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  • AADD Moderators: swilow | Vagabond696

Pain Management in Australia

Hey thanks for the vibes - I can really use those atm. And thanks for sharing the K treatment info and how it affects your condition, it's really interesting and I'm keen to hear more from you, appreciate it. Positive vibes right back at you RTP. :)
 
Is this the Niki pump? https://www.youtube.com/watch?v=0QjOQ1OQXzQ
Ive never heard of ketamine being used here in NZ for chronic pain apart from topically (which is hella expensive)
Was it something your Pm doc suggested? How did it come about?

I had a lignocaine infusion once which did nothing.
 
^In regard to the K infusions I don't know how frequently they're considered a pain management option, as in whether they're even offered up north.

Other than the patients I've met as an inpatient I don't know of anyone who's had the treatment. Even here on BL, I've been asked about the infusions, but don't think anyone's gone ahead. Might be worth asking your doctor if he/she's heard of the practice.

Did you taper off the Lyrica yet? I recall that you were then going to give Endep a trial? Doesn't the whole drama of these hit & miss meds drive you crazy? The waiting game.. I recently read an article from a study of pain patients in Melbourne, more ppl taking the above two meds had the majority of falls, car accidents, & workplace accidents than those taking purely opiates for chronic pain. Just FYI ;)

One drug I really reacted badly to, Palexia is the brand name here, it wasn't until I was vomiting blood that my GP finally let up on the "let's just give it one more week" line. From then on I have been much more in charge of what does & doesn't feel right for my body.

Let me know how you're doing soon

Rtp
 
Geez RTP, yeah i'm sure those vomiting blood episodes made your GP a little more skiddish when coming up with new drug suggestions/prescriptions.

I've tapered off the Lyrica and I'm taking 50mgs of Endep in the evening. I think I could take these in the morning too, I've had no notable side effects apart from perhaps a little drowsy which is quite welcome, I had hoped for a bit more actually. I can understand these drugs playing a role in falls and accidents for sure, the dumbness and wobbles that come with lyrica. Ew. But I would persist if it helped my pain though. And yes RTP, the drama of all the hit & miss drug treatment is a drag. I used to be healthy.

The last year has taken it's toll on my mind and body. I used to lift weights, weighed 90kilos at around 12% fat, hospitalised with idiopathic pancreatitis and left the hospital 2 weeks later weighing 71kilos at 8% since dropped to 67kilos 10% fat. I'm anxious as f^&k now too, often teetering on the edge of a mental breakdown, doesn't take much pressure before I'm sweating, I've never been like this. Oh and then there's the pain, that relentless never ending pain. It's not the severity of the pain after a while, though I'm thankful it isn't worse, it's the fact that it never leaves, it just doesn't ebb and flow enough for my liking which is why I ultimately sought medical treatment.

Thanks for your reply RTP, appreciate your time. I'll be sure to mind that Palexia too, sounds nasty.
 
Pain management in Australia is a very touchy subject, mainly because many try to get opioid medications to sell / abuse. I'm a mid twenties male who has been jumping through the hoops for too long now, i find it disgusting how many PM clinics treat their patients and mostly see them as addicts, my doctor has me on the bare minimum of pain medication which is currently 15mg morphine ER at night / 5mg endone x 2 a day when needed for 10 days of the 28 and 300mg pregablin x 2 a day.

One of the private PM clinics has tried me on buprenorphine patches and tapentadol ER despite my allergic reactions to tramadol, after those were not working he stripped me of all my medication and told me i was not suitable for his therapy and to immature / drug seeking and cut me off and left me in opioid withdrawal for 7 days before i could crawl back to my doctor and fight to get my old scripts back, because of this i am currently looking at disk fusion to try and reclaim what is left of my life.

I am currently in a public waiting line to see a public PM but after attending one of their lectures which was compulsory i know they will strip me of my meds and focus on physio therapy and healthy eating as opioid's do not cure anything in their eyes. I hope you have a better experience at your PM clinic, but personally i would avoid them and try and stick with your GP and work out a medication plan with him if he is happy to prescribed your scripts monthly.
 
Is this the Niki pump? https://www.youtube.com/watch?v=0QjOQ1OQXzQ
Ive never heard of ketamine being used here in NZ for chronic pain apart from topically (which is hella expensive)

Was it something your Pm doc suggested? How did it come about?

I had a lignocaine infusion once which did nothing.

^Yes, that's the pump, & yes, my pain mngmnt spclst put me onto ketamine infusions. He has told me that our area is "cutting edge" in pain management, & he's also involved with the public pain clinic, regularly writes for medical journals, & is a senior lecturer at one of the local university's medical school.

As I mentioned in an earlier post, it took me a long time to warm to the idea of such a procedure. I had a phobia of hospitals, not to mention being attached to a drip containing a "horse tranquilliser" for an unknown period of time. However, such was the extent of an excrutiating flare up of neuropathic pain, with no end in sight, that I practically gave consent for my doctor to do anything he wished that had the potential to help me.

I also have had Lignocaine infusions. One, rapid, IV, in the coronary unit of the hospital over two hours. Two others while receiving the ketamine infusions. They weren't helpful for me either.

@Brighton, what sort of pain do you suffer from, & from what source does it originate?

Rtp
 
^ Cool, how much would the ketamine decrease your pain by? Out of ten, before and after?

I have nerve damage in my wrist from tightening bike spokes one day 6 years ago. Im really lucky because thru physio I have managed to pretty much eradicate the pain and get my strength up to a point where Im able to study carpentry full time :) But it was agony for years. I also have a dodgey right knee from surgery last year that likes to swell and stiffen. My next project ;) I just started suboxone in January. I just feel awful, depressed and not myself without opiates now. The suboxone is great.
 
^out if ten, when it's been a really severe flare up,- maybe at best would come down to six or seven if lucky. So no huuuuge improvement which is why I'm currently set on coping better with the pain psychologically.

So subs huh? Were u on opiates the whole six yrs? I have a viscous cycle regarding my oxy use... I'm on a pretty big dose & not getting the desired effects anymore, so trying to find the inner strength to start lowering my dose.

Rtp
 
I have a viscous cycle regarding my oxy use... I'm on a pretty big dose & not getting the desired effects anymore, so trying to find the inner strength to start lowering my dose.

Rtp

This is where I'm at. I didn't push it too far though, pulled myself up when 2 x 80mg OP's didn't touch the sides - I still remember when 20mgs would alter me sufficiently where pain wasn't my middle name and smiling reintroduced itself to my face. Opiate tolerance sucks. It just does. It's taper time.

So to taper I started at 160mgs and dropped to 120mgs the following day, then 90mgs, 90 again today. I'll settle into this dose for a day or two and maybe go for 80mgs. Basically I'll see how I feel and if I think I can take less the next day I'll do it, if I'm struggling with a dose I will stay on it to settle in so as to help prevent another episode of mentally beating myself up for cracking and taking a pain killing dose (Probably back to 160mgs). Honestly, after being sober for 8 years, catching an oxy habit causes me tonnes of anxiety, I am so fucking upset with myself...Anyway....I'm all about this oxy taper at the moment so we'll see.....

Endep (amitriptyline) has had an antidepressant effect on me I think. This is welcome. No physical pain relief as such but the mental aspect has improved somewhat. Time will tell. I took 25mgs for a couple of days then increased to 50mgs for another two days and now I'm on my second day of 75mgs. I was previously quite negatively opinionated about antidepressant drugs and their use but after being introduced to living with massive anxiety and stress I was eager to try amitriptyline when my GP spoke of it. I am being prescribed it for pain and apparently it's not prescribed for depression anymore but I'll stick with this if things improve like they seem to have.
 
^ Glad to hear the amytriptyline is having a positive effect on your mood! I take a much smaller dose, but am considering speaking with my GP regarding going back onto an antidepressant. Whether it's an increase of the above, or a different type.

Emotionally, I've been lacking motivation & find life less appealing as time goes by. I hate waking worried about if I have enough pills left, whether I'll spend another week in wds or just a few days each month.

I know I'm fortunate to be prescribed the amount that I am, & don't ever want to risk my relationship with my doctors. I want to be able to taper to a reasonable level, but if the pills are here & I'm in a heap of pain, then it's really getting harder to resist taking more. Well done to you who can!!

SKR, are you able to work atm? I'm a mum as well, so I'm not able to manage paid work. Recently I've gone on board the NDIA. Formerly I'd get home help from the council, but since the switch, (I'm in a region where the National disability insurance agency has rolled out their pilot program), I'm lucky enough to have five hrs per week of assistance with my housework, shopping etc.

They also fund taxis for me when I can't drive,- my right hip/leg has sciatica, to attend hydro, physio etc.

Back to your post, I get how upsetting it is to be in the evil clutches of oxy. I have daily arguments with myself as to whether I'm actually better off with it. Sure, it helps the physical pain, but IMHO also causes depression & anxiety.

You're extremely strong to do what you're doing. Good work, keep it up!!

Peace,

Rtp
 
^ Glad to hear the amytriptyline is having a positive effect on your mood! I take a much smaller dose, but am considering speaking with my GP regarding going back onto an antidepressant. Whether it's an increase of the above, or a different type.

Well I may have spoken too soon cos I was all tears and depression this morning. It's apparently common to have increased anxiety and depression when starting these class of drugs so hopefully it will settle down as I progress. I've only been taking the Endep for a week so we'll see. I'll stick with 75mgs in the evening and just monitor how I feel. I can certainly see the benefits regarding how one handles their pain if your head is screwed on straight. Maybe if we can get the depression and anxiety under control we can lessen the opiates so when pain is really bad we can actually get decent relief from oxy without having to take a fistful.


Emotionally, I've been lacking motivation & find life less appealing as time goes by. I hate waking worried about if I have enough pills left, whether I'll spend another week in wds or just a few days each month.
I know I'm fortunate to be prescribed the amount that I am, & don't ever want to risk my relationship with my doctors. I want to be able to taper to a reasonable level, but if the pills are here & I'm in a heap of pain, then it's really getting harder to resist taking more. Well done to you who can!!

Yes, all the worry does my head in as well. I hate not having control of my supply when it comes to any drug. If I can't grow it or synthesise it then I know at some stage I am going to get stuck and that causes me anxiety which is another reason for me to get my doses down, I'd rather get stuck with a 50mg per day habit than a 250mg daily habit that's for sure. And yes it's hard not taking more when you have the pills that help and the pain is singing loud and clear but as I said before the anxiety from thinking about having a day or two with no relief is slightly greater than my need to get too buzzed - I make sure as best I can to never run out completely, I'm too mentally weak at the moment to handle withdrawal.


SKR, are you able to work atm? I'm a mum as well, so I'm not able to manage paid work. Recently I've gone on board the NDIA. Formerly I'd get home help from the council, but since the switch, (I'm in a region where the National disability insurance agency has rolled out their pilot program), I'm lucky enough to have five hrs per week of assistance with my housework, shopping etc.

They also fund taxis for me when I can't drive,- my right hip/leg has sciatica, to attend hydro, physio etc.

I'm still working, I'm a manager at a company I have been with for 15 years, a couple a dozen staff and a bunch of other bullshit has me crumbling under the pressure lately due to my health, I'm about to take a couple of months off (Long service leave) to try and get my shit together. It's my head that needs the most sorting even though the problems with the body are driving much of it, but I can step back a little in my role physically without compromising the performance of the divisions I head up. So get the head right and I think I'll be able to carry on working. If not then I may be considering disability pension myself RTP. Just don't know yet but I'm looking forward as best I can to the time off.

I'm a parent as well, lil champ is 20 months old and he means the world to my wife and I, I owe it to him and my wife to do the best I can and really try and pick myself up. It's all too hard sometimes. Feel like such a sook these days, angry, anxious asshole always complaining to myself about pain and life. There are billions worse off than me though, could be worse, but I certainly know that this is the worst I've ever been.

Back to your post, I get how upsetting it is to be in the evil clutches of oxy. I have daily arguments with myself as to whether I'm actually better off with it. Sure, it helps the physical pain, but IMHO also causes depression & anxiety.
You're extremely strong to do what you're doing. Good work, keep it up!!
Peace,
Rtp

Yes absolutely - that inner (and outer) dialogue, constant argument with yourself about bloody pills. Quite frankly it's killing me too, I know I'm digging a deeper hole with opiates. I have to agree wholeheartedly RTP, oxy causes me depression and anxiety for sure. Even if it was purely psychologically motivated the effect that my use of oxycodone has on my anxiety is substantial - worries me to tears.

Strong isn't a word I would associate myself with these days but thank you for the support. I of course, as I knew I would, took what should have been pain killing dose this evening for a little break - barely enough pain relief from 160mgs to have made it worthwhile with respect to my taper which was at 90mgs daily. I'll drop to 120 tomorrow and work throughout the next week at the 100 - 90mg daily then drop again to 80mgs. So it'll be 30mgs for breakfast and 50mgs for afternoon tea. And yes I may throw in a fuck up or two like a true addict. Yay.
 
Sorry to hear that the endep isn't working for you at the moment SKR.

I saw my gp again this week, she's not able to suggest anything else similar to endep (10mg/daily) or lyrica (25mg/daily) for pain management based on my previous side effects.

She did give me half a dozen Zaldiar to try instead of panadol osteo. It's a low dose of tramadol with paracetamol, which surprisingly worked very well for me yesterday until I headbutted the corner of the rangehood..

If the addition of Zaldiar continues working for me, I'm going to start looking for work again because it made the day me a whole lot easier and more pleasant.

If I'm working again, I'll be able to afford to see a specialist and find out what's going on with my spine..

I'm really looking forward to some answers.
 
Hi Ash,

Well I did have a better morning today regarding depression - I do think the Endep is having some effect but depression like almost every other issue has to be treated at the source, identify the cause rather than rely on medication to do the heavy lifting so to speak. Just gotta be thankful for what I do have rather than what I have lost I suppose. Well I'm pleased to hear that Zaldiar gave you some relief - I know tramadol all too well but didn't know it came as a paracetamol mix. I've got plenty of tramadol in my cabinet but I try not to use it as my opiate base when seeking pain relief, it's not as effective for my pain and comes with a few less desirable side effects but it is good for sleep for me. Excellent for restless legs I've found in fact it seems to target legs for some reason, I know others who have found this also - seems odd but there you go.
 
^Have you a certain specialist in mind, or does your GP? Ime, so long as you contact the office ahead of time usually a payment plan or extension can be arranged.

Especially if it enables you to have an exact diagnosis so that you can receive the correct meds/surgery.

SKR, don't beat yourself up too much. I go many days without oxy, then when I get my script binge. figuring i "deserve" a decent days pain relief. Currently I'm biding time with a fent patch.

I didn't realise PM was so difficult in OZ. Can I ask what your prescribed oxy dose is?

Rtp
 
Hi RTP, I hope you are well and thanks for your support.

I'm prescribed 10mgs ER oxy morning and evening (20mg daily total) with 5mg Endone IR's x up to 4 per week for breakthrough. Pretty standard entry level doses so to speak. My GP is seeing my condition as something that I am likely to be stuck with for a while so she is trying to keep my doses low for as long as I can handle so that I don't hit ceiling doses too soon. However recently my GP is allowing me to take more Endone now in the middle of the day so really I'm 10mg ER morning, 10mg Endone at 6 hours after morning dose and 10mgs ER evening and if I require some more Endone here and there then so be it. So I'm at 20mgs ER and up to 20mgs IR per day. I have to visit my GP fortnightly to pick up my scripts for 28 x 10mg Extended Release Oxycodone and 20 x 5mg Instant release

I am gearing my GP up for an increase this coming week. To use a phrase you used in an earlier post in the eyes of my GP I am earning my stripes. What my GP does not know is I began using oxy 4 months before she finally prescribed the drug to me (which we both knew was inevitable unless there was a change in my condition). Had I been in my twenties, admitted hard drug use and addictions in the past and also not had other idiopathic health problems such as pancreatitis and MGUS I doubt I would have been prescribed oxycodone quite frankly and by the sounds of things that mirrors the experiences of other Australians on this forum.

What my GP does not know is that I started taking oxycodone for my condition 4 months prior to her prescribing it to me. Unfortunately by the time I was prescribed I was already taking 80mgs split morning and night consistently - with the 80 - 200mg days thrown in between here and there. But I needed that prescription for two main reasons - legitimise the reason to have opiates in my blood and be possibly carrying the drug on my person or in my vehicle and then second reason is this bloody pain that won't let go. Anyway that's my ramble for this evening.
 
As per posting via iPhone,-just lost what I'd written!! Grrr

So, beforehand, 80mg of endone or oxycontin split into two doses daily right? A minimum of 40mg? Did/do you ever take the oxy whole to allow for the slow release? Or chew/cut/snort?? I'm asking as I cheek a fent patch ;/
Understand that you're actually prescribed less.

Just asking out of curiosity, long ago now I began chewing up the OPs as I found the almost instant relief superior to slow release. (Duh), Especially since they've re modified the original OC's, lost the "quick dump" mechanism. After all, I'm in it for the pain relief.

No wonder you find it costly,- huge difference between what you were dosing & what you're prescribed. Re: the ceiling effect, with oxy there really isn't one, unless side effects get in the way,- you've certainly got a fair way to go, but of course it's in the prescribers hands. Or, uh,yours ;)

I myself have initiated Mirtazapine treatment, meant to act within a week for depression, - I'd love to wake not dreading each & every day!!

Also, I've made an appt to see my previous pain dr. My new one was quiet & nervy. I far prefer a confident & outspoken specialist, especially when he's advocating opiate therapy & not morally opposed!!

Rtp
 
Yeah I'm prescribed a maximum of 30 - 40mgs per day (20mgs slow release, 10mgs Instant release), but I buy boxes of the 80mg OP's illegally and take between 80 - 250mgs per day depending on my willpower to use less. I have always crushed/chewed my pills. I've recently been trying to taper down what I take and working to have the GP increase the amount I'm prescribed with the hope of meeting in the middle somewhere. I have a pain problem, a drug problem and an anxiety and depression problem. These are by far the worst days of my life.

I had a terrible morning fighting off a panic/anxiety attack. I think perhaps the Endep is exacerbating the anxiety and depression. I'm going to take less this evening.
I too would love not dreading each day. Gotta work another week, crash course train someone to do my role and then it's 2 months off. I hope I can make it through this week. Going to have a long chat with my GP on tuesday, I almost checked myself into emergency this morning to beg to be knocked out - MIDAZOLAM NOW!!!!!!
 
Well it probably wasnt the best idea but i was getting nowhere with my GP and a friend of mine had recently had surgery to fix up a crushed vertebrae and was prescribed 3 x 80's a day for 6 months leading up to his surgery - after which his doctor has allowed him to keep getting the scripts, lucky for him money wise and lucky for me pain wise. It will come to an end soon so i had better get my use down or I'm fu*ked. How do you handle withdrawal RTP?
 
^usually with Lyrica, but if I was working I wouldn't be able to get away with bumping into shit & mumbling/slurring my words.

Geez, that's actually not as messy as it sounds, but if I'm gonna be cushioning wds with lyrica I plan ahead so if don't have to drive or do anything much outta the house. Or cook, I've burnt myself, even splashed hot oil into one eye & ended up at ED!!

At home I can just zone out & watch a movie or put on some music & chill. It seriously works well, I save up most of my script either for potentiating opiates or withdrawl days. Loperamide too, as no grown up ever wants to not make it to the toilet on time :/

Other times I just have to agree to be sick for a few days. I pull myself together as best possible, & say hey, I'm in my thirties, I've been sick many times before, & this is just for a few days, & suck it up as best I can.

I realised a few yrs back that if I'm gonna require & abuse opiates to the extent that I do, then not every day is gonna be peachy. Obviously I wish this wasn't the case though.

Reading BL helps too, for support or just to know others are struggling as well.

I'll be starting working with a psychologist again soon, & it'd be helpful if I could be 100% honest.

We'll see..

Rtp
 
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