The biggest problem for me (and many people like me who have a chronic pain problem) is that these two drugs WORK - they significantly reduce overall pain levels by a substantial margin. In fact, they work far better than most other pain medications I've tried in the last fifteen years, and have fewer side effects that can make life almost as miserable as the pain they've been prescribed to treat.
It's hard to talk about pain. Each person has a different "pain threshold", and experiences pain differently. That means that what's a significantly painful episode for me may be a minor annoyance for someone else, or vice versa. I've been told that my pain threshold is quite high. It's hard to know exactly what that means, except that high or not, I hurt - a lot!
Pain thresholds are measured by a 0-to10 scale by most medical professionals today. Unfortunately, there's not much in the way of explaining and quantifying these experiences so that the scale relates equally to everyone. Currently, the "0" means "no pain", and "10" means "the worst pain you've ever experienced". Certainly, we've not all experienced the same "worst level of pain", so this isn't really a reliable scale. We need some better definitions of what those "0"-to-"10" levels mean. Is it a sliding-scale, or a logarythmic scale? I doubt it could be a log scale, since that would mean that "10" would have to be 10 to the tenth power, or about 1 TRILLION times worse than a "1". So let's assume the units of measurement are all equal, and level "2" is twice as painful as level "1", rather than ten times as painful.
"0" should indeed mean "pain-free". That's self-explanatory. Beyond here, however, we need some firm examples. We need to first define the WORST PAIN EVER EXPERIENCED, so we can determine the internal units, defining both the top and bottom of the scale.
I've experienced some "9+" pain in my lifetime, yet I don't think I've ever experienced a "10". The top of the scale is "so much pain you should have died, but somehow didn't". It's a burn victim who's body is covered with second- and third-degree burns over 75% of their body or more. It's a 90-pound woman in labor with a 12-pound child, in breach. It's an automobile accident victim who has had all his extremities broken, several ribs crushed, and significant other damage. It's an earthquake victim buried under tons of rubble, with half or more of his body crushed, and huge blocks of concrete and steel still weighing heavily upon his back. You NEVER want to experience this much pain, but that's the kind of pain we need at the top of our scale.
Let's now define the halfway-point of our scale, level "5". Level "5" is five times as bad as level "1", but only 1/5 as bad as level "10". Most of us have experienced a level "5" pain. Level "5" pain is the kind of pain you'd expect to feel during the first couple of days of having a broken wrist, or a cracked rib. It's the kind of pain you have with a headache bad enough to send you to bed, or a pulled large muscle. It doesn't keep you from functioning, but you're ALWAYS aware of it. It affects everything you do, from sleeping to eating to normal daily activities. It's TIRING, and you always feel drained of energy.
So now we have three points on our scale of 0 to 10 defined. It's possible to go back now, and complete our scale.
- 0 - No pain
- 1 - Very mild pain, light enough to be virtually ignored. A very mild sunburn, ant bite, or a small cut cause level-1 pain.
- 2 - Mild pain - the type of pain associated with a pinched finger, bumping into a wall (without bruising), an "almost-headache", a treated moderate sunburn, etc.
- 3 - Light pain - a bruised muscle, most headaches, a bee sting for an adult, a "twisted" ankle or sprained wrist. Light pain may last for an hour to several days, gradually fading and disappearing, even without treatment.
- 4 - Very moderate pain - a bad sunburn, deep bruises, a deep cut, an "easy" tooth extraction, a bad headache that lasts for several hours, stomach cramps caused by eating green fruit or too much spicy food, or first- or second-degree burns. People with very moderate pain can function normally, but require extra time and modifications to their routines.
- 5 - Moderate pain - the type of pain experienced from a broken wrist, cracked rib, pulled large muscle, or very bad headache. May not be able to function normally or do some tasks without pain relief.
- 6 - Moderately severe pain - migraine-type headaches, multiple bruises and contusions, extraction of wisdom teeth or impacted teeth, several broken bones without complications, second or third degree burns, or complications associated with other diseases such as viral or bacterial infections resulting is severe coughing, diarrhea, and vomiting. Require treatment. Usually cannot function without medical treatment, of which pain relief is only a part.
- 7 - Severe pain - Pain that lasts longer than twelve hours with or without treatment, pain caused by damage to major nerves or nerve groups, second and third degree burns over 20% or more of the body, severe (third-degree) sunburn, broken bones with complications, dislocation, severe back pain, multiple muscle cramps, multiple tooth extractions, major operations where muscle tissue was cut and stitched back together. Person cannot function without major medical treatment and/or significant pain relief.
- 8 - Debilitating pain - Pain severe enough to keep a person from being able to perform normal health and hygiene functions such as cooking and eating, dressing, bathing, normal household routines, and interaction with others. Large and frequent dosages of pain medication are essential for the person to do normal activities. Pain associated with most normal births.
- 9 - Very debilitating pain - Pain significant enough that the person must receive outside help to do even simple functions such as eating and dressing. The kind of pain that leaves a person bedridden. Very severe migraine headaches, pregnancy and birth with complications. People admitted to hospital Intensive Care Units from automobile or other accidents.
- 10 - The worst pain that could be experienced, as shown in the examples above.
My chronic pain problem has multiple causes. I've got a horrendously bad back. I had a two-level cervical (neck area) fusion in 1990. I've got at least one herniated disk in my lower back, and a deformed L-5 vertebra. I have myofascial pain problems in my mid-back, and pinched nerves, carpal tunnel, repetetive motion, and degenerative disk problems. I also have osteoarthritis in about 40 different joints, and a tinnitus and hyperaccusis problem. I KNOW pain, all too well.
The tinnitus problem keeps me from taking some of the high-end NSAID drugs (non-steroidal anti-inflamation drugs) such as Mobic, Ibuprofin, Feldene, and other medications in the same family.
With Vioxx/Bextra, my normal pain levels fluctuated between a "3" and a "5", with a few periods up to an "8" from time to time. I've been off these drugs for only a few days, and my pain levels have already increased. My "normal" pain level has increased to between a "4" and a "7", with occasional periods up to a high "9". I take Ultram (2x50mg) and Flexeril (10mg) for those occasions when the pain level goes above a "5". That's rapidly becoming the norm. Instead of taking these medications once or twice a day, I now seem to be taking them every four hours, and even wake up in the middle of the night needing them.
I know I'm not alone in this. I've heard from several of my friends that have been on Vioxx or Bextra for some time, as I have, who are also complaining that the "alternatives" they've been prescribed don't seem to work as well. Frankly, they - like me - would gladly trade a few years off the top of their lifespan for being able to function NOW.
The Food and Drug Administration owes us, bigtime!