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Harm Reduction The Pain Management Megathread (Chronic and Acute Pain Discussion) v6

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switching from methadone to fentanyl

I usually take 30 mg of methadone a day. My doc is switching me to fentanyl patch 25mcg every 3 days. I have a feeling this will not be a high enough dose. I switched from subutex to fentanyl before and I could feel withdrawals through the dose.

What do you guys think?

what would be an accurate dose of fentanyl for someone on 30 mg of methadone a day?

My doctor did not even tell me how long after my last dose of methadone to start the patch. How long would I wait?
 
You should wait until you're in very slight withdrawal from done. Start low, you can always work your way up, suffering a bit physically is the price to pay to be in safe water. 25mcg, then 50 if after three to five days you feel you need more.

30mg methadone isn't a high dose, just be careful not to od on both drugs.
 
Like they said, best thing to do is call. Dangerous combo. Blusebreakers advice is very sound. Good luck
 
Hi Irony,

Did they put you on an extended released pill? The ideal treatment includes an extended release to keep fluctuations at bay, a short acting for flare ups, exercise, massage, ice, heat, injections, etc. I know it sucks to think you'll be on meds the rest of your life. I'm 41, and it drives me crazy. I also catch every cold or bug that floats by, due to the lowered immune system from long term opiate use.

Someone started a thread somewhere recently about going through withdrawal every month. IOM, that means your pain is not being managed appropriately. Or being abused, or a combo, or being abused due to not enough relief (me).

It sucks, but we're here to listen and be a sounding board for venting or ideas.

Sorry I've been out; been having a hard time. Fell down my outside stairs on Wednesday; hurt myself pretty bad. I'm not sure why God is laying it on thick this year, but I'm trying to hang in here.

Dixie, are you ok?

RtP, when do you get results? MRIs are so weird.

Closeau, sorry about your car. Hope you're ok in general. Praying for you, man. Praying for everyone to have just a little extra relief tonight.

hugs and drugs, friends.
 
It's good to hear from you, Shroomi. Good for you for not insufflating anymore. Hope you're ok.

Hi SKR; glad you checked in, too.

Big G and Mr Root; Thank you for your service. Helping others must be so rewarding, but I can't imagine the things you've seen. I know that I could never do your job. I truly admire your strength and courage.

Sorry if I missed anyone; in terrible pain and trying to deal.

We have some newcomers; hello and welcome! We are here to share, bitch about the shit cards we've been dealt and listen!
 
Thanks for the kind words everyone. I haven't been thinking those incidents for a long time and although remembering them were unpleasant ot actually was well for them to go back to my mind as the last time I had thought about those it was just after I had finished my therapy for PTSD. This I could look back into past things and not let them control me at all. Didn't even had to take any drugs as breathing excersises did wonders.

I know that if I'll start writing my thoughts this will end up being rambling and venting but try bear with it as I definately have to write this as it helps me to sort out my thoughts.

I don't know how I have been able to get through from a hell of a lot life threatening situations. Even my therapist said that statistically I should be dead at the moment. Unless I would have checked my phone just before that bombing in the mall I wouldn't have been behind the pillar that prevented shrapnel from hitting me and being only 5 metres away from the blast I would have died pretty much instantly.

Once a tire blew off from my car while driving 120km/h and I hit a fence and the car jumped over it and hit through trees at 4meters high until it stopped and fell to ground. Only broke my wrist lightly.
Had another car related accident in which a drunk hit my car with his car while speeding 100km/h while I was waiting for the light to turn green. My Opel Vectra went from sedan to coupe instantly as the whole trunk section disappeared but I got only bruise marks from the seat belts and pneumonia few days after.
Once an electric hand brake in a Ford turned on on it's own while driving icy road and the car spinned out of control and hit snow bench just a seconds before a truck drived past. Not even bruises.

In Afghanistan I accidentally fell over trip wire and instantly thought I would be dead but the explosive rigged to that wire was dud. Once my exra cover plate stopped an sniper round as I instinctly turned towards where the shot came from although there is no possibility that I would have anyway reacted to the shot as bullet travels faster than sound. Multiple occassions on which I instinctly chose right doorway or window as the next one would have been shot at the time I would entered through.
On the day the car I was driving was hit by roadside bomb our normal lighter patrol car was in service and we had to use better armored car normally reserved for VIPs which pretty much saved everyones lives in that car as the lighter one wouldn't have stayd in one piece and I "only" damaged my spine.

I should be dead or atleast totally incapicited but somehow I have managed to get through those and multiple other situations and in most cases I haven't even got a scratch.

It is quite rewarding feeling you get from doing the right things while stumbling upon accident. It seems even nowadays that I am somewhat disaster magnet and I carry big first aid bag along with fire extinguisher and such stuff on my cars as for some reasons I seem to be among the first in place of RTCs (and willing to do something else than just taking videos or tapping the horn). Few years ago while we were driving with my current ex-wife to meet our relatives there was a head on collision and most of the people just sat in their cars or otherwise just buzzednaround not helping. I had to take lead of making sure that both cars won't start to burn and got the batteries out and even extinguished small fire that started on the engine room of the other car and at the same time my ex-wife who during that time worked as paramedic started to assess the condition of victims give first aid as well as she could with limited supplies. I had to yell people to get more supplies from their cars as most of the around hundred people present where just watching and filming and some even said that first aid kits cost so much that don't want to give out them.

At the same time I was communicating with emergency operator through my hands free kit and they told to clear a site on the road for a helicopter and people weren't that much willing to drive their into the roadside as they might broke on that kind of terrain. I went to the guy who protested most loudly and butted my head into his and took his keys and drove his new car into roadside so well that it got stuck there and told I'll be doing same for the rest unless they want to do it themselves and magically things started to happen.

All this while I was suffering great pain because my back problems escalate when I do something physically hard things. I still just can't let anyone suffer because I might get dirty (yes someone said that he can't help because he has his finests on) or suffer myself. Finally after the helicopter came and also ambulances and other rescue vehicles started to pour in and after I had reported with my wife what is the condition of the victims and where the victims with minor injuries are I started to feel a hell of a lot pain and the paramedic who was in front of us noticed that and told me to go to a ambulance and lay back for a while and someone will attend me when they have spare time.

I then explained my injuries from the past and that guy said that I am crazy for trying that much in my condition and got me some pain killers and monitored me for a while. After the crashed cars were get out of the road we continued our trip and arrived in the hotel we were heading we only then noticed that I had oil smoky substance as well as blood all over my clothes and my ex-wife had lot of blood stains on her clothes. It is weird how you can forget those kind of things when the adrenaline rush is over and you are some kind of weird feeling afterwards.

The receptionist look was priceless and we explained the situation and he said that on the radio station they had on in the reception had a news coverage of that accident and that the firefighters had thanked for the couple that helped preventing the situation getting even worse. Hotel manager heard that and gave an bottle of champagne on the house as well as let us use the spa for free so we got even material reward for doing the right thing although just knowing that we did right would have been enough for both of us.
 
Wow mate that's pretty intense stuff...

While my life has never been in that much danger I've attended armed seiges a few times when I worked with the HART team (hazardous area response teams)...

We had decent military grade body armour with trauma plates built to withstand a 7.62mm NATO round but it was still scary shit...I've had a shotgun pointed at me more than once too.

While that's nothing compared to what you have gone through it's still intense for a civilian in the UK.

My trauma mainly comes from attending RTCs mainly involving children . Also seeing people trapped inside cars slowly dieing with absolutely fuck all you can do to help them...

And having to go for a change of uniform because yours has someone's brains on it.

All in all I've got through OK mainly because I can rationalise what is happening....it's a cruel world and shit happens ....

All I can do is try to help and minimise said shit as best as I can.....
 
Dam bro, thats all really amazing. Aint no technically about it, you should be dead. Ive escaped a few ones like rolloning my car 5 times with only a nick on my hand. But nothing like yours. A religious man would say Gods looking after you. An athiest would say your lucky. Im prob some where in the middle. So you get help with PTSD. Thats good man. Are you clean or on any pain meds for all these things. They had to take your toll but mostly on your mind. I commend you for being a hero man. Good job!!
 
BigG, It is definately much consuming to be in life threatening situations due others as I guess you have got just some special training for HART cases but you don't train everyday for them while on duty as those are just exceptional and rare cases I guess?

It is easier to face life threatening situations in an armed conflict because you know each day you woke up that this might be the day when the worst happens to you or your mates and you have readied yourself for that. Seeing a mate fall isn't as mentally crushing as you know he was there voluntarily and knew what he was up to.

If it feels hard to see suffering then you still have all your human properties intact.

Most consuming things for psyche is to see someone who has nothing to do with that conflict die no matter how well you have tried to protect those people. We had escorted plenty of kids to that orphanage from other even more dangerous areas and even got few of our soldiers wounded while protecting those transportations. Seeing those kids who just had played football few days ago to end up in a mass grave felt just awfully wrong. We had tried to protect them but we had failed as some bastards didn't value human life and especially childrens life. It made me so mad and disappointed at the same time and that feeling continued for a long time and I felt that anything I do won't make a difference.

Closeau, I started using pain meds after that roadside bomb blow our car around and I have had multiple surgeries due it but finally now I don't have (much) pain. I am tapering out of oxycodone and I am on the last quarter of that hike. I have noticed that opiates have dulled my mind for a long time and I am much more emotional than I was while taking much higher dose than now and now I can think about these things that have happened in my past much easier than I had before. On a higher dose I was just totally numb when I thought about these after finishing therapy but before therapy I had a lot of nightmares about these and even during daytime I had flashbacks and panic attacks.

Although I guess that using opiates gave some comfort to PTSD and that part of my recreational use self medication to suffocate feelings related to it.

It is by the way hard to find a therapist who can tolerate that kind of things especially if I use graphical language describing how things looked for example after that suicide bombing (and I try to not use it here) but luckily I found one who has dealt with refugees from military conflict areas and could bear all those gory details without getting seemingly disturbed.
 
Well during my 5 years on the HART team we did more training exercises than actual jobs (although were still paramedics and expected to respond to "normal" jobs too)

HART was established after the 7/7 terrorist attacks in London when they realised normal paramedics weren't trained to get close enough to the event to offer proper help.

There's talk of disbanding HART since there aren't enough hazardous area to respond to...the gear and training is expensive anyway...

I left to drive a rapid response trauma car instead.
 
Ah. So it is a permanent group that trains when there are no jobs. I thought it might be the same as our dangerous person involved teams that have just had some training and have special gear but who do normal jobs until something happens in which they are needed.

There has currently been debate here about are paramedics able to defy orders to go treat a patient who is known to be violent if cops are not yet there. Due this they are going to add more this specially trained teams and will give them time to practice too.
 
Yeah that's exactly what it's like mate...
Training and normal jobs while waiting for the hazardous job that never comes....that's why I left....

If anyone is violent with me they can fuck off until the cops get there....I don't get paid enough for that shit...
 
Yeah in my opinion if someone is hurt he should be glad that paramedics arrived and if he shows any violent action then he has forfeited his right to receive care until there is someone available who can make sure that paramedics won't get hurt as they are just helping.

Edit: And it seems like this violent behaviour among patients is increasing in every situation.
 
Exactly mate.

Unfortunately with the drinking culture in the UK violence toward emergency response crews happens all the time...

Night shift on a Saturday night is a sight to behold..

You're spot on regarding forfeiting right to treatment if the person is violent....

Unless they're dying they get nothing from me.
 
I can definately relate to nighshifts with drunk people around behaving badly. Before army I worked as a nightwatchman and had my share of drunk people. I guess our brinking habits are quite the same here in Finland as in UK.

Lately after the last drop in my tapering schedule I have had withdrawal like symptoms between the doses and I am thinking if I should quit totally right now and deal with the withdrawals or ask for buprenorphine for the rest of my schedule as it has longer half life or could that be totally dumb idea. I don't want to go through withdrawals, although mild right now, every day and night.
 
Well, i cant speak on any of your professions guys. All i know is that youre both brave men and should be seen as such. I cant imagine. Mr Root, your withdrawls will ease. You said youre in the the last quater so youll feel squirrly off them for awhile but then its all in your head. PAWS is a bitch and will lead you back on them quick. Hang tough, youre almost thru it. Thanks again to both of you for what youve done and what you do!!!
 
Thanks closeau.

I have used this tapering time to get my life truly back in track by starting to exercise and get back to my old hobbies and also I have gathered all the help I could get so I could cope with PAWS and to prevent relapse.

As I have legitimate reason for pain killers it is just so easy to get back on old habits as all it takes is to go to doctor and tell I have pain and then start to ask for more and more and more. I am going to keep this pharmacy contract on even after the tapering schedule is done so atleast I can't go dr shopping and as my primary already knows about my prior problems he will put things straight if I ask for pain killers.

I know I can cope with my current pain level without opiates although it prevents me for lifting heavy things and such and I do hope that Lyrica will help with some of the pain, RLS after ceasing opiates and hopefully with PAWS.
 
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