Painkillers - do they do more harm than good? (long-term)

“We’ll be here when you wake up.” As the anaesthetist pressed down on his syringe, flooding my veins with sedatives, all I could think was: “Please, not too soon…don’t wake me too soon, just let me have this.”

In the long, swollen and sickly weeks after an operation to ‘block’ — or cauterise — nerve endings in my neck, my third and final investigative procedure, it became clear that the last-ditch effort to resolve my mysterious, lingering chronic pain hadn’t worked. Despite everything that was going through my head, the memory of lying there, grinning like an idiot with the cannula in my arm, kept surfacing. After four exhausting, soul-destroying years of investigations, operations, therapies traditional and alternative, endless consultants and a sinking life-raft of painkillers, I was beyond desperate for relief: I had embraced the oblivion of the surgeon’s table like someone checking in to a five-star hotel. I can’t say for sure that I wanted to wake up again.

This was my consultant’s attempt to give me back a life without my cocktail of analgesics — the same pow-erful opiate-based drugs put under the microscope this week by a new, worrying report from the American Academy of Neurology, which laid out the extent of the modern ‘addiction’ to painkillers. There has been a dramatic increase in the prescribing of these painkillers in the UK over the last decade. Such is the growing concern that in the treatment of chronic pain these drugs could be doing more harm than good, the British Pain Society, together with the Royal Colleges, is now revising its opioid-prescribing guidelines.

I have a chronic pain condition, which affects the left side of my body, as a result of whiplash in a car accident. For reasons that still aren’t completely understood, sometimes the body’s protective pain response, which should recede when the ‘acute’ injury or danger is gone, never switches off. My nervous system is hypersensitive due to damage at a molecular level in the spinal cord and brain; it’s in a constant, adrenaline-fuelled state of emergency. As far as I know it’s irreversible. Every day is like living in the most extreme epi-sode of Tom & Jerry: my bones are squeezed in a vice, my muscles are drilled full of nails, there’s an anvil on my neck, I’m encased in ice, burnt alive, and my nerves are twisted like spaghetti on a fork.

Yet, I welcome the questions being asked about the pills and patches that are routinely prescribed for chronic pain. Painkillers, I now understand, are like pressing down on a coiled spring: it pushes back, and if you ever let up, it springs right back to its starting position. They don’t heal, they only hide.

In cases of severe, 24/7 pain like mine, where just turning my head or moving my arm has been known to make me vomit, the doctors tinker with a chemistry set of opioids to find a combination that improves your quality of life. I ran the gauntlet of medicines that dampened the pain but made me feel like I was taking off into space, others that made me wildly nauseous, dry-mouthed, soaked in sweat and restless — each of the drugs so strong that they can only prescribed in tandem with a pregnancy test and contraceptives.

I was finally ‘settled’ on a combination of heavy opiates (including codeine), anti-inflammatories, an anti-convulsant which calms electrical activity around the nerves, and an anti-depressant which, taken at night, punches your lights out. Yet I still woke, breathless, at 4am when the anaesthetic wore off, and my husband would find me weeping in the bath, or on the floor. Daytime saw me climbing out of a deep hole, with electric shock-like sensations in my limbs and trembling hands. I slurred or forgot my words, confused left and right, and even struggled with spatial awareness: I would stagger to one side, as if always slightly under the influence, always altered.

With chronic pain, this is usually all there is. Doctors keep raising the dose because in cases like mine, where yoga can only do so much, and physiotherapy, osteopathy, acupuncture, sacro-cranial therapy, you name it, all bounce off you like rubber bullets, painkillers are all they can offer, with counselling on the side. It’s the principles of palliative care but for people who are going nowhere. In my darkest moments, I wondered if I was going to spend my whole life dying.

As the underlying cause isn’t ever ‘cured’ you need ever-higher doses to feel any relief, and over time it can actually raise pain levels as the body decides to compete. My days-of-the-week pillbox was eventually re-placed by an overflowing biscuit tin. The act of taking them all, one by one, made me feel like a lonely octo-genarian robot. They weren’t achieving anything, but I kept going, supplementing them with heat patches, freezing gels, electric blankets, a fortress of pillows and a wrist splint.

One night my whole upper body seized up: I couldn’t draw breath because the pain was so severe, and I ended up in A&E. My armoury gave me nothing — I could have been taking Smarties. All through the night the doctors attempted to control the pain until at 7am they had to slow down my heart, now more concerned about the panic than the pain. Finally, a dose of liquid ‘oromorph’, which goes like lightning into the blood-stream, allowed me to stop writhing, but still, no sleep.

Life limped on like this for years. I saw many doctors before I met a pain specialist who had the confidence to let the young woman in front of him sit uncomfortably close to the edge of reason rather than risk a lifetime of dependence and unknown consequences. Had I been older, he told me, he would have just hit it harder and allowed me the respite. But at 29, with three years of opiates under my belt, a new husband and hopes of a family, he wouldn’t let me risk damaging my fertility and goodness knows what else, and living with that, too.

He, along with a psychologist, referred me to a residential pain management programme at St Thomas’s Hospital in Westminster, where I lived for a month with a group of patients, all of whom had been told this was their last chance of a better life. The hope, intermingled with dread, felt like we were on the deck of a ship heading into a storm. With chronic pain there’s danger in hope, and we all knew it.

There, surrounded by psychologists, physios, occupational therapists and pain specialists, we were offered an alternative way to cope with all the aspects of life — sleep, relationships, doing up your own shoelaces — that are thrown into chaos by chronic pain: learn to accept it. Acceptance and commitment therapy, an offshoot of cognitive behavioural therapy, reasons that if you can’t change something, stop fighting it and spend the energy on something that makes your life fuller and more meaningful instead.

I had to come to terms with the fact that the pain was coming with me on my journey, but I should put it in the boot rather than letting it in the passenger seat. It was an unfortunate analogy, given how I got here, and at first it seemed preposterous, but it’s the only thing that has worked. I’ve come to realise that the fear of the pain amplifies it, and when it returns, it crushes you all over again. You lie awake at night reading from online forums that are full of desperate people just like you asking, ‘Is this life?’, and feel worse still.

We were encouraged to understand that these painkillers — essentially heroin in respectable packaging — were never going to ‘heal’ anything; the health risks down the line would only compound our suffering and, just as the study released this week explained, most of us were getting very little relief from them anyway. It was like asking someone in hell to go down another few floors, but in the end, I knew I could never have children with these chemicals in my system; even if I couldn’t lift those children when it came to it, I had to take the chance.

I haven’t taken a painkiller for nearly two years. Life is harder, but it’s not worse.

I soon realised that the side-effects of the drugs were as unnerving as the pain itself. I’ve read everything I can find about the science of pain, because thinking of it unemotionally helps me cope. Now I’m no longer suspended in artificial sedation at night, I sleep deeply: I’ve started dreaming again.

Nearly seven years on from the accident, I live with the knowledge that no matter how much worse it gets, there’s nothing that can sort me out. I sometimes watch people taking a couple of over-the-counter painkill-ers for a headache, the kind of acute pain that these medicines are effective at treating, and marvel at it; it’s like a miracle, that pain plus pill equals relief.

If only that was the sum of it, and there weren’t thousands of patients all over the country knocking them back and achieving nothing. Whoever said ‘whatever doesn’t kill you makes you stronger’ wasn’t talking about the drugs, but the pain itself: we assume we can’t handle it, but the body and mind are more powerful than we give them credit for.

I’ve kept the biscuit tin, full of unfinished prescriptions, and on really bleak days I take it down and look in-side. It’s not like an alcoholic smelling a bottle of gin: I don’t want it, but the weight of the tin makes me feel lighter somehow. Given my time again, I wish I’d never taken any pills at all.

Every day is a battle, but a strategic one: it’s like chess, you have to just find a way through — and when you live with a condition you can’t control, that feels far better than surrender.