If Pain Doesn't Go Away Even With Tramadol (Opioid Analgesic) | Incheon Chronic Pain
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Hello, I am Korean Medicine Doctor Choi Yeon-seung from Baengnokdam Korean Medicine Clinic.
“I have pain that doesn't respond to painkillers.”
Many people say this in the clinic. They've tried changing medications multiple times, received physical therapy, and even had all the injection treatments recommended by hospitals…
Yet, they still report pain. It's not just ordinary pain; they say, “It just doesn't get better at all, isn't there anything stronger?” When they say that, exhaustion is already evident in their expression, and signs of their body's rhythm being disrupted are outwardly visible.
These individuals have already tried anti-inflammatory painkillers (NSAIDs), and sometimes even central-acting analgesics like tramadol. But what's surprising is when we hear that even those strong medications “seemed to help for the first few times, but quickly became ineffective.”
The Complexity of Pain
In such cases, it's not simply due to high pain intensity, but rather, the body's pain circuit itself has evolved in a more complex direction.
However, there's an important point here. Pain is never merely an event occurring at a single point. Especially, chronic pain is not an 'injury' but a 'condition'.
“Now, more than what the illness is, I want to know why this pain persists in me.”
The Action of Tramadol
Tramadol differs slightly from typical analgesics. This medication doesn't just reduce inflammation or act only on peripheral nerves, but rather, it directly affects the central nervous system, meaning the brain and spinal cord.
It works by blocking pain signals from reaching the brain, or by regulating the brain so that it doesn't even perceive pain. Additionally, tramadol has a dual action of inhibiting the reuptake of neurotransmitters like serotonin and norepinephrine, thereby calming both mood and sensation simultaneously.
“Tramadol is a fairly strong medication, so why isn't it working?”
Distortion of Pain
However, if the pain persists even after taking such medication, it may not simply be due to the intensity of the pain, but rather, that the entire nervous system's way of perceiving pain is already distorted.
In simpler terms, even if you press the 'off switch' for pain, the switch itself is broken and not working. This cannot be solved by simply increasing the strength or dosage of medication.
Sensory Errors
Many people wonder, “Is it a nerve problem? Or a sensory error?”
Of course, such cases exist. If peripheral nerves are compressed or there's an inflammatory response, neuropathic pain can occur, and in such instances, it can be resolved by injecting at the precise location or by using neurotransmitter inhibitors. However, the situation is different for chronic pain, especially when there's no response even with tramadol.
The Memory of Pain
This is less of a nerve problem and more akin to 'sensory habituation' or 'sensory fixation'. It's a type of sensory loop that keeps repeating. And this loop cannot simply be broken by willpower.
This is because the body's sensory processing system, emotions, sleep, and immune responses are all interconnected. What's needed in such cases is not to treat the damaged tissue, but an approach that re-tunes the distorted sensory circuits.
Korean Medicine Approach
In Korean medicine, such a state is interpreted as stagnant vital energy that cannot move, such as 'Qi Stagnation' (氣의 울체), 'Phlegm Stagnation' (痰의 정체), or 'Fixed Deficiency' (虛의 고착). In these cases, rather than simply applying medication to the painful area, treatment that alters the body's overall flow and sensory patterns is more necessary.
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Baengnokdam Korean Medicine Clinic, 3rd Floor, Songdo Dream City, 81 Convention-daero, Yeonsu-gu, Incheon
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