Chronic Pain

Opioid Dependence and Mental Illness

/ Robin

Pile of pills

I’m not an addict. I’m not! I’m mentally ill. I have Bipolar Disorder. I also suffer from chronic pain in my lower back.

My primary care doctor (PC… PCD? Uhh… let’s go with MD) had been prescribing me oxycodone for the server and persistent (chronic) pain that I’ve had for years. After being active and doing something super strenuous like gardening for 15 minutes I think I’m dying. I’m exaggerating of course, but when I work as hard as Atlas does while holding up the world my eyes leak, I whimper and sit down. Sometimes I end up laying on the floor. The floor is such a very bad idea. If I straighten my legs my whimpering becomes desperate and I realize I’m crying. If I forget myself and straighten my legs I’m done. I can’t move. The pain paralyzes me.

I’m NOT an addict.

When I can think again, I try to find my phone. If I can’t find it right away I feel the panic rising and it triggers thoughts and emotions I thought I’d had under control.

This last time I thought I was managing my mania and depression (mixed state, rapid cycling) pretty well. I haven’t bought piles and piles of books on ducks or Oprah or how to be an astronaut. Honestly, I really haven’t. But please, don’t ask me what I’m thinking about. Also, I’ve been able to get out of bed AND wake-up in the morning and even go for walks. My depression skips through the dandelions with the mania comingling into a mixed state, which is always confusing.

I’m not an addict.

After many months of giving me a legal way to get my the Oxycodone I take for pain legally, and for free. The label on the bottle says I’m to take the little unassuming pills three times a day. They are 20 mg. Currently, I’ve convinced the assistant fellow at the pain clinic to reduce my Oxycodone to 20 mg twice a day.

I’m not an addict.

I’m mentally ill. I have Bipolar Disorder, ADHD, chronic pain, and other stuff.

I was referred to a pain chronic clinic… ah… chronic pain clinic, where my Oxycodone prescription was reissued. A five-minute verbal probe, that’s what it took for the doctor to determine whether or not I needed the narcotic. We didn’t talk about Bipolar Disorder or any potential interactions the Oxycodone might have with drugs that are meant to manage my wild emotions or tame my fantastic panic attacks. I’m not certain she has any record of my current medications. She asked questions, and I quickly tailored my answers to fit what I thought she was waiting to hear. She made a few notes on a paper as small as her palm. I wondered if she was actually making notes that she could refer to later. She thought for a few seconds and then wrote the prescription. I sighed in relief.

I’m not an addict.

A while later, like over a year or maybe two, I’m still taking the narcotic. The clinic has new owners and staff. They no longer asked me questions. Sometimes they required a urine test. Then, they stopped asking me anything at all. We spent my appointment chatting. I started asking if we could please try to figure out what was causing the pain and try to deal with it by correcting the problem. I wanted the pain to stop.

They didn’t listen. They wrote the prescription without hesitation.

I’m telling you, I’m not an addict.

My mental health drug dispenser began paying attention after I updated her about my drugs and included Oxycodone in the list. She stopped talking about whether or not my meds were working to stabilize my moods and started talking about “Black box” warnings.

She had my attention. I started to panic.

At the time I had over five medical people prescribing medications. They didn’t know what the other office prescribed me. They relied on me to tell them the truth. I didn’t have to tell anyone I was taking Oxycodone. That got me thinking.

I’m not an addict.

Later…

I’m still asking the medical folks to figure out the cause of my chronic lower back pain. I’m still not getting results. I’m getting way too much Oxycodone every bloody month.

Because I can, I’ve been researching my of collages of illnesses, disorders, and psychological malfunctions.

Ah ha! Black box warning. Do NOT take anti-anxiety medication (benzine’s) – death may result.

Oxycodone 20 mg

I recently saw Dr. T, my very superior knee surgeon. He saw the condition of my spine when he was looking at the x-rays of my hips. He was making certain that my persistent knee pain, post second replacement, wasn’t being caused by anything running amock in my hips. He was eliminating any possible cause of my knee pain before he even considering using surgery to further correct the inept effort Dr. B made the initial knee replacement. Dr. B successfully replaced my knee, but that’s where the project ended.

It sucked. My leg from the knee down, well, it kind of turned the wrong way.

Dr. T corrected the first replacement. He tried to minimize the damage his surgery could do while trying not to blow up my entire joint… okay, the joint that was already gone.

Dr. T showed me the x-rays he’d just had taken and explained where and why he left Dr. B’s “efforts,” while replacing the replacement. A month ago we tried a shot to relieve the pain and keep from having to have surgery again.

Nope. I’ve had no relief from the pain. In fact, my brain was overjoyed and thought that my knee was doing awesome. Holy cow! I should NOT have knelt down like that! Looks like surgery is probably what our next conversation will be about. I’ll need to be on pain medication again…. I intend to be off Oxycodine ASAP. I would really like to have some kind of painkiller to take after surgery – assuming I have it. Always be prepared! Sigh…

I’m not an addict.

After my constant complaining about my back pain that happens every time, I do regular human type activities involving the lower back. I’ve finally had x-rays of my back taken. Holy heck. Next stop is at a spine doctor.

The online personal information provided by my medical organization includes this: Opioid Dependence.

My chronic pain clinic instructs me to continue taking the Oxycodone. I haven’t been able to identify any specific relief from the pain in a long time. I have never felt any “fun” results from taking it. It has never made me feel sleepy.

I have found that taking Oxycodone at bedtime with the medication I take for Restless Legs Syndrome (RLS) helps me to get to sleep and not wake up in agony caused by the RLS.

Am I an addict?

“Taking opioids over a long period of time produces dependence, such that when people stop taking the drug, they have physical and psychological symptoms of withdrawal (such as muscle cramping, diarrhea, and anxiety). Dependence is not the same thing as addiction; although everyone who takes opioids for an extended period will become dependent, only a small percentage also experience the compulsive, continuing need for the drug that characterizes addiction.”*

I’m mentally ill. In my opinion taking any medication, especially one that alters my brain chemistry (opioids do this), should be thought about and discussed with other medical personnel who are also responsible for my continued living – and to live my best life.

Am I an addict?

No.

I have Opioid Dependence.

Dependence. I can live with that, but look, let’s get rid of that too. Okay?

{I have Bipolar Disorder. I’m a little manic now. I’m using it to write and post while I can. So, for now, I will post often because tomorrow, I may be depressed and unable to say what’s on my mind. I may not have anything on my mind.}

* https://ghr.nlm.nih.gov/condition/opioid-addiction

Bipolar – I Think You Should Take Fewer Pills

/ Robin

I’m going to notify my counselor that I must be rid of my med provider as soon as it can be arranged. I’ve told Arthur, my counselor, that I don’t feel that Jamie (med provider) is working in my best interest. My next appointment with her she started right off by confronting me about what I’d told Arthur. I confessed thit it was true.

It got me no where.

She says that I’m on too many pills and she doesn’t want to add anymore. Apparently, this is her rational for not giving me medication that might actually have helped me.

I’ve been practically begging for something for my anxiety that only get’ s increasingly more consuming with each passing day

This whole school year has been like a nightmare.

She doesn’t want to give me more pills? Bull!! It is not her choice to decide whether what other doctors prescribe me for illnesses she knows even less about than I do.

She has repeatedly used this as an excuse not to give me something that could prevented me from my brake down. I have high cholesterol, my thyroid is out of whack, I have chronic horrible lower back pain, I have FM, RA, OA, a facial tick (probably stress related), PTSD, and have recently been diagnosed with IBS-d. It’s a crap load of stuff, but they have all been dealt with by someone more intelligent than she is.

I’ve asked each and every visit for something to help with the burning anxiety. She refuses. She gives me fewer chill pills.

Does she think I like taking a handful of pills twice a day? Moron.

I’ve finally had a breakdown. I blame her. In December I confessed I’d been having thoughts of harming myself. I’d hidden that for years, but at that point it was too much, and I confessed it.

She did nothing.

If I can’t trust my med provider to guard my mental wellbeing, than who will? There aren’t many options here.

I’ve started to shake, Twitter, and twitch again. I’m graduating today. My anxiety that mixes like a charm with my mania and depression making my constant mixed state even more confusing and painful. It’s too much to handle anymore.

I’m firing her. She truly doesn’t have my best interests in mind. I don’t need one of my medical professionals contributing to my madness. That’s just sick.

A Confession & Positive Med Visit

/ Robin

CONFESSION – Impact of Bipolar Mania – 
In the last few years, I’ve accumulated 15 websites, blogs and email accounts.

Yesterday I visited with my Med Provider Jamie. She finally heard me. She decided that my mood stabilizer wasn’t working, so she’s increased it and has me taking it twice a day instead of just once.

When I first got there, she started by saying that my counselor Arthur had told her that I really felt that she was doing me more harm than good in her treatment of me. I said yes, I felt that way. Then I explained why. I have been feeling at least as bad as I did when I wasn’t being treated at all with meds for my illnesses.

She also agreed to talk to my Chronic Pain Management guy about taking medications that it is strongly suggested that they not be taken at the same time. He didn’t agree with her stance on the subject. I want to mention that I’m almost completely off my pain meds now. (Boy am I feeling it.) I’ve done this so she’ll stop complaining that I can’t mix my meds (a Benzo and Oxycodone). The problem is, and I should have realized this before I lowered my pain meds, that at the clinic I go to they don’t want me taking the Benzo at all. I felt threatened when she informed me that some of the providers there would just cut me off right now. I responded by pointing out that she wasn’t doing anything about my super massive anxiety.

This last quarter I started having outbursts in one of my classes (4 times in one class the professor had to come and get the guy I was arguing with and myself to be quieter). It was humiliating.

I’ve also been experiencing rage. It’s been a really long time since I’ve felt this bad. I admit… I’ve been really scared that a meltdown is coming. Now that she’s adjusted my meds, I feel like things might get better.

Bipolar – Med Provider Day

/ Robin

I’m unstoppable.

I’ve been trying to sleep, but it eludes me like a chicken running for its life.

I’m going to see my med provider at 10 in the morning today. I hope she listens this time. If she doesn’t I’ll be requesting someone else and informing them of why I’m choosing to under go all the stress that comes with a decision like that. I’ve had enough.

I’m going to confront her with the facts. I’ve been keeping a list of my symptoms since I saw her 30 days ago. It has grown quite long. It looks even worse than before I was being medicated.

I’m unstoppable.

My pain management guy and I had to ween me off one of the long acting pain killers I’ve been taking for a couple of years because of supply issues. I went from 100 mg twice a day to 50 mg over night because there wasn’t anymore to be found anywhere. No one knew it was going to happen so there was no helping it. It didn’t feel so great. Then we kind of gradually weened me off the rest. Now my pain level is constantly higher. Also, the torn fascia in my foot still isn’t healed. It’s painful. I got special shoes for it today. But as the compassionate woman said while I walked around and around testing shoes, my foot was going to feel soar and tired. It still is. It wasn’t fun.

All this has added to my overall stress level, as you can imagine. Withdrawal is never a good time, nor is added pain.

I’m unstoppable.

I will be thankful if my counselor, Arthur, can make it to my appointment. He said he’d try. He feels it is important for her to understand my mental state from his side of the equation. He’s been with me two previous visits.

It hasn’t helped.

I’m still choosing to be unstoppable.

I may stumble, and I may fall over and over, but this damn illness is not going to continue to run my life. I’m very ill. I’m too exhausted not to fight anymore. I feel like my life has been a waste.

I’ve had enough.

I’m unstoppable.

Help me. Or, stay out of my way.

I refuse to stop!

Angry, Raging, Bipolar

/ Robin

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I scared the ever living poo out of my fancy beta fish a minute ago. I don’t think I’ve ever seen Victor move so fast! He hid on the bottom and refused to take his dinner from me. All I did was walk up to his tank when he didn’t see me coming.

Fish. I feel rather like a fish.

You’d think we’re fish as much as we’re listened to when time after time we beg for different medication. Something has been going on with me mentally for around 3 or 4 months. I just thought it was growing anxiety because I have one more quarter to go and then I’m finished with school. I’ll need a job. I’ve never been able to hold a job for over a year. Even my own brother had to fire me because of my behavior, and my anger.

I take that back, I have worked for longer. When I worked for myself, I was able to manage to work with the management.

This feeling that’s been growing… I told my family in December that I’d had thoughts of hurting myself, and I honestly was. I’d had those feelings on and off for most of my life. Telling them seemed to help. Maybe it did. I felt that way tonight for about 10 minutes.

Then despair, anxiety, rage. Do these feelings take your face and squeeze it till it aches with the pressure?

Anxiety. It has been growing in my mind like a pustule about to burst black tar all over my mind.

I came to understand yesterday, through thinking over the end of the quarter problems and verbally fighting very loudly with another student – repeatedly, a colonoscopy I had to have two days in a row, a painfully torn fascia in my driving foot in December that is still painful (I’m so sick of this boot thing. It causes a painful lump on my shin bone.), intestinal troubles since Christmas, and runaway away anxiety I continuously tell my med provider about (I even take my counselor with me to make sure she’s listening. Oh yeah, that’s working great.)… I get it. I’m in a rage.

I used to live every day, every moment consumed with rage. I wasn’t a good kid. I wasn’t fun for my family to be around. My mother has finally agreed with me that I was, a terrible child. I was full of hateful and blinding – rage.

I have those feelings again. The ones I fought so ineffectively to be rid of. That consuming anger. I feel like I’m about to blow up on someone who probably did nothing to me. It’s just this thing my brain does sometimes day after day, month after month til years are wasted in fury and hate or like now when I’ve been crying out in fear and pain only to be ignored by those I dutifully trust my life to.

I’m so angry. My mind burns and I want to break things and hit stupid people. But I don’t.

I am often moments from saying things that could get me kicked out of school or arrested. But I don’t.

I’m so tired of fighting all the time. I just want to have a life free of pain. No more arthritis or Fibromyalgia. No more being too big to be healthy. No more chronic back pain. This is no life for me. This isn’t what I signed up for. I’m SO ANGRY! It’s like emotional cancer that manifests in feelings that most people can say they understand, but they don’t. Not really. If you have Bipolar Disorder Type 1 and you have had violent, angry, manic episodes you probably understand.  If not, please don’t give up on me.

Question is: what’s gonna give?

Addendum: Read on, please. This changed everything.

This morning I was listening to a TED Talk called, “the role of human emotions in science and research. Great title, right? Sounds like just what I need. At the end of her story, Ilona Stengel said this: I do not suggest that we should use feelings instead of facts. But I say we should not be afraid of using our feelings to implement and catalyze fact-based science and innovation. Emotions and logic do not oppose each other. They compliment each other. And they reinforce each other. The feeling of being dedicated to something meaningful, of belonging to something bigger, and of being empowered is crucial for creativity and innovation. Whatever you’re working on, make sure that it matters, and take it to your heart as much as you like.” [I’m pretty sure this isn’t a word for exact word match.]

Suddenly I understood. All my life I’ve believed I’ve had a purpose. I thought it was within the church, but I was always told, “No, it’s not time now Robin.” And my heart would be broken and my life stripped of meaning.

I believe without meaning, we relinquish our lives to the feelings I have been feeling. For this moment, I remember the meaning of my life. It will not be easy to follow. It incurs great emotional risk (something people with Bipolar Disorder should try to avoid). But if I can remember it. If I can remember it every moment of every day, I won’t have to rely as much upon others for the stability of my mind. My mind will be fighting my emotions with logic. I’ve done it before and I’ve succeeded. I must try again. My children have left my home. They’re all grown up. That role of the parent is gone. I feel like I have no purpose.

But I do. I do. I’d just been swallowed alive by the vomit of extreme emotions that allowed rage to consume me. For this moment. For this morning. I say no.

She said: “Whatever you’re working on, make sure that it matters, and take it to your heart as much as you like.” I am taking up my mission again. I must. If I don’t, then what’s the point? 

Do you understand?

What’s your mission? Tell me.

Robin