have a place in recovery and have made a big difference to me. But at a cost. Physiotherapy costs about 50 euro a session, as does acupuncture. One physio session a week is normally the minimum – which means that for physio alone you’re looking at 2600 euro a year. Add to this regular check ins with your GP (at least fifty euro a month if not more – 600 euro a year), any consultants (An appointment with a pain management consultant can be in excess of two hundred euro for a ten minute slot.), and you’re looking at a bill that climbs steadily. Many exercise based programmes require much more than once a week – one I was quoted cost, on average, 400 euros a month for two sessions a week. That’s before you have to figure out the time, or the childcare, or the ability to get there.
If you can pay dearly, you can skip the queues a certain amount. The waiting lists, even as a private patient, for these can be excessive too. There simply aren’t enough experts in the field in this country. For public patients, it can take in excess of two years to be seen – and that’s before the wait starts for procedures or therapies. For private patients it can be anything from 3-4 months. It is in this space that the pain medications are a necessary evil – you have to get by while you while away the time.
Chronic Pain is not covered under the chronic illnesses list that the Department of Health provides a medical card for. As I’m lucky enough to be in a situation where both myself and my partner are employed, we’re not entitled to even a GP card. I’ve got a running joke that I’m waiting for the plaque on the wall in my GP surgery to mark the extension of an extra room, funded by my GP bills. I’m lucky in that my employer pays for health insurance, something I thank my lucky stars for on a daily basis. Without this, it’s likely I would still be on a waiting list to see a pain management consultant, or, having seen them once, for my first intervention.
For much of the last three years, the Drug Payment Scheme was the cap to my payments each month for medications. In many cases, we were working on a trial basis – lets try this for a month and see how it works. It quickly becomes very expensive to discover you’re allergic to half of the painkillers, and most of the others render you unable to parent or function. It especially becomes expensive to do this while out of work due to said chronic pain. I was one of the lucky ones, covered by a partner working, able to manage on one income and social welfare benefits.
I am in a position where I have two invisible illnesses. Chronic pain, which there is no real test for, cure for, or understanding of in general society, and depression. So much work has been done over the last few years to address the idea of stigma around depression and other mental health issues. When I was in my early teens, it was considered “attention seeking”, now it’s something that’s acknowledged and treated with respect.
Chronic pain on the other hand has gone through no such revolution. We are still at the stage where doctors assume drug addiction instead of genuine pain. I have had doctors unfamiliar with my file look at me and tell me I’m too young to be in so much pain on a permanent basis, that I can’t be in pain ALL the time. People assume you’re an attention seeker, and hamming it up for whatever benefit they perceive you’re after.
As far as depression is concerned, I’m aware that medication is not a long term fix, but it allows me the time to get there. It makes it so that I can live and work and get out of bed in the morning. When you’re in pain all of the time, your mental state can deteriorate. The numbers reporting peristent chronic pain and mental illness correlate to this.
I am not ashamed of my taking medication. Yes, I am angry at times that this is what it comes to. On my lower days, I berate myself for needing a pill to be a good mother. For the most part though, I’ve come to terms with that being my reality for now. I am managing to work, play with my child and enjoy life. I am undergoing therapy and utilising CBT and I hope that soon I will be able to reduce my medication. Eventually I hope to be off it – but not before my doctor approves.
I would be afraid that on viewing last nights show, people will go against medical advice and stop taking medication their doctor has prescribed for a reason. Framing the use of Xanax, Prozac, Sertraline and many others as “hiding behind a wall of drug dependence instead of facing life’s problems” is reductive and is easy to say when you aren’t in the trenches. Many times these drugs are used as a stopgap until the user can gain treatment in other forms. With our current health crisis in this country, it’s a long wait. GP’s should not be berated for doing what they can with such limited choices.
I understand that it is worrying that our society does seem to have a “pill for every ill”. However, scaremongering documentaries like the one broadcast on RTE 1, which criticise GPs for their prescriptions can have a damning effect on those with chronic pain. We are seeing an upsurge in reports of people in genuine pain being denied the medications which allow them to get through daily life in the United States under increasingly stringent rules. For the fear of becoming such a medication nation, we are allowing people in genuine pain fall through the cracks.
As John Lindsay on the Claire Byrne show after the documentary aired said, we need to be clear that addiction and dependency are not the same thing. In our attempts to lower the addiction rates, we are bypassing those with genuine need and dependence on these drugs. My fear is that this focus on GP’s over-medicating will negatively affect those in real pain, as GP’s will become less willing to provide them with prescriptions. In that case, the options will then be stay in pain, or obtain the medications by other means. That’s a whole other problem that’s too big to get into right now. So, what do we do?
We need to be mindful of the harm that painting all medication users with one brush can do. Instead, we should work on an alternative to this medication nation that works for everyone involved. Alternative therapies need to be provided in much larger quantities from our health department. It will lower the amount of pain patients winding up in Emergency Departments – currently the fastest way to get seen for those in pain. It will lower the amount the government needs to spend on drug payment schemes. In addition, it will lessen the numbers affected by side effects which leave other health implications.
We need to make them affordable to all; as pain is not something that should ever be down to a socio-economic class issue, but it clearly is so. We need to listen to patients with chronic pain, chronic illness, and not just dismiss what they are saying . As the people living this reality, we have voices and opinions that need to be heard when it comes to changing how we are treated.
Pain medication is not the easy way out. It’s an essential component of recovery. In our current Health Service, it’s all that a lot of us are able to obtain right now. It is not the patients who deserve this criticism, but the health service that has put us here.
Chronic Pain Ireland has been a massively useful resource for me since I discovered their work last year. They’re full of information and understanding, and you can find out more about what they do at www.chronicpain.ie.
I’d love to start a conversation about this topic – let me know what your thoughts are! Are we overmedicated in this country? What solutions do you see are there? Let me know in the comments or over on Facebook or Twitter.