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Painkillers and a few of their Side Effects

Should I talk about this? Well, in order to be complete, I probably need to talk about it. Fellow cancer patients need to know that they are not alone in their difficulties, and are not somehow freaks of nature. It is hard enough to go through the diagnosis and treatment, even without the mental issues which plague us when we do not know that what we are going through is really a normal thing.

The following topics are not fun to discuss.
If seeing this discussed honestly bothers you, you really should just hit the "back" button on your browser, and find something else to read.

Opiates and Driving

In most jurisdictions in the USA, driving while taking any opiate is a felony. It doesn't really matter why the patient has to get somewere, and it doesn't really matter whether the patient is a very safe driver. If the patient is found to be driving under the influence of an opiate painkiller, even one which is prescribed by a doctor, it is a felony. You really do not want to complicate your medical problems with added legal problems.

One of the most difficult things about the eight months while I was taking oxycontin was that I could not drive, even though I had to go places. If it were not for some very generous friends who offered to drive me where I needed to go, and if it had not been for an employer who encouraged me to telecommute, it would have been a very difficult time indeed.

Opiates and Digestion

Dr. Winter Wilson is a very plain-spoken man, and I think he summed it up very well. He said, "If I took just one of those Oxycontin pills you are taking, I wouldn't be able to poop for a week." He is being quite honest when he says that, and from my experience he is right-on. The high-power opiates interfere with smooth-muscle function, and that includes the digestive tract. What this means is that it is very likely if you take any of the opiates for pain control, that you probably have major problems with constipation. This is potentially quite painful, can result in nausea, and can make it so that you do not eat, and end up losing large amounts of weight unintentionally.

In order to treat such serious cases of constipation, there are a couple of potential approaches. One way is to drink a lot of water and eat a lot of fiber. This simply did not work for me. I was so full that I could not keep down the water or the fiber. Another way is to use the strong laxitives such as Dulcolax. Administered as a suppository (i.e. you place the waxy pill in the rectum) it is a gut-wrenching, painful method, which never seemed to empty me out, and left me in major pain. That was much too harsh for me. Yet another way is to use something besides fiber to keep water in the intestines, to help things move along. Dr. Wilson prescribed 17 grams of Glycolax (polyethylene glycol 3350) in a glass of fruit juice three or four times a day, and while not quick, this proved to work well enough to make sure that my digestive tract did not stop-up entirely. The result is stools which are soft and runny, but at least everything moves and does not back-up.

If you have similar problems, go see your GP or gastroenterologist about finding a solution which will work for you. This one prescription made it possible for me to stop losing weight uncontrollably. After losing 35 pounds in six weeks, the change was remarkable.

Opiates and Sex

The written and video information which I have seen in preparation for radiation and chemotherapy treatment all seems to indicate that sex is fine during the treatment, just as long as you avoid getting pregnant (if the patient is a woman) or getting someone else pregnant (if the patient is a man). These restrictions have to do with the possibility of conceiving a child with birth defects, due to the way the chemotherapy drug and radiation work to kill cancer cells. So the advice seems to be that sex is OK if that is what you want to do, and you take the proper precautions regarding pregnancy. What no one talks about is the side effects of the treatment drugs on sexual intercourse, and the emotional fallout from the side effects.

We are used to our bodies pretty much doing what we tell them to do. For decades, when we tell our bodies to get up and walk across the room, for the most part, they do what they are told, when they are told. If it is within our physical limitations, if our mind tells our body to jump, the body jumps. Unfortunately, opiates interfere with this on more than one level. The first level is similar to that listed above under the digestion topic, i.e. the opiates interfere with smooth muscle function. Guess what? Some of the muscles used during intercourse are smooth muscles, and do not behave normally for the patient who is being treated with opiates. The second level is that the desired effect of the opiate is to reduce the pain level, by binding to specific receptors which cause us to feel things. Note that these do not just interfere with feeling pain, but also other things physically one might feel. Guess what? Once again, among those feelings which are blocked are those which give us pleasure during intercourse.

I will limit myself to speaking of this from a male perspective, since I am not now and never have been a female. For a male, the opiates interfere directly with sexual intercourse on several levels. One is that because of the opiates' interference with smooth muscle function, it interferes with both the physical ability to have and maintain an erection, and also to have an ejaculation. Both may be possible to some extent, but what is "normal" may well change dramatically. Expect change in this area, and do not be surprised at a general weakness in both areas. But also, since the opiates directly block the ability feel both pain and pleasure, the second related side effect is that, even should a sufficient erection be possible, and even should an ejaculation occur, the person taking the opiates may not feel much of anything at all. This numbness is a strange and unwelcome feeling.

Besides the physical effects of this, there are additonal emotional side-effects which go along with this. The inability to "perform" sexually is unpleasant at best. The pleasure is going to have to come from the mutual love and intimacy itself. He can focus on making his wife happy rather than himself, and enjoy from that perspective. The "rush" may be missing, but there is every reason to continue having sexual intercourse with one's own wife, as an intimate act of love, whether you feel great or not.

If you should have to take opiate painkillers, and if you are able to get off the opiates at some later date, do not expect things to be normal sexually for months. Things most likely will not just quickly return to normal. 

Opiates and Physical Dependence

Because I have gotten so much better, the pain has gone away, and I felt the need to get off of all of the pain killers. The issue here is that in taking Oxycontin in large doses continually for many months, I became physically dependent upon it. Basically the body compensates for the suppression of pain, and turns all of the bodily sensors up all the way to compensate. This is not a problem until you need to stop taking the pain killers, because this makes it very difficult to do so. What happens is that when you stop taking the drugs, or even just reduce the dosage, you have withdrawal symptoms. These can be quite vivid, and make it so that it would always seem easier to just keep taking the drugs than to stop. It sure sounds like addiction, doesn't it? The only real difference between the physical dependence that a patient who is treated for pain experiences and the addiction of someone who abuses the drugs is that the patient associates the drug only with the reduction of pain, and the abuser associates it with some form of pleasure. As such, the patient, once off the drug, sees no need to return to the drug, but the abuser is much more tempted to do so.

In my case, I went off of the Oxycontin cold turkey, all at once, with no medical support. I knew what was coming, and that I would experience a very difficult week, but that after a week things would be largely back to normal. So I just stopped taking the Oxycontin, and waited for the symptoms to occur. It was interesting to go through withdrawal, because I knew the cause of the problems it caused, and because I knew that it would be of a limited duration. So what Happened? First, I was unable to sleep at all for about three days. My mind was overstimulated, and would not slow down. I felt violently cold and hot all at once. I would sneeze suddenly, repeatedly, and with no apparent cause. I itched and itched for no reason. My everything ached. Now this went on for about five days, and gradually subsided. The continuous hot and cold flashes stopped by about day four. By day five I could sleep some again.  By day seven life was semi-normal, but there are some things which stayed abnormal for more than a month. By now (more than two months later) most of the symptoms are totally gone, but there are still signs that it will take still longer for a total end to the symptoms.

This brings up an interesting point. One of the reasons that doctors many times have real reservations about giving cancer patients sufficient pain medication is that if the patients should recover, then getting off of the drugs is very difficult. For some people, they may never be able to get off of them. So there is this risk involved in prescribing sufficient pain medication. On the other hand, failure to prescribe sufficient pain medication can leave the cancer patient in excruciating pain, with no possibility of relief. This is a very hard choice.

So my statement about the major pain killers is that you should ask for what you need, but realize that there are side effects and consequences which will have to be dealt with. Today there really are not any major pain killers without major side effects, and we must use what is available today. If/when you do not need them anymore, get off of them as soon as possible. You will feel ever so much better when you do.


My cancer blog may be found here: http://diehlmartin.com/cancer.html

Update
Diehl Martin passed away in October 2007. If you need to contact someone, please contact Monica Martin.

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