HOOKED ON PAINKILLERS

Treating Chronic Pain Runs Risk

When it comes to prescription painkillers such as OxyContin, there's a fine
line between use and abuse.

The vast majority of people who use a narcotic under close supervision of
their doctor to manage legitimate pain won't cross that line. But it can be
difficult -- sometimes impossible, experts say -- to predict who might be at
risk.

That's why conservative radio commentator Rush Limbaugh's recent
announcement that he is addicted to prescription painkillers he began taking
after spinal surgery didn't come as a surprise to addiction experts.

"It's a line that any person can cross,'' said Ed Carter, spokesman for the
Community Health Center, an addiction treatment center in Akron.

Anyone who takes narcotic painkillers for long enough will build up a
tolerance as their body develops more pain receptors to compensate for the
ones being blocked by the drug, said Dr. Victoria Sanelli, a psychiatrist
and associate medical director of Summa Health System's Ignatia Hall Acute
Alcohol and Drug Treatment Center.

In other words, they'll need more of the drug to get the same relief.

People who use these drugs legitimately also will have withdrawal symptoms
- -- things such as abdominal cramps, nausea, vomiting, dizziness and pain --
if they try to stop taking them abruptly.

But red flags go up when people start taking more of the drug than
prescribed or begin popping pills simply to get a feeling of euphoria rather
than to control their pain.

"Addiction is more than having a higher tolerance and withdrawal symptoms,''
Sanelli said. "Addiction is all the things that go with it: doctor shopping,
going to ERs at night for drugs, exchanging that drug for other things,
using it because you need to sleep better, taking it when you're not
supposed to. It's all the activities that surround the use that make it
addictive behavior.''

There are some people who must be more careful with prescription painkillers
or avoid them altogether.

Those with a previous history of substance abuse, as well as those with a
family history of drug or alcohol abuse, are at more risk of developing an
addiction, Sanelli said.

"We talk to them about avoiding narcotics,'' she said.

Abuse of prescription drugs -- particularly painkillers -- is more
widespread than many people might think.

According to a recent federal report, an estimated 6.2 million Americans
ages 12 and older misused a prescription drug in 2002. Of those, 4.4 million
abused painkillers.

That number far eclipses the number of cocaine users, which was estimated at
2 million. But marijuana remains the drug of choice, with 6.2 million
Americans using it in 2002.

The narcotic painkillers prescribed for medical use all have a similarity to
heroin when abused.

"You feel really mellow, euphoric,'' Sanelli said. "If anything happens, you
really don't care.''

OxyContin, particularly, has become a popular drug for abuse. Unlike other
painkillers, it has a built-in time release mechanism that allows people to
get steady pain relief over a 12-hour period.

People looking for a quick high have learned they can destroy the
time-release mechanism and get an instant feeling of euphoria by chewing the
pill or crushing it.

OxyContin and other painkillers can serve an important role for people
trying to manage chronic pain, such as the nagging, persistent pain caused
by osteoarthritis, said Tim Brown, a clinical pharmacist at West Side Family
Practice and Akron General Medical Center.

"By controlling pain,'' Brown said, "we can actually keep people healthy.
The thing we can't forget is, pain is real.''

In fact, undertreating pain can push people toward abuse, said Dr. Nagy
Mekhail, chairman of the Cleveland Clinic's pain management department.

At the Cleveland Clinic, doctors try to trace the type of pain people are
experiencing -- whether it stems from damage to a nerve, muscle or joint,
for example -- to determine the best way to alleviate it.

Painkillers can play an important role, but many other options exist today,
Mekhail said.

Sometimes the solution involves implanting a stimulator that sends
electricity to the spinal cord to interrupt the pain pathway. Other times, a
tiny amount of painkiller can be administered via a pump directly into the
spine without side effects.

"That's much better than putting people on medications all the time,'' he
said.

David, a 48-year-old Akron resident, knows the struggle of living with
chronic pain all too well.

He asked that his full name not be used for fear of people breaking into his
house seeking his drugs.

Since being injured in a passenger train accident 11 years ago, David has
had numerous neck surgeries and has used prescription painkillers to ease
his stabbing pain.

But after seven years of taking more and more drugs with no success, he
sought help at the Cuyahoga Falls Pain Management Center.

Six years ago, the center implanted a morphine pump under his skin to
deliver a steady stream of painkiller to his spine.

The pump, combined with a regular exercise routine, have helped him use
fewer drugs and regain his life.

"Now I'm able to cut the yard, keep the yard up, vacuum the house,'' he
said. "I do things now that help my wife out a great deal, which I couldn't
do before.''

At pain centers such as the Cleveland Clinic's and Summa's program at
Cuyahoga Falls General Hospital, a team of specialists -- doctors,
psychologists, counselors and others -- work with patients to find the best
options for their individual cases.

"It's a very challenging field,'' said Dr. James P. Bressi, director of
Summa's pain management center at Falls General. "This is one of the most
challenging populations to treat, because the pain is ongoing.''

When narcotics are used, the programs routinely require patients to submit
to regular drug tests to make sure they're not mixing drugs or abusing them.

"We really would like to minimize the amount of medications we give to
anyone,'' Bressi said. "We want to control the pain. We're not intending to
give these medications to be abused."