I sometimes wonder whether the idea of getting 'something for nothing' actually became collectively seeded early in our childhood, when we were exposed to magic carpet rides, 'arising from out of thin air', 'alakazam' and other sorts of myths in which the normal rules governing cause and effect are suspended. When I think about it, board games and television probably did nothing to discourage the unconscious notion that one can actually 'Get Out Of Jail Free' without having to pay the piper. Maybe that's why we have all been so softly and sweetly lured into thinking that indefinite series of never-ending band aids amount to the same thing as being "cured".

Wherever the source came from, somehow we collectively have been led to suppose that medication use can carry on forever without any real consequences, and that endless access to pharmaceuticals amounts to the same thing as health care. The truth, insofar as chronic pain in particular is concerned, ends up presenting a far different picture than your garden variety "happily ever after" fairy tale ending.

The fact is that one cannot use opiates such as morphine, hydrocodone, oxycontin and methadone over a sustained, indefinite period of time without individuals being subjected to hyperalgesia, or increased sensitivity to pain, which can be brought on by damage to peripheral nerves called nociceptors. Hyperalgesia is linked with the presence of platelet- activating factor (PAF),which is brought about by an inflammatory response. Typically the body uses inflammation as a protective mechanism to remove harmful stimuli, and initiate the healing process.

What this ends up meaning is that the longer common pain medications are taken, the worse the pain they are being taken for can become. Seems a little counterintuitive, don't you think? Kind of like 'The Sorcerer's Apprentice' gone wild.

When opioid-induced hyperalgesia is typically reported to attending pain specialists, it often ends up becoming inadvertently compounded by increasing the dose of the opioid, which ends up worsening the problem by further elevating the individual's  sensitivity to pain. That means that the pain sufferer now needs more medication to achieve pain relief, which they experience less and less frequently. Throw in the phenomenon of addiction, and loss of functioning, and you have the sort of individuals who become obliged to seek out non-toxic approaches for managing their pain, which are the sort of people who make their way to Pacifica Pain Management, based out of St. Helena Hospital.

Here our multi-disciplinary staff is dedicated to restoring functional integrity while providing comprehensive, non narcotic- based pain relief. So, as the results of the graduates of our pain program constantly remind us, happy endings can indeed be achieved, but probably more often by applying a little old- fashioned elbow grease rather than rubbing a magic lamp and expecting three wishes to be granted.