Pain: Physical Pain as a Primary Aspect of Dukkha

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I have always believed in the constant minimizing of one’s pain medication doses, trying to wean oneself entirely from drugs or else stripping doses down to the bare-bones minimum. When it comes to reducing pain-killers or meds that combat pain, sometimes I cut the doses too radically and too quickly, and I end up in screaming pain. Like right now. Acute agony with no relief in sight.
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My “zonkers”, i.e., amitriptyline (a tricyclic antidepressant), are the tried and true prescription to enforce deep Stage-4 sleep and heal my FMS (fibromyalgia syndrome). Over a series of weeks they start to ease the pain. The problem is that they are what I call “zonkers”; they zonk me out and leave me with the mentality of a zombie. But I must balance this zonk-out effect against the “brain-fog” zonk-out of untreated FMS (exhausting pain plus incredible fatigue plus brain-fog). In this delicate game of finding the right dose, my mental acuity often falls off one side or the other, leaving me an imbecile. Like right now.
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When still living in the States, my zonker dose was from 50mg. to 100mg. – a huge dose. I cannot imagine how I functioned on so much (and, indeed, my teaching did trail off into the lower poor range, making it an embarrassing fraud if I had held on to a secure tenured teaching position for one more year while just going through the motions).
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Here in Thailand zonkers (amitriptyline) are over-the-counter and cheap, so I can get them whenever I need them. But the same dilemma applies, should I take too little or too much? Where is the proper balance?
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I have been taking 40mg. for a long, long time and maintaining a balance between pain and functionality. But, in concert with my lowest-dose target principle, I have recently reduced the doses down to 30mg. to 20mg. to 10mg. And suddenly I am in paralyzing screaming pain. Dukkha! Chronic and acute Dukkha to the very max! It feels like someone hit me in the center of my back (T-7) with a baseball bat – with a full-out homerun swing! Added to that, I am fatigued out and moving like a knuckle-dragging primitive hominid with an IQ way down the scale.
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The FMS brain-fog is equivalent to the over-medication of zonkers. They both leave me a staggering half-wit, not good for much. I hate each of these mental fogs as much as I hate the acute pain, because I am unable to function normally in either state.
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As a postscript, I will once again rage against those within the medical community who ignore acute pain. To prescribe over-the-counter “pain relief” placebos such as aspirin, Tylenol, Motrin, etc., for real pain is an insult to those who truly experience such pain. Such medication does not even begin to touch true pain. In my agony I find myself wishing that such doctors would experience, just for one full day, the pain I am feeling now so that they truly understand. While in a free society one could choose one’s medicine (and accept the consequences), most societies today are far less than free and they over-regulate and over-control pain relief (unless the elite regulators/ legislators need personal relief for themselves).
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I hurt. I hurt right now as I type this. I am in acute pain. My life is stalled because of pain and fatigue, and I am in a horrendous rage.
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-Zenwind.
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