Pain, Insomnia & The Opiate Pain Killer Connection: 5 Things to Know

In Blog by Alyssa Reid2 Comments

Does this sound familiar?  You have chronic pain and you can’t sleep at night.  You’ve taken your opiate pain killers, and they used to knock you out, but for some reason, not so much any more. And now? Insomnia has crept in and the thought of sleeping through the night is only a pipe dream.  This article is about chronic pain, insomnia and the opiate pain killer connection, with 5 things that you really need to know if you take opiates!

What Are Opiates?

Firstly, let me tell you a bit more about opiates. The term ‘opiate’ and ‘opioids’ are interchangeable and derive from the word ‘opium’ (yep, the same addictive stuff that was famed for providing author Lewis Carroll’s the many altered states and hallucinations that became Alice in Wonderland).

Opiates are used as ‘pain killers’ for pain control and work by binding certain receptors in the brain; this enhances the effects of certain neurotransmitters in the brain that alter the sensation of pain.

Some opiates are derived naturally, such as codeine; whilst others are synthetic, such as Tramadol/Ultram.  Furthermore, some opiates are legal, such as codeine and morphine, whilst others are not – such as heroin and opium.

Ring Any Bells?

You’re in excruciating chronic pain and the only little bit of relief that you can get is when you sleep.

When your doctor first prescribed you opiate pain killers (such as co-codemol (Tylenol 3), oxycodone, morphine or Tramadol/Ultram, they knocked you out flat.  And it was like a blessing… RELIEEEEEFFFFF.  (Well, not really, but you were so desperate for that little break from the pain.)

Before you continue reading, please note that I am not a medical professional and I am certainly not advocating that you stop your opiate medications. If you choose to make this decision, it should be done in conjunction with your doctor’s assistance at all times).
RehabCenter.net List Of All Opioids In The United States Who Abuse Opioids Worldwide

And then….

Very soon after starting these opiates, your tolerance level increased…and in many cases and for many people, the pain relief aspect wasn’t working as well as it once was.

Your doctor upped your prescription. And your sleep may have been crappy due to your pain, but now?  Now it seems to be even worse.

The next thing you know is that you are on the max dosage of pain killers…and all of a sudden, instead of being out like a light, although you may drop off (or feel ‘knocked out’), but you’re unable to sleep soundly through the night.

Sound Familiar?

The sound of a sleeping bed buddy snoring away, (partner, pet, you name it), and you are in envy mode.

You spend your nights on social media, playing games (which, btw will keep you even MORE awake due to EMF and light), and the next thing you know, dawn’s fingers of light start to infiltrate the night, and once again, it’s been another night tossing, turning and restlessness – a night of little to no sleep and…insomnia. AGAIN.  (Think of Bill Murray and the movie Groundhog Day. That.)

Opiates Don’t Just Affect Sleep…

And if insomnia and sleep deprivation wasn’t enough,  like me, you may have possibly found yourself on:

  • Laxatives for constipation
  • Anti-Depressants
  • Medication to stop itching
  • Medication for nausea and vomiting
  • Medication for sleep
  • Increased dosage/new opiates for increased pain (!)

All of the above are related to side effects from opiates (and there are many others…). DOES THAT MAKE SENSE TO YOU?  It sure didn’t for me!

Heck, I could have opened a small pharmacy with all the prescriptions I wound up on due to opiates!

Blackouts/Seizures as a Side Effect

You may feel I am digressing, however, I feel it is imperative to share this experience in the hope of, well, potentially saving a life.

In addition to the above side effects from opiates, one of the most concerning issues and a side effect that I was experiencing, (as were many of my fibromyalgia/CFS buddies) was seizures and blackouts.  After waiting 9 months to see a neurologist, only to be told it was ‘psychological’ (aka ‘in my head’), I refused to believe this.

I lost the ability to drive, and was having seizures and blackouts watching movies, or going anywhere with flashing lights or over-stimulation.  I literally felt like my brain was zapping! I got to the stage where I hardly would leave our home. For 2 years.

And yet all it took was a minute of research to find out that Tramadol/Ultram has this side effect….You can read my blog all about the Tramadol Blackout/Seizure Connection here.

I was SO desperate for sleep and the ability to relax, but I was constantly being knocked out and then awake within an hour and unable to sleep on Tramadol.  For 9 years…!  (I just never clued in that it was Tramadol causing the insomnia, because when I first started it, I was falling off of the toilet, it knocked me flat out!).

Concerning Times

On top of the issues that opiates can cause regarding disturbed sleep, and insomnia and proving to be ineffective for chronic pain (see point 3 below), AND  potentially causing a whole host of health issues and side effects, I would be remiss in not mentioning the opiate crisis.

Prince’s death was related to overdosing on Fentanyl.

Unless you’ve been living under a rock, chances are you are aware of the highly concerning opiate crisis, an epidemic taking 115 lives a day and the subsequent crackdown that has swept across the USA.  And it is on the doorstep of the UK – as we are the highest opiate prescribing country in Europe.

According to the CDC, in 2016, opiates were connected to 42,249 deaths in the USA.  And of course, one of the most well-known incidences of this is the death of artist formerly known as Prince – due to overdosing from the opiate pain killer, Fentanyl. (Fentanyl btw is estimated to be FIFTY times stronger than heroin…).

What takes this crisis to the next level of sheer scariness is the fact that prescription opiates are considered as the gateway drugs to heroin addiction.

5 Things You Need to Know About Chronic Pain, Opiates & Sleep

1. Opiates Can Cause Death Through Overdose by Affecting Breathing and Respiration

If you live in the US, then there’s a good chance that you (or a friend/family member) haven’t just received a prescription for your opiate pain killers, but also a prescription Naxalone in case you overdose.

On top of their well-known potential for addiction, they cause respiratory depressant effects. In other words, you can stop breathing. And die.

2.  Opiates Disrupt the Sleep Cycle

Fig. 1. Schematic cartoon depicting the interactions among pain, opiates, and sleep along with the proposed role of adenosine. ( 1 ) The experience of pain is known to impair sleep. ( 2 ) Recently, it has become clear that sleep disruption can directly exacerbate pain. ( 3 ) The use of opiates to alleviate pain leads to desired analgesia as well as ( 4 ) undesired side effects on nuclei capable of modulating arousal, such as the substantia innominata of the basal forebrain (BF), the pontine reticular formation (PRF), the ventrolateral preoptic nucleus (VLPO), and other sites. ( 5 ) It is unknown whether opiates modulate endogenous adenosine levels in sleep-active loci such as the VLPO or in other wake-active loci. ( 6 ) As reported in the current issue of the Journal, in the BF and the PRF, such effects are likely mediated by a focal decrease in endogenous adenosine. Although not shown, it is worth noting that systemic infusions of adenosine elicit analgesia as evidenced by reduced opioid requirements in animal models as well as in double-blinded clinical studies. However, the fraction of adenosine's analgesic properties that arises from its somnogenic effects awaits evaluation. Conversely, caffeine, which antagonizes the actions of adenosine, is the world's most widely used psychostimulant. One might rightly question whether caffeine use and ensuing sleep disruption leads to opioid dose escalation and hyperalgesia.

Pain, Opioid Use, Sleep Disruption Cycle (Journal of Anaesthesiology)

Opiates also disrupt sleep architecture, blocking access to rapid eye movement sleep and to the deeper restorative stages of non–rapid eye movement.

On top of the lack of sleep, there are the side effects caused – from being more accident prone to the increased likelihood of depression.

No wonder you’re so exhausted and not sleeping! The opiates are preventing you from dropping off into a REM state – where your body not only is more relaxed – but it’s the time when it will be healing, too!

3.  Opiates Can Increase Sensitivity to Pain

Although it is well-recognised that the experience of pain impairs sleep, only recently has it been established that impaired sleep by itself can directly exacerbate pain by causing hyperalgesia (increased sensitivity to pain).

This happens because long-term use of opiate painkillers causes a decrease in your ability to tolerate pain and an increase in sensitivity to pain. In fact, people taking opiates long term may keep having pain, or may see their pain increase, long after the original cause of pain has healed.

4.  Opiates May Not Work Well for Chronic Pain -and Increase the Chance of Depression

According to a study published by the National Institute of Health (NIH), on top of finding that opiates may not work well for the longer term, chronic pain patient, they also increase the likelihood of developing depression.

Researchers have shown that pain-induced changes in the rat brain’s opioid receptor system may explain the limited effectiveness of opioid therapy in chronic pain and may play a role in the depression that often accompanies it.

5.  Opiates Can Affect Your Overall Health

On top of opiates disrupting sleep, increasing pain and proving to be ineffective over the longer-term on chronic pain, they also carry a whole host of health related concerns.

As a toxic substance (toxic meaning, not naturally in your body or keeping your body in balance (homestasis)), opiates can cause a whole host of potentially dangerous and life-threatening health issues – in addition to the obvious addiction issue.

Opiates can cause the following:

  • Respiration – opiates can slow down breathing/cause shallow breathing – which can result in death
  • Depression
  • Psychomotor impairment  – slowing down of movement
  • Constipation
  • Nausea / Vomiting /Lack of Appetite
  • Inhibition of immune response, increasing susceptibility to illnesses
  • Liver damage
  • Sleep Disruption & Insomnia
  • Increased Pain
  • Mental impairment – thinking slowly

Are You Taking Opiate Pain Killers? (And maybe don’t even know it?)

Here are lists for the different names (generic and brand names) for the various opioids available on the market in the US/Canada and the UK.

USA Opioid/Opiate Drug List

UK Opioid/Opiate Drug List

Opiate Pain Killers – the Doctor’s ‘Easy Answer’

With conventional/Western medicine’s top  and ‘easiest answer’ being medication – and in the form of opiate pain killers, I became a walking pharmacy.

In fact, I wound up being on 40  various pills a day, due to requiring all the meds for all the side effects of the opiate medications. The best (read, the worst) bit? I bet 3/4 of the pills (or more) that I was on were to counteract the side effects of the other meds – the opiates being the worst offenders!

(Take a moment to count how many you’re on, multiply by 365, and be prepared to be staggered and shocked!).  For me, that was a whopping 14,600 pills.  A year.

And I didn’t even realise that some of my symptoms were actually opiate related, either! (And my doctor or pain specialists certainly never piped up either. In fact, they just prescribed MORE PILLS. When, in actuality they were INCREASING MY PAIN and affecting my sleep to the point of insomnia, not to mention severe depression.

The Result?

I spent 9 years of my life surviving – not living – and dealing with high levels of pain, depression and insomnia. I will hold up my hand and state that I have no doubt that opiates played a huge role in this experience (read, nightmare…).

I can now wholeheartedly say that since being off opiates for coming up 2 years now, my sleep is almost 100% improved, my pain is still there – but I am not bed-bound all of the time.  I am enjoying life – my depression has lifted completely and I finally feel semi-human again.

My accidents and memory loss have improved significantly due to getting a more restful sleep and my motor skills have improved.  Most importantly, I feel that I have a lot more control back over my health.

No, my neck has not improved (and never will 🙁 ) and yes I am still in a vast amount of pain.  But no more so (and probably a bit less), than I was with being on the opiates. Plus, no more insomnia!!!!

How did this happen? I said…

Enough is ENOUGH!

What I Did to Move Beyond Opiates, Kick Insomnia, Reduce Pain & Feel Better

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Firstly, I hit rock bottom.

I recognised that I had lost control of my life.  Something had to give. I realised that the BEST person to take control of my health was…ME!

This lead me to decide that it was time to not only make a difference for myself, and try to get my life back, but also to be of service to the millions of other people also struggling with chronic pain, and complex chronic pain issues such as fibromyalgia, CFS/ME, Lupus, MS etc.  (That is how this blog came about and how our app, FibroMapp Pain Manager+ was born).

I started tracking my medications and in particular, tracking my mood, sleep and pain with the pain killers.  And realised…they were making my health WORSE.

Question Time

When I started to really connect the dots regarding how these opiates were causing me all these other health issues – both mental and physical, (which, btw, my GP just wrote off as ‘part of your fibromyalgia symptoms’), I realised several things that I needed to really question, and I encourage you to do so as well:

  • Are these opiates really helping me with my pain?
  • Are these opiates possibly affecting my sleep?
  • Am I taking these opiates because I *think* they may be helping (but I’m not really sure…?)
  • What side effects (and number of medications as a result) am I on because of the opiates?
  • Is it possible that these opiates are increasing my pain?
  • Have I become more depressed/anxious since taking these opiates?
  • Could these opiates be having a substantially negative effect on my life and that of my family?
  • Do I *need* these opiates to get by every day?  Could I possibly be addicted? How easy would it be for me to stop?
  • Have I ever over-medicated by mistake (or not)?  Or overdosed from the opiates I’m taking?
  • Would it be worth trying not to use my opiates to see if it makes a difference regarding my pain, sleep, mood?

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The Other Thing that Helped Me Hugely with Sleep and Chronic Pain…

After cutting out ALL my medications (with doctor’s supervision) and using things like ice, heat and natural supplements, cutting out wheat and dairy, (not easy…I love cheese and bread!), I did a gentle liver and colon cleanse.

You see, one of the symptoms of a toxic liver (which, btw is your body’s filtration system), are insomnia and sleep issues.

I knew that problems with sleep, inflammation and pain, skin issues and much more were all signs of toxic overload syndrome – not to mention how my colon and liver (and the rest of my body) was struggling after taking thousands upon thousands of pills – for many years!

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And miracle of miracles…I started to sleep!  Solidly through the night!!!! Without medication! 

Conclusion

There is no doubt that opiates have a direct connection to chronic pain, (and increasing it!),  insomnia and sleep problems, and a vast number of other health issues. Furthermore there is the very serious and real risk of addiction, overdosing and death, not to mention the potential for heroin addiction.  I hope that this article and the 4 things that I felt you really need to know helps you, or someone you know, who is dealing with opiates in their lives.  Please feel free to comment below regarding your personal experiences with opiates.

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