Chronic Illness and its Various Meanings

What is the true definition of a Chronic Illness?
Further to that, does the most basic definition really capture the widespread severity of long-lasting illnesses.

Click here for a link to an article that discusses the various definitions of chronic illness and the implications of having so many different meanings and understandings of this term. This link also discusses the differing definitions explained on various websites, including MedicineNet and Oxford Dictionaries. 

Excerpts from the first link:
                    'Another academic study on chronic disease, authored by a geriatrician, classifies chronic illness as “conditions that last a year or more and require ongoing medical attention and/or limit activities of daily living”'

'The World Health Organization states that chronic diseases,

are not passed from person to person. They are of long duration and generally slow progression. The four main types … are cardiovascular diseases (like heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructed pulmonary disease and asthma) and diabetes'

And criteria listed from another site:

'complex causality, with multiple factors leading to their onset

a long development period, for which there may be no symptoms

a prolonged course of illness, perhaps leading to other health complications

associated functional impairment or disability'

Other definitions describe chronic illness as anything lasting 3 months or longer, in direct opposition to an acute illness.
So would you call a 6 month long stint with mono 'chronic mono'? Or a broken leg taking longer than 3 months to heal 'chronic bone fractures'? There are times when utilizing the term 'chronic disease' is done too liberally. 

So what is my understanding of a chronic illness?
What are definitions on various medical sites of chronic illness? 
And is putting the word 'chronic' in front of an already understood lifelong disorder - like 'chronic asthma' redundant?

So how do we know what is truly considered a chronic illness.
With so many definitions, the meaning can be lost.
My understanding of a chronic illness is a disease that requires constant medical care, is incurable as we know now, and is a lifelong disease that has fluctuations in severity but will never go away, and affects an individual's ability to function normally in daily life. This includes both physical and mental illnesses. 

Some definitions contradict what I have learned. Some definitions point out that the only real chronic illnesses include cancer, respiratory diseases (like asthma and COPD), diabetes, and arthritis.
Other definitions include *everything* - medical or otherwise - that lasts longer than three months. Various links even suggest the use of the term with behaviours - like chronic nail biting, chronic exercising, or a classroom being chronically overcrowded. With medical terms it has even gone so far as having a chronic sprain, chronic acne, or a chronic sunburn.

In my opinion, the overuse of this term, and the lack of consensus on what the true definition of chronic illness is, results in trivializing those who do suffer with chronically painful diseases.
This type of overly used terminology can lead to discrediting those who truly suffer - very much in the same way that over-diagnosing illnesses like Lyme Disease or Fibromyalgia (when the cause of the patient's suffering just cannot be narrowed down immediately) leads to a general disbelief in the diagnosis itself - even though the diseases are very real.

So how do we decide the true definition of chronic illness?

If we look at particular diseases/disorders, like Chronic Migraines, there is a specific set of criteria that must be met. According to neurosurgeons and various societies dedicated to migraines and severe headaches, a patient must suffer at least 15 migraines a month for a period of at least three consecutive months in order to be considered a chronic migraine sufferer. 

With a disease like Chronic Pouchitis (which sounds made up, I know), the constant inflammation of a J-Pouch (created with the small intestine after the removal of the large intestine) has to last for more than 6 months. In addition, Chronic Pouchitis is diagnosed when medications have been ultimately unsuccessfully in driving out the inflammation. 

What about Inflammatory Bowel Diseases? What about lifelong Hereditary diseases - like Huntington's Disease? Does a disease need to be severe or potentially terminal to be considered chronic? Does an illness have to be considered incurable or a lifelong disease to be termed chronic? Or does a chronic illness simply refer to any symptom lasting more than 3 months? 

In my opinion, we need to be very careful in regards to what illnesses we call chronic. 

Just like using umbrella syndrome definitions results in the minimalizing of those who truly suffer, using the term 'chronic' for anything that causes discomfort for a few weeks will result in more patients having to fight to be believed.

False Equivalences in the Opioid Crisis

Not every person taking an opioid will become addicted.

Addiction is not the same as Dependency.

Someone who is dependent on opioids can also become addicted.

Someone who is addicted to opioids can become dependent.

Someone who is addicted to opioids may not ever become dependent.

Someone who is dependent on opioids understands that they will not die without opioids, that they will simply suffer.

Someone who is addicted to opioids feels as though they will die without their next dosage.

Someone dependent on opioids may never become addicted.

Chronic Pain patients on opioids are not necessarily addicted.

Chronic Pain patients can become addicted.

Anyone can be dependent on any medication or substance. Dependency does not equal Addiction. Diabetes patients are dependent on insulin. Too much insulin can become fatal. People with Thyroid disorders are dependent on Synthroid. Too much Synthroid could become fatal. Dependency does not equal addiction, but they CAN go hand-in-hand in some cases.

Not all addicts started out with addiction issues.

Some addicts experience chronic pain.

Someone does not have to suffer from mental illness to become an addict.

Someone does not need to suffer chronic pain to become an addict.

Marijuana does not relieve all pain.

Marijuana can help addicts wean off of opioids.

Marijuana will not necessarily help those whose illnesses depend on opioids for functionality.

Chronic pain patients are often also taking medical marijuana to combat their illnesses.

Not everyone can take marijuana, not everyone experiences relief with marijuana.

Increased pain off of opioids is not necessarily a symptom of 'withdrawal'.

Increased pain off of opioids CAN be a symptom of 'withdrawal'.

It can be dangerous to discontinue opioids without weaning off of them, but not necessarily because it will 'cause' addiction, but that the withdrawal symptoms themselves can be dangerous.

If removed off of opioids, there are other avenues than going and searching for illicit pain pills on the street.

Chronic pain patient programs are short-term.

A person who needs opioids to function at all (to walk, to work, to be able to get dressed, to have a relatively normal existence) are not necessarily addicted.
A patient may need pain relief in order to walk and also not be addicted.

The mental state of a patient who is an addict is completely different from a patient who is dependent. Thought processes are different, behaviours are different, general day-to-day motivations are different.

Addiction can stem from dependency and chronic pain.

Addiction does not always stem from dependency or any pain at all.

Addiction is more about the mental and physical sensation while on a substance. Dependency is solely about the pain relief in order to function normally.

Many chronic pain patients only take enough medication to reduce pain to a manageable level (approx 6/10 for most chronically ill patients).
Many addicts take enough medication to be entirely without organized thought.

If a dependent patient is abruptly removed off of opioids, that patient may not necessarily seek out other sources.

If an addicted patient is abruptly removed off of opioids, that patient will most likely seek out other sources.

For a dependent patient, opioids were most likely a last resort.
If a doctor were to offer a new medication that would eliminate the need for opioids, a dependent patient would likely not even hesitate, because of the risks.

If a doctor were to offer a new medication that would eliminate the need for opioids, an addicted patient would likely hesitate/fight to remain on opioids, despite the risks.

Dependent patients, though requiring pain medication, would do anything to get off of the medication, especially if there are such high risks. If dependent patients are told that there is a high risk of DEATH, they would easily refuse the medication. If they found something that improves their function and is not an opioid, they would have no issue removing themselves off of opioids.
Addicted patients, though WANTING to get off of opioids, would do anything for their next hit, regardless of other options, regardless of risk of death. If addicted patients are warned of a HIGH risk of DEATH from the substances they take, those patients are still unable to remove themselves off of opioids.

The addiction crisis has hit hard and it has affected people from all walks of life.
Unfortunately, the war to battle the addiction crisis is also negatively affecting those people who are not addicted. There are various false equivalencies being made every single day because of the seriousness of the crisis and the lack of understanding when it comes to the various (yet sometimes subtle) differences. All of these subtle nuances within terminology can be confusing to anyone.
Unfortunately, chronically ill patients whose illnesses cause severe and intense pain, are being dragged in with this crisis. Please remember that these illnesses often have no cure and are degenerative in many cases. The more medication we remove from our arsenals to fight these illnesses, the more we will see an increase in suicides, medically-assisted deaths, patients seeking pain pills on the street, and an increase in addicts. Forcing chronically ill patients to suffer 10/10 pain each day instead of ~6/10  pain, for example, will only result in more tragedy and more addiction.

If you are suffering with addiction, please call the Addiction Helpline:

1-866-332-2322

Adverse Reactions

I read some pretty interesting threads today.
Although the debate itself isn't anything new, the arguments on both sides continue to be fascinating.

Do vaccines cause Autism?

I am not going to debate this, but I wanted to point out a particular argument that claimed that autism is listed as a possible adverse reaction to a vaccine.
The language in a medication or vaccine package insert is vital and can be complicated (often being misleading).
For instance, 'Common Known Side Effects' are primarily those effects discovered during a controlled drug trial. 'Side Effects of Unknown Prevalence' or 'Possible Adverse Reactions', however, are primarily based on self-reporting.
So if I were to get a vaccine, go home, then suffer from food poisoning, if I report it, the package insert is required to list it as a potential adverse reaction.
The reason they do this is because - as we have all seen - drug trials are not always long enough to discover all of the common side effects of a medication. Self-reporting is often how the medical community discovers rare side effects and prompts further testing to find a conclusive answer (or as conclusive as possible). That way, once they found out (for instance) that blood clots can occur with certain medications, doctors will think twice about prescribing that medication to an individual at high risk for strokes.

In the picture below is a portion of the Gardasil vaccine's insert, and the link can be reached here. This insert is easily accessed on the FDA website.
The reason I bring this one up specifically is to show the section of 'adverse reactions' that can help in understanding how these leaflets are put together.
Under this section, there are 5 adverse reactions listed that seem out of place.

4 people reported a 'motor vehicle accident' as a side effect of the vaccine, and 1 person reported a 'gunshot wound' as a side effect of the vaccine.
Now, while a motor vehicle accident *could* have been a result of anaphylaxis or seizure while driving (or several other possible medical reasons), I fail to see a reasonable explanation for how a vaccine can cause a gunshot wound.

There is a valid and useful reason to include all self-reported side effects and adverse reactions, because knowing how any substance affects the body is vital. It is also important that the general public know of these potential correlations so that a person can make his/her own decision when it comes to taking a prescribed medication.
The problem is that there appears to be a lack of understanding when it comes to deciphering the actual correlations and the self-reported and randomly claimed correlations.

Always remember that even if it says that a particular symptom is a potential side effect, that does not equate causation, nor does it mean that everyone will experience that symptom.