In light of this nation’s PAINDEMIC with an ever-increasing use of opioids medications, there is a strong motion by the Drug Enforcement Agency (DEA) to decrease the opioid availability to the general public with the recent change in the scheduling of hydrocodone. Hydrocodone is an opioid usually used in combination with acetaminophen (e.g. Norco, Vicodin) to help with severe chronic pain or for acute pain, such as after surgery. Hydrocodone was previously a Schedule III drug but now has been changed to Schedule II in the United States as of October 6, 2014. What does that mean? No longer can a patient have a hydrocodone product called in to the pharmacy. The patient must carry the written prescription to the pharmacy to have it filled. This is radically changing the landscape of pain medicine, which will likely continue to evolve.
Many of the opioids out in the public are being used to treat acute and chronic pain. Unfortunately, as many Americans are beginning to learn, there is risk associated with higher doses or when opioids are combined with other drugs that decrease the drive to breathe. That risk is making some of the general public and physicians re-evaluate the necessity of opioids, especially since they typically do not relieve most chronic pain to any significant degree. But why does acute pain become chronic? Well, that is the million dollar question. The medical field is getting a sense of how powerful the nervous system is with modifying the pain experience; yet, there is still much to be learned.
Pain has been the invisible burden for generations with a negative connotation. Yet, do you know that feeling pain in certain situations can actually be a good thing? If you touch a hot stove and feel pain, then you will retract your hand in order to avoid devastating or permanent injury. But, what if you were born without the ability to feel pain? Is that possible? Well, there are actually individuals that have mutations in a gene, such as the SCN9A gene. A mutation in SCN9A is associated with congenital insensitivity to pain. Believe it or not, these patients must remain vigilant with their surroundings as their body does not warn them via pain that there is a threat to life or limb. There could be a deep laceration or broken bone without any feeling of pain. Obviously this could be life-threatening if there is significant blood loss or infection if not addressed promptly. Or imagine a child chewing their tongue off because it felt fun but no pain! This is not a typical problem a parent would have with their child if pain is experienced.
So, why do I bring this up? Pain is intended for survival of the human species; yet, many of us abhor the idea of any pain, discomfort, or inconvenience in life. True, some acute pain is unbearable. Some pain is just plain horrible, not just due to the experience itself, but because it may be associated with a concerning condition. Yet, most pain is not life-threatening if red flags are ruled out. Some pain may be a wake-up call that we should take care of ourselves better, such as losing the extra 100 pounds that we put on that likely led to knee, hip, or low back pain. Then again, some pain may be a source of mystery that the world of medicine still needs to understand. But, when we realize that most pain starts out trying to tell us that something is not right or warning us of danger, then SOME PAIN IS GOOD.