I live with chronic pain and fatigue.  I have since I was 9 years old, over 20 years ago.  It’s chronic though not consistent in severity, although overall, over the years, it’s degenerative.  All the causes, as well as the whole fight to get anything done about it….well, that’s another post.  Let’s skip ahead a bit.

I was on Vicodin for a little over a year and a half, until the Dr. who was giving it to me moved out of my insurance network.  I never became addicted, since I could take it fairly regularly my body adjusted and I barely even had the sleepy side effect, and I took it on an as-needed, relative-to-what-I-had-to-do-and-the-balance-between-pain-and-alertness-factor basis, just like all of the other options I had in my arsenal at the time — also with conflicts in mind, of course.  I had about a 50% increase in functionality….which, considering how functional I’m usually NOT, is a big deal.  I was exercising to the extent that my body lets me (bearing in mind structural deformities and the like), I was able to get Ash out of the house more often, I was able to get work done in my studio to earn extra money, I was able to keep up with the housework better, and I wasn’t spending my days and nights utterly exhausted.  It was the best I’d felt in years, and I haven’t felt as good since. Most people wonder why I didn’t suddenly get so much more done last year, since Ash was finally in school, and there was this big chunk of hours, five days a week, when I was free to get work done or whathaveyou.  The fact is, I spent most of the past year being too exhausted, and in too much pain, to do much of anything.  I didn’t have anything of suitable prescription strength to combat it.  I have to save my spoons for taking care of Ash, and if I don’t need to be “on” for him, I’m in a daze of pain and fatigue and using whatever tricks I can to keep my body from being even less likely to move when next I need it to.

I MISS VICODIN.

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I grew up with abuse.  I graduated from high school in three years so as to make my escape earlier, only to end up with a freshman roommate with NPD.  Before I figured out that you have to break the chains of abuse inside you as well as those around you, I also had a boyfriend who was an emotionally manipulative cheater.  Even once my emotional life became healthy, my circumstances weren’t necessarily so.  I have found myself in a position of responsibility regarding someone with BPD.  I’ve lived on the razor edge of poverty.  I live with being the physically disabled mommy of a neuro-disabled son that we were told not to expect to survive.  Just a….selection….you know.

There are certainly worse things that can happen to a person, but that hasn’t stopped me from earning a few PhDs from the School of Hard Knocks.

Through all this, I have never once been on a “head-med”.  I’ve never even had professional counseling.  I have been doing it for myself my whole life, and it works for me.  Sometimes I wonder HOW it works for me, but it does.  I’ll admit, I’m somewhat proud of that fact.  A little self-moderated PTSD and BDD, but aside from that, my psychiatric profile is remarkably stable.  I’ll confess, I’m also happy about it — about not needing any “head-meds”.  Oh, don’t get me wrong, I’m not especially prejudiced against them, or those that take them.  I do think too often then are used inappropriately in one sense or another (again, that’s another post), but I also know a ton of people who have valid chemical and/or circumstantial need for them, that they work well for.  I’ve got no problem with that.  That doesn’t mean I don’t prefer NOT needing them, though, especially when it comes to myself (and my kid, but yet again, that’s fodder for another post).  If it tells you anything, teetotalling isn’t a choice for me — not with a history of alcoholism in the family, a circulatory disorder, the alcohol tolerance of a fieldmouse and plenty of potential drug interactions — but it’s a choice I’d probably make anyway.  Caffeine aside, I’m not a big fan of altering brain chemistry just to get more….or less….out of a situation.  I rather do the same thing naturally, with full self-awareness and self-control.  An uncommon side effect of my upbringing, perhaps.

Eniways, so it goes.  I’ve been offered anti-depressives and anti-anxiety meds in the past, at likely times, but I’ve always turned them down.  I was the woman filling out the weekly parent depression questionnaire at the NICU with things like, “Well, you didn’t really expect me to feel GREAT right now, did you?  I mean, that would be a bit….off.”

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The issue of whether or not to have an epidural during labor is a somewhat controversial, fairly loaded one.  When I was going to have Ash, however, the decision was taken out of my hands.  It was deemed medically necessary for me to have one, so as to reduce the strain on my heart condition.  Would I have been strong enough to push through (no pun intended) without one, for the sake of just-in-case-it-would-be-for-the-best?  I have no idea, but it was a moot point.  Apparently, my body required one, to have a shot at functioning at all.

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Bear with me.  This is where the three bits and bobs above, all come together.

Seeing as how we were about to fall into a gap in our medial insurance again (because if Steffan makes $12 too much a month for state aid insurance and food stamps and full disability payments for Ash, it totally balances out not receiving the thousands of dollars’ difference in our medical-debt-drowned-budget, right?) — and remember, the last time this happened, just shy of a year ago, is when my gallbladder decided to go kerplodie, so let’s all pray, please — Steffan and I managed to sneak one last Dr’s appointment for each of us in, on the last day of August.  The hope was that we’d be able to both get and pick up a new asthma inhaler Rx for him, and new birth control and pain-killer Rx’s for me, that afternoon.  Weeeeelllll Steffan got his Rx….he’s got one fresh inhaler in hand, and so long as we get some sort of insurance back so he gets the Rx coverage to pick up more, he’s got more refills on it for the next year’s time than he should, hopefully, need.  I have a year’s worth of refills on my birth control, although since I was halfway through a pill-pack at the time, they wouldn’t give me another one, so there will probably be at least a few months before I have the insurance to pick any up affordably.  I’m not looking forward to that, since for me, birth control pills aren’t just about being extra, extra careful.  Without them I develop ovarian cysts, alternating with having them burst, every month.

But then we get to the fun part — my pain killers.  I did not walk away with an Rx for Vicodin.  I didn’t even walk away with an Rx for Diclofenac (my arthritis medicine, which is ibuprofen based, the reason — because of conflicts — I don’t also have an as-needed med specifically for migraines), plus Tylenol3 (codeine-spiked, prescription-strength acetaminophen), as had been fairly standard, if only vaguely helpful, in more recent years.  I wasn’t even given bloody 800mg ibuprofen, which I laughed desperately at when it was originally “tested” for me, since I can get THAT much into me by taking four of the over-the-counter ones.

Nope.  There were a number of arguments featuring attempted logic like:

Her: People are not meant to be on pain-killers long-term.
Me: People are not meant to have their joints in the wrong places.  People are not, in fact, really MEANT to have any number of issues which result in plenty of people out there besides me, being prescribed reasonably strong pain killers on a regular basis.

Her: If you take any given narc for too long, it stops taking care of your pain.
Me:  If I’m not taking the narc at all, it doesn’t even start taking care of my pain.  There are other narcs out there besides Vicodin which have been proven as options for me, should occasions arise when I need some short-term, heavy-duty pain-killing distinct from the effects — dwindling or otherwise — of Vicodin.  In the meantime, I have a history with Vicodin which proves substantial results with next to no side effects and a resistance to its addictive properties, when taken on a regular basis, over a period of at least two years at a stretch.  I wouldn’t know if I could go for longer on it, because that’s about when it was cut off, and it’s been around two years, I think, since I’ve gotten it back…

Her: There has to be a more direct way to address the problem.
Me: You mean like going to the Pain Clinic, which I’ve been waiting for my referral for an appointment to go through for, for over two years?  Or like having things like regular massage therapy, custom braces, accessibility tools and mobility aids, to reduce the accumulating strain, that myself and my doctors have yet to convince insurance to cover?  Or perhaps you mean addressing some of the physical conditions even more directly, something one of the top specialists in the country, a veritable House MD of his genre of medicine, threw his hands in the air and declared beyond his vision to do anything about, after he ran out of tests and scans and whatnot.  And by the way, the things which he says are impossible to do, are basically what I’ll need done if I continue on this track, especially if I continue adding strain to my structurally unsound joints by continuing to gain weight now that having a child changed my metabolism, because I am in too much pain to exercise, and too physically unsupported to exercise THROUGH more of the pain.

You get the idea.

No, despite all, my Dr. (who until now had proven one of the more useful ones) would not give me any sort of (pre-established-in-terms-of-me or otherwise) drug designed as a pain killer, for my pain.  She gave me Cymbalta.  That’s an anti-depressive.  I’ve never taken it before.  I’ve never taken anything like it before.  Did I mention it’s an anti-depressive?  I am diagnosed with all sorts of things that result in pain.  I’m not diagnosed with clinical depression.

No, she wasn’t doing this because she suddenly decided it was all in my head, or because she thought it would be helpful to help me feel happier about the pain which wasn’t being treated, and its compounding impact on my quality of life.  To be fair, there’s some medical precedent for Cymbalta being prescribed specifically for pain associated with Fibromyalgia and Osteo-muscular related pains, which certainly are among my major issues.  To be fair to the immediate reactions of Steffan and myself, she also didn’t get into any of that.  What she said was, “Well, there’s been some evidence that a side effect of taking Cymbalta for depression is that there can be a reduction in fibro pain, though they don’t understand why, and since taking Vicodin only gave you a 50% improvement, maybe we should experiment with this.”  Note that she only mentioned fibro pain.  I have fibro, and pain from fibro.  I also have pain from a number things that are not fibro.  Things which have nothing to do with the rhaumatological system.  Things which would therefore, according to only this information, not be addressed in the slightest by this treatment.  And by the way, “experimenting” with my physical and emotional capacity to function, when it isn’t necessary, and when I have a special needs child that I am the primary caretaker for, does not strike me as material for a casual proposal.  Oh yes, this all sounded PERFECTLY RATIONAL.

Option 1) I’ve taken the drug before.  I didn’t get addicted.  It made a big difference in treating what it was designed to treat, which is something I have a diagnosis for.  I had next to no side effects.

Option 2) I’ve never taken the drug before, or anything like it.  It’s designed to correct a particular kind of chemical imbalance in the brain, which I don’t actually have, so we really don’t know what it might do to me.  The goal is treatment VIA one of many potential side effects, some of which are quite nasty and dangerous.  We don’t know what it might do to me, and we don’t know if it will do what we hope.  Oh yes, it also conflicts with a good lot of pain-killing options, from my dwindling stash of more effective things, or even the standard stuff — and, if it works, it probably won’t work for a month.  So, that means basically no pain-killing AT ALL for a month.  Right as we’re getting to the season where I start hurting even more.

We are less than thrilled.

In fact, ironically enough, it made us feel a bit depressed.

But so it goes.  Things happen to be fairly depressing right now, for other reasons, but I was getting along without pharmaceutical aid.  But now, for lack of options, I’m going to be going on an anti-depressant anyway….for pain.