If it hurts, we often take something to make it hurt less. The use of medicines and drugs for pain control has been with us since antiquity. This includes the liberal use of opiates in the "tonics" of Victorian England the use of extracts from Willow trees-that eventually became refined into aspirin. But these so-called "painkillers" represent a double-edged sword.

While they do cut through our pain, it is not a clean cut. The drugs taken to "kill pain" have many side effects that can often rival the benefits of taking them in the first place. Even the word "painkiller" speaks to the way we package pain. The sensation of pain is a part of us, and not something we can actually kill, despite our active attempts. The best outcome is to modify the pain at its source-in the periphery. But, when that isn't possible, as in many chronic pain syndromes, in come the painkillers.

A dark side of painkillers is the hugely addictive potential of something that helps take away a debilitating sensation. The main outcome of these drugs is to dull the responsiveness of the nervous system. This means they can make your brain less responsive-to everything.  Alcohol and narcotics are examples of non-specific pain killers. And they can both have unfortunate side effects like high addictive potential.

The big problems with drugs for pain management are this relatively high addictive potential combined with nonspecific site of action. Certainly reducing the activity of neurons in the brain and spinal cord can reduce pain sensation it means also reduce sensation of all kinds. And overall reduced function in the nervous system.

Probably the most widely used general pain drugs are the opiates. They truly have been used since antiquity. Back in the 9th century BC, Homer wrote in the Odyssey "Presently she cast a drug into the wine of which they drank to lull all pain and anger and bring forgetfulness of every sorrow." Many scholars believe that the "drug" to which Homer refers is an opiate. Opiates were originally harvested as a liquid from unripened seeds of the opium poppy and the Sumerians are thought to have routinely produced opium in this way since 300 BC.

Likely they were originally ingested as a kind of drink, since the opiate name comes from the Greek "opos" meaning "juice". There is reference as early as 1500 BC in the famous "Ebers Papyrus" (the oldest Egyptian medical text spanning 110 pages and over 60 feet in length) to using a derivative of poppy seeds as a tonic for crying babies. Suffice it to say that opium has been around for a long time and is very effective at suppressing activity in the nervous system and controlling pain perception.

Finally, in 1806, Friedrich Serturmer isolated the active ingredient in opium, and thus became the first person-ever-to isolate an active ingredient from a plant to be used for medicinal purposes. He called this opium extract morphine with reference to "Morpheus", the Greek god of dreams. Fast forwarding to 1932 we find the chemical isolation of pethidine or meperidine, a drug more commonly known as Demerol. Demerol is a relatively fast acting opioid once widely used for pain management.

Which brings us to the King of Pop, the late Michael Jackson, and the recent trial of his personal physician, Conrad Murray. For many years reports suggested Jackson was in chronic pain. His pain came from numerous injuries related to the strain his fantastic dancing placed on his body, a back injury, lingering effects from the fire that burned him, and his numerous plastic surgeries. At the recent trial a defence witness suggested that Jackson had been a heavy user of Demerol and may have been addicted to it. During many of his plastic surgeries, Demerol injections were alleged to be used for pain control and an addiction formed.

With the opiates, or other chemicals that bind to the opioid receptors in the brain, there is the significant problem of overdose and suppression of respiration (you stop breathing). There is also the huge addictive problem that comes with habitual use. Hope was raised in 1898 that a safer and non-addictive version of opium was now available. It was touted as a synthetic opiate that would be free from the problems that plagued opium-smoking and morphine ingestion.

The name of that drug? Heroin. As most will know, that didn't really unfold as advertised. It seems the more we try to make our brains behave the way we want them through artificial means, the more problems we can accidentally create. This is particularly the case for chronic pain management where the side and incidental effects of the drug that helps with pain can be as troublesome as the pain itself.

From over 2 decades of personal experience with chronic pain, it seems to me there is a difficult balance. The sedation that comes from many of the prescription or over the counter pain meds have definitely been things I have tried to avoid. This has been despite the obvious relief from the pain that this provides and the seductive nature of the sedation itself. This is where my practice of martial arts comes in. My training has helped instill in me a connection between my brain and the rest of my body.

Because of my training, I prefer to be in control of my responses as much as possible, even if I know that powerful suppressants of pain sensation like alcohol and pain meds can have. As a result, I don't like to feel "disconnected" from my body and my potential. Although the medications largely affect sensation and don't directly impair motor ability, they do create a significant sedation.

Extensive use of pain meds might provide temporary relief from sensations that I would like to reduce, but the cost in reducing my overall alertness and potential are too high for me to pay. In this way my martial arts training has helped me avoid the addictive potential that lurks within so much of pharmacological pain management. Despite that, I can see how so many can succumb to this trap.

Going forward, clearly we need more effective pain management with more targeted beneficial effects and fewer unwanted side effects. I think an effective management plan should also include lots of physical activity and movement. This is a theme I will continue to explore in future posts, particularly with relation to mindful movement. Much of my own chronic pain management has been centered around keeping active and in motion through traditional martial arts practice. I will have some future posts addressing non-traditional ideas about the nature of pain, pain management, and effective living. If you're interested, please stay tuned!

© E. Paul Zehr (2011)

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