When my husband Dave was diagnosed with multiple myeloma in June 2008 after a compression fracture at his T8 vertebra, we were thrust into a life crisis of a cancer diagnosis.  However, the more immediate issue was managing Dave’s tremendous and debilitating pain.

Dave had never been in the hospital and was not on any medications at the time of his diagnosis. For him, as for many otherwise healthy adults, he had to “rethink” his views on pain medication. He feared becoming addicted. He would not take his pain meds as prescribed, hoping that somehow the pain would disappear. He was thrust into the constant situation known as “chasing pain.”

As his caregiver, I was very frustrated with his lack of understanding of his condition and his passive protesting of taking pain medication without telling me why. Finally we were able to have a frank discussion, largely due to my pushing the issue with him, to try to uncover any false data he was operating off of.

His divulging his fear of addiction was a great start for us to have this conversation. It was true, he would become addicted, but it was not true that he would become an “addict.” There is a difference. I acknowledged with Dave that I understood his fear, but he didn’t have much choice, as first we needed to handle his physical discomfort. It was paramount. I explained to him that when we were further down the road in his treatment we would receive help from the physicians to wean him off the pain medications, safely and appropriately, and that he should be fine.

Once we got that sorted out, I then set about the task of finding better pain management drugs. He was on a fentanyl patch, which is a time-released morphine-based drug delivery system. This patch was not effective enough for his pain on a consistent basis, so he had two more oral drugs to take for “breakthrough” pain.

He hated it. He hated all the pills, and he hated feeling the dull ache of the pain returning off and on.

It continued to be difficult to get him to properly assess his own condition and to self-medicate. I certainly didn’t want to be pushing drugs on him, but as an inexperienced patient, his learning curve was steep. Addressing his preconceived ideas continued as an ongoing process of enlightenment and education. I would notice him wincing, or his irritability, and realize he was trying to withdraw from the drugs while still having pain.

Throughout our ordeal, I was blessed to have had a very dear friend who was a top internal medicine physician in the Washington, D.C., area. She had experienced her own debilitating injury that required long-term pain management. When I relayed my frustration, she encouraged me to have the doctor prescribe Kadian ^[1] (morphine sulfate extended-release) for Dave.

She shared with me her own research in trying to find a pain management drug for her own injury. She learned of this drug in her research.  As she explained it to me, it has the best continual drug delivery in the blood stream of any of the time-released morphine-based drugs. In other words, it doesn’t have huge swings in the amount of drug in the blood stream to combat pain. It is more constant than what Dave was currently on.

I made the request for the change.  The doctor had heard of the drug and was willing to give it a try.

It took us a couple of weeks to get onto one pain killer and wean off the other.  At first, the doctor prescribed a very large amount of Kadian, so we had to decrease the dosage. This error came from trying to mathematically calculate the switch from the patch to the pill. My friend came to the rescue and helped us calculate the correct dosage. The pill is time released, so you can’t cut them in half.

Once we got Dave on the right dose of Kadian, it totally changed his life in a positive way. One pill every 12 hours, and he no longer had any need for breakthrough pain meds. He was much happier, and I didn’t see him wincing in pain. He could go to work and be productive. He could sleep at night without problems.

Once we got his vertebrae treated, we began the long weaning-off process.  Once we got him down to a much lower dose, he eventually went cold turkey (under medical supervision, which was basically him announcing he wasn’t going to take it anymore!). He still had some breakthrough pain meds if he needed them to “take the edge off.”  He had a few restless nights, and then he was fine.

This was our experience. If you are having trouble managing your pain, I encourage you to talk with your health care team about Kadian.

Lori Puente, mother of two young adult children, lives in Northern California with her husband Dave and her lab Kip. She is an artist and has been a myeloma caregiver since June 2008. She chronicles her journey and what she has learned, hoping to offer strength and courage to others, at Riding the Wave ^[2].