Talk to someone suffering with chronic Lyme disease, and chances are, they have been prescribed some form of medication for pain. More often than not, the medication is opiate based (or synthetic) and marks yet another threshold of humiliation for the chronic Lyme sufferer.
Pain, the most common symptom of Lyme disease, is often debilitating in chronic cases and even more so with neurological Lyme disease. Although not everyone with a chronic case of Lyme disease suffers from neurological symptoms, it is far more common than people think.
Neuroborreliosis or neuro-Lyme occurs when Borrelia enter the central nervous system which can happen within minutes. Spirochetes easily pass through the blood-brain barrier and into cerebrospinal fluid, which is quickly followed by the inflammatory response which is what causes pain.
Spirochetes can also enter the central nervous system through peripheral nerves which is why neuroborreliosis is probably much more common than previously determined.
Acute pain is the hallmark feature of neuro-Lyme and has been described as severe burning, stabbing, sharp, excruciating, agonizing, unbearable, insufferable, racking and/or tormenting. This pain can occur anywhere, and it can occur suddenly without warning, or last for days, months or even years.
Hydrocodone is an extended release opioid analgesic sold under the brand names Zohydro ER and Hysingla ER. It’s also an ingredient in dozens of combination drugs, including Vicodin and Vicodin ES. Hydrocodone is a true opiate-based narcotic used for medium to severe pain.
Tramadol is a synthetic opioid that is marketed as a non-narcotic pain reliever. However it works like a true narcotic with two different actions in the body. It is analgesic, which means that it attaches to receptors in your brain to change your perception of pain. It also works like an antidepressant, prolonging the actions of norepinephrine and serotonin in the brain. Tramadol is available under several brand names, including ConZip, Rybix ODT, and Ultram. Another medication, Ultracet, is a combination of tramadol and acetaminophen.
Oxycodone (OxyContin) is a powerful narcotic that is widely abused. It was launched two decades ago with a bold marketing claim: One dose relieves pain for 12 hours, more than twice as long as generic medications. Patients would no longer have to wake up in the middle of the night to take their pills, Purdue (the manufacturer) told doctors. One OxyContin tablet in the morning and one before bed would provide “smooth and sustained pain control all day and all night.”
However, it now appears that OxyContin can make pain worse. Experts say that when there are gaps in the effect of a narcotic like OxyContin, patients can suffer body aches, nausea, anxiety and other symptoms of withdrawal. When the agony is relieved by the next dose, it creates a cycle of pain and euphoria that fosters addiction, they said.
Over the last 20 years, more than 7 million Americans have abused OxyContin, according to the federal government’s National Survey on Drug Use and Health. The drug is widely blamed for setting off the nation’s prescription opioid epidemic, which has claimed more than 190,000 lives from overdoses involving OxyContin and other painkillers since 1999.
Prescription Fentanyl is perhaps the most commonly used pain medication for acute neuropathic Lyme disease. It is available as a generic drug or in brands including Duragesic, Actiq and Fentora. It is normally used to treat severe, chronic pain patients may have, such as in late stages of cancer or severe orthopedic injuries involving long recoveries and is typically prescribed when patients have already tried several other medications, such as OxyContin, but are still having pain.
The most common form of fentanyl is a transdermal skin patch, which is rectangular and transparent. Patients apply patches to smooth areas like the upper arm. Fentanyl, which carries a Food and Drug Administration “black box” warning like other opioid drugs, poses safety risks for several reasons. “It’s 100 times more potent than morphine.” says Mohammed Jalloh, an American Pharmacists Association spokesman.
There’s an unfortunate irony for people who rely on fentanyl, oxycodone, and other opioid painkillers: The drug that’s supposed to offer you relief can actually make you more sensitive to pain over time. That effect, known as hyperalgesia, could render these medications gradually less effective for chronic pain, leading people to rely on higher and higher doses.
The bottom line is that people with chronic Lyme disease who need the strength of opioid pain relievers (and are under a doctor’s supervision) should be supported emotionally by friends, family and their community.
For more read America’s Addiction to Opioids by National Institute on Drug Abuse.