Comments on: Abdul Kicks Painkiller Addiction

"American Idol" Judge Says "I Could Have Killed Myself"

[FlamNgoil]

As a member of the painfoundation.org and a long time chronic pain sufferer, I am saddened
and discouraged by your coverage of yet another celebrity pleading that the evil pain drugs are at fault for her problems, without a factual response from a physician who is well versed in pain medicine.
We have a major crisis of untreated pain in this country. You could help to make great changes in the lives of those who endure pain daily, and more and more often have nowhere to turn for help.
Both patients and doctors are targets in a state and federal witch hunt, which gained momentum with the "Hillbilly Heroin" stories of oxycontin, though they actually involved only a relative few, and were blown out of all proportion. Many find it is not worth the worry of losing their license to treat the many, due to the few, like Ms Abdul who are abusing their medication. That is why so very many cannot find an understanding physician to partner with them in controlling their pain. While the pain cannot be taken away completely, it can often be made more endurable, so that we can at least get up, and do some of the very basic things most people take for granted, rather than being isolated in a physical and emotional prison of pain.

The misunderstanding of the terms addiction and dependence continue.
Those who take even the most notorious medications...which also happen to be the safest and most effective do not become addicted, or feel "high" from them! The body uses them when one is in pain. We who need them, have a healthy respect for them, and do not abuse them.
Conversely, someone who is not in pain, has a psychological problem that they're self medicating with pain drugs and muscle relaxers as Abdul did, will feel "high" as she admitted.

Some mistake the physical dependence which comes with taking them for a long time with addiction. If - by some reason the patient no longer needs the medication, they can slowly be tapered off, and the sweating and chills Ms Abdul made reference to need not be endured.
Many non-pain drugs must be weaned off of slowly, or risk life threatening consequences. As you can see, there are far too many half truths and misconceptions in this area, which only lead to more needless suffering.

It's my hope that in the future, you will look into this national crisis. It is not one that you are aware of until it impacts you, and the many who suffer are not able to swarm the streets in protest, someone must state the facts and sweep away the cobwebs of ignorance and lesser journalists who have made this into a problem.

Thank you

[boxerlover5]

The percentage of people who suffer from chronic or intractable pain that become addicted is only 1 - 3%. The focus instead needs to be on the people who suffer from chronic pain that cannot get adequate pain relief because of the misinformation and fear about pain medication. The time has come for those of us in pain to have our rights recognized and for us to stop being punilized because of those who abuse drugs. Lets see a story about chronic pain and the difficulties that chronic pain sufferers have to go through in order to be adequately and usually under-treated. We are here and it's time for us to be heard!

[tntitanfan81]

Is this Dr. a pain dr.?? and as for Paula I read a few years ago she was cured of RSD whic as far as I can read up on it since I was told I had it from having 5 hip replacements done in 6 months in 2004 that this does not have a cure only treatments and if she was in Drs care she should have never became hocked on the pain meds.My Dr. will NOT but give me so many a month this si to protect her and me. I sure could not do what paula does on Idol as far as the hours she has to set in a chair of course maybe that is why she gets up from the chair as mach as she does BUT dancing now that's another story
God Bless all that live with RSD everyday
Vicki
Lives with RSD 24/7 since 2004

[Mediaquen]

I am absolutely appauled by the irresponsible reporting from Dr. Jennifer Ashton regarding the news story on Paula Abdul. It is so obviously apparent when a doctor has no training or knowledge whatsoever regarding the appropriate treatment of chronic pain by referring to the variety of pain medications available, merely as 'narcotics'. Additionally, for a doctor to clearly not understand the basic difference between tollerance or physical dependency and addiction, is both disturbing and ubsurd. I even shutter at the use of the term 'pain killers', as it only feeds this hysteria in a country where citizens are primed to believe that anyone who takes a paid medication for more than a week is an 'addict'. Is there abuse and misdirection of these medications? Of course there is. But to the millions of us who live daily with unrelenting chronic pain and take our medications as prescribed, we are done such a disservice by irresponsible reporting such as this. Well-meaning and knowledgeable Doctors have become targets of the DEA for trying to treat their chronic pain patients with the appropriate pain medications and unprofessional reporting such as this, just makes it all that more difficult for them to do so. I sincerely hope that Ms. Ashton, nor anyone she truly cares about, ever has to live with chronic pain. As only then, will she understand the irresponsible nature of her words.

[wammer122]

CBS, I suggest you investigate and produce a story perhaps called "Pain in American". Choose experts, patients, Doctors. Cover immerging diseases that produce chronic hard to treat pain.
More info ? See me. Im going on 14 years with RSD/CRPS.
I would love to talk to you.
Thank You,
Stephen Monaco , Yucaipa, CA.

[MareLeV]

Shame on Paula Abdul for her part in irresponsible reporting that?s being bantered about the media. Shame on Medical Correspondent Dr. Jennifer Ashton who inaccurately called pain medications ?narcotics? and failed to differentiate between pain medication dependence, tolerance and addiction when she listed the signs of addiction. Such biased and unbalanced reporting needs to come to an end!

These perpetual stigmas have affected me in a real way and on a personal or level with family members bringing me these so called reliable ?reports? as they now feel sufficiently educated about my illness (Thoracic Outlet Syndrome, and RSD) and the medications I take to manage my chronic intractable pain.

The American Pain foundation defines these definitions as the correct definitions of addiction, dependence, tolerance and abuse and are as follows:

Physical dependence is characterized by biological changes that lead to withdrawal symptoms (e.g., sweating, rapid heart rate, nausea, diarrhea, goose bumps, anxiety) when a medication is discontinued, and is not related to addiction. Physical dependence differs from psychological dependence, or the cravings for the euphoria caused by opioid abuse. Symptoms of physical dependence can often be ameliorated by gradually decreasing the dose of medication during discontinuation.

Tolerance is a biological process in which a patient requires increasing amounts of a medication to achieve the same amount of pain relief. Dose escalations of opioid therapies are sometimes necessary and reflect a biological adaptation to the medication. Although the exact mechanisms are unclear, current research indicates that tolerance to opioid therapy develops from changes in opioid receptors on the surface of cells. Thus, the need for higher doses of medication is not necessarily indicative of addiction.

Addiction is a disease characterized by preoccupation with and compulsive use of a substance, despite physical or psychological harm to the person or others. Behaviors suggestive of addiction may include: taking multiple doses together, frequent reports of lost or stolen prescriptions, and/or altering oral formulations of opioids.

Abuse is the intentional self administration of a medication for a non-medical purpose, such as to obtain a high. Both the intended patient and others have the potential to abuse prescription drugs; in fact, the majority of people who abuse opioids do not suffer from chronic pain.

Pseudo-addiction describes patient behaviors that may occur when pain is undertreated. Patients with unrelieved pain may become focused on obtaining medications and may otherwise seem inappropriately ?drug seeking,?which may be misidentified as addiction by the patient?s physician. Pseudo-addiction can be distinguished from true adduction in that this behavior ceases when pain is effectively treated.

If CBS plans on discussing RSD or any other Chronic Pain related topic, it would be in their best interest to have someone other than Dr. Ashton representing the medical community as she clearly lacks the understanding of Chronic Pain that a Pain Management Specialist would have.

[wammer122]

THANK YOU Mrs. E. Feulner for your educated response to this matter. Those of us who belong to The American Pain Foundation are not pleased about the way this subject was covered by CBS and their Doctor. I also have the disease Ms. Abdul does, called Reflex Sympathetic Dystrophy or Complex Regional Pain Syndrome. It alone is one of the worst pain syndromes there is. It ranks near the top of all pain disorders including cancer. I would not be alive today if it were not for pain treatments and mostly medication. Pain can be so severe that it can drive you off a cliff. I have been medicated for this pain every day for 14 years. I am taking 3 different class II meds and 1 class III . In these many years I have never been to the hospital, over-dosed, been unresponsive or had any other problem. Certain people make it difficult for those of us who could not bare to live without pain medicine. This alone has been as much of a problem as the disease I carry hourly, daily. Do not ever try and put us in a box.
Thank You,
Stephen Monaco

[FroggerGirl8]

I find this a very dangerous article if CBS is trying to educate anyone about pain management and medications by using Ms. Abdul as an example. I'm glad she has found relief and better health but her situation does not pertain to all pain patients. Her withdrawal symptoms are those of physical dependency. This article does not differentiate at all between psychological addiction and physical dependency, two very different things with very different appropriate treatments. If a person with a physical dependency were to suddenly stop their medication for fear of being addicted, THAT could indeed kill them. You cannot lump all pain issues and all medications under one umbrella and make broad statements like this. With some medications, if you take them off and on to "let tolerance go back down" they will eventually stop working altogether at any dosage. Neither are all "painkillers" narcotics. This article is extremely irresponsible and re-enforces many more misconceptions than it tries to clear up.

[cnarad]

Even though this article was in The Ladies' Home Journal and on Wednesday, May 6th CBS Early Show also discussed this topic and Medical Correspondent Dr. Jennifer Ashton inaccurately called pain medications ?narcotics? and failed to differentiate between pain medication dependence, tolerance and addiction when she listed the signs of addiction. Such a misrepresentation only goes to show that those of us that suffer daily from chronic pain were not represented properly. It is hard enough to go day by day without someone reading or seeing that information and think we are "addicts" when we are only trying to survive.

[eddieapn]

Less than 5% of people who take opioids for pain relief become "addicted". If the medications are taken for the reason they are prescribed and not for other reasons, and if pain exists, it is very rare to see a true addiction. Tolerance is an expected result as the body adjusts to the opioid. Needing larger dosages does NOT mean the person is addicted; it means they have developed tolerance. Tolerance helps the person adjust to potential side effects such as nausea. Dependency involves having side effects (withdrawl symptoms) when a medication is abuptly stopped and this is NOT unique to opioids. Steroids, anti-hypertensives, anxiolytics, and anti-depressants are just some of the NON-opioid medications that must be slowly weaned off to avoid withdrawl and nobody accuses someone of being "addicted" to a beta blocker! Addiction is a very complicated finding that involves genetics, emotional/psychological, and physical findings. When there is NO pain and the opioids continue to be taken, the effect is psychoaffective - there may be a "high" and that is what contributes to the process of becoming addicted. When there IS pain, then taking opioids blocks the release of, or the transmission of, many substances and signals that send the message about the pain to the spinal cord and ultimately to the brain and there will be no "high". Someone with chronic pain is advised to take long-acting opioids rather than short-acting medications because the former offer a smoother, more continuous blood level avoiding the spikes associated with the peak times of short-acting medications. Of course, non-opioids should be trialed first and non-opioid adjuvants can often augment the pain relieving capability of opioids and thus reduce the dosage of the opioid. But chronic pain necessitates chronic pain relief. Unrelieved pain adversely affects the quality of one's life, delays healing, and causes a cascade of other detrimental physical and emotional sequalae. Pain itself can kill. Edna Nardone Feulner, RN-C, MSN, ANP-BC, Pain Resource Nurse, Elmhurst Memorial Hospital, Elmhurst, IL.

[SusanStoHelit]

All that time the show was denying anything was wrong, when it was so obvious something was very wrong. A pity they didn't push her much earlier to get help.

[hologram5]

Addiction is a thing to worry about that is for sure. But also, addiction is a state of mind. I have many years clean from illegal narcotics, I woke one day and decided that I was tired of living that way and have been clean ever since. I have taken pain medication for chronic pain, when I get to the point that it doesn't work at the same dosage anymore then I quit taking it for a while, dry out and let tolerance go back down.