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Harm Reduction The Pain Management Megathread (Chronic and Acute Pain Discussion) Version 5.0 ~ V

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Thanks for the replies. I also remind myself that there are people a lot worse off than me. I need to count my blessings. I have a good doctor now too, I'm even prescribed diazepam finally so I have everything I need.

I'm doing quite well generally; when I am not on opiates I tend to be very moody.

Good things have been happening to me lately - trippy coincidence type stuff. I think my life is going to work out.

I had a belly at one point before I got on the opiates, since I couldn't work out and I was taking a gram of seroquel a day for my panic disorder which caused weight gain. Most miserable time of my life... that is one thing I am very thankful for. I have not used seroquel in a year and I never will again. I have pills that work now and don't outright fry my intellect. I can do like an hour of yoga a day which is fine for exercise, I am no athlete like I used to be but I exercise my brain more.
 
Couple of quick questions:

Just because Methadone has a very long half life, does this also mean that it actually has a very long duration of action? I know Valium has a crazy long half life, but a relatively short duration of action, so the two parameters don't necessarily relate to one another.

I currently take Oxycodone 3x per day. If I changed to Methadone, would splitting my dose into 3x per day be more effective than just 1x morning dose?

In addition to your normal daily dose of Methadone, can a small dose of Methadone actually be used to help fight breakthrough pain, or would I have to use a quick acting Opiate such as IR Oxycodone or IR Morphine on top of the Methadone for breakthrough pain?
 
Methadone takes longer to reach peak blood plasma concentrations. Ideally, when you've reached your ideal dose it should cover your pain well due to it's long half life.

Ppl OD when starting methadone for chronic pain as they feel it's not working and take more, not understanding it's mechanism of action.

Short term, an IR medication can be used for BT pain, but whether that will actually help will depend on the dose of Methadone. If you're on a relatively low dose it should work, but not likely on higher doses.

Rtp
 
30mg Oxycodone vs. 30mg Oxycontin

Hi everyone I am new to this group. As you may have guessed I have Fibromyalgia as well as a artheritis, bone Spurs and a horrable back. It's been hard finding the right medication -!: havin to hump thru so many hoops for insurance purposes as I am sure many of you have done.

My questions are:
1) how long (on average) does 30mg oxycodone last compared to 30mg oxycontin. I know that the company OxyContin is time release and can last up to 12 hours so I need to know approximitly how long a 30mg oxyxodone

2) have any of you tried detonated patches for severe pain. How did it work. Did you like patches or medication better
3) whats Opana? Is it comparable to oxycodone/OxyContin

4) what medications do you feel work best for your chronic pain issues?

Thanks for your time everyone
I look forward to your responses

Sincerely,
Fibromyalgia101
 
Welcome to bluelight. I'm going to move your thread.

Anonymous -> Other Drugs (pain management megathread)
 
@fibromyalgia101, I'm well versed with oxy & have similar pain issues to urself.

Typical dosing of oxycodone is 4-6 hrly, for breakthrough pain. Whether it will help your pain for that length of time differs due to individual factors such as metabolism & genetic makeup.

I haven't heard of detonated patches, could that've been a typo? Fentanyl? It sounds as though you're new to pain mgmt,- I'd leave them for now. Save them for further down the track, they're the strongest opiate available.

Opana? I'm not in the states, but you could try google, apparently it's oxymorphone. A step up from oxycontin.

I've been in pain management eight years & have tried most opiates. The full agonists at least. You can see my any of my posts or threads that I'm a big fan of oxy.

Hope this helps, & welcome to BL

Rtp
 
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Opana, is much more than a step up from OxyContin. Orally, it's on par with Dilaudid, and when administered intravenously, it's twice as potent as Dilaudid. I've heard bad things about Opana involving dependency issues, duration issues (even with the extended release), and tolerance issues (it just skyrockets your tolerance to everything).
 
^with due respect I highly doubt that @fibromyalgia101 is asking what Opana is so she can be IVing anytime soon.

Rtp
 
I highly doubt it too, but in areas they use Opana, they have Numorphan (Oxymorphone) for intravenous use in hospitals. Any time she has an acute attack and winds up in the ER, her doctor will more than likely order the same drug she's on at home for intravenous use.
 
I just got a new PM doc who put me on LDN (low dose naltrexone) for the fibro/autoimmune issues (pain and fatigue both) as he has had good luck with it so far. Has anyone else tried this? I'm really excited to try it as I'd like to keep off opiates. Wondering if anyone has any first hand advice.
 
I highly doubt it too, but in areas they use Opana, they have Numorphan (Oxymorphone) for intravenous use in hospitals. Any time she has an acute attack and winds up in the ER, her doctor will more than likely order the same drug she's on at home for intravenous use.

It's that easy over in the states??

Did I read that correctly? So, eg: I'm clearly on a high dose of oxycontin, if I lived in the US & presented with acute on chronic pain I'd be referred back to my home with IV Oxy?

Or just the case with Opana?

I've lurked for many yrs on BL before I became a member, but have been on Erowid etc...never heard of this.
Rtp
 
I just got a new PM doc who put me on LDN (low dose naltrexone) for the fibro/autoimmune issues (pain and fatigue both) as he has had good luck with it so far. Has anyone else tried this? I'm really excited to try it as I'd like to keep off opiates. Wondering if anyone has any first hand advice.

Hey Wez,

Personally, I have no first hand knowledge however I have been on at my pm doc about this!!

Rumoured to heal everything from HIV to Cancer, I've read much anecdotally about the benefits of LDN for chronic pain.

Naltrexone is avail here for alcoholics but in staggeringly high doses compared to LDN... Like some who've contemplated faking or undertaking a heroin habit to obtain methadone for pain, I've wondered the same about alcoholism as, surprise, LDN is as yet unheard of as a viable treatment here.

Love to hear how you get on, pls keep us posted!!

Rtp
 
Hey Wez,

Personally, I have no first hand knowledge however I have been on at my pm doc about this!!

Rumoured to heal everything from HIV to Cancer, I've read much anecdotally about the benefits of LDN for chronic pain.

Naltrexone is avail here for alcoholics but in staggeringly high doses compared to LDN... Like some who've contemplated faking or undertaking a heroin habit to obtain methadone for pain, I've wondered the same about alcoholism as, surprise, LDN is as yet unheard of as a viable treatment here.

Love to hear how you get on, pls keep us posted!!

Rtp

I have a feeling I got very lucky in getting a very progressive doc, as he prescribed turmeric as well a this and some other things to try and was very no nonsense. Naltrexone has to be compounded at the pharmacy to LDN as it comes in the 50mg tabs and I'm prescribed 3 mg... I know it's not popular as only one pharmacy will do it and it has to be shipped to where I live. But I will definitely update with how it goes. Hopefully it comes in today :)
 
It's that easy over in the states??

Did I read that correctly? So, eg: I'm clearly on a high dose of oxycontin, if I lived in the US & presented with acute on chronic pain I'd be referred back to my home with IV Oxy?

Or just the case with Opana?

I've lurked for many yrs on BL before I became a member, but have been on Erowid etc...never heard of this.
Rtp

I'm not saying they would send her home with ampoules of oxymorphone, I'm saying if she winds up in the hospital, more than likely the doctor would order the intravenous version of whatever medication she was on if it is available.

Oxycodone prescribed individuals would have to be given something else such as Morphine or Hydromorphone as Oxycodone isn't prepared in an intravenous form due to it's extremely high oral bioavailability.
 
^ oh, lol,- I guess you could read that one if two ways?

Hospitals here usually only stock either Morphine or Hydromorph, but in more recent times the latter seems more popular.

Rtp
 
That hasn't been my experience in the U.S. at all being in the hospital for acute flare-ups of chronic pain, and unfortunately there was a stretch of time I was going really often. Most of the time if your regular doctor doesn't send you with a note suggesting what the ER physician do-- which they don't have to follow-- the ER doctor will do whatever they think is best for your symptoms regardless of what you’re already on. Maybe that's narcotics, maybe it's not. To be fair, there is really terrible acute pain that responds better to other drugs than narcotics (mostly neurological and it still depends on the person), but god forbid the doc decide that's what's going on if you really need an opioid. It's absolutely ridiculous with chronic pain patients; it's like reinventing the wheel every time. It doesn't matter if you can tell them conclusively it would work. It doesn't matter if you've been at the same hospital and have been given narcotics before for the same complaints and condition. It doesn't matter if you're on them already at home and in fact this sometimes makes it even less likely because I've actually had doctors say "well if all that oxycodone isn't working, why do you think a [big, fat] shot of hydromorphone will?" If that physician thinks something besides a narcotic will work to get you out of pain, and often they do, you can damn well be sure that’s what’s happening first. This makes perfect sense if someone is presenting for the first time with an unknown complaint but not when it is completely counterintuitive to a patient’s documented medical history.


I can feel this turning into a really long post so I’m going to try to curb it, but as much as I hate it I have literally been in hospitals around the country and it’s always the same. I can’t tell you how many grueling eight hour Emergency Room visits I’ve had that could have been done in two hours or less if they would have just given a shot of hydromorphone and sent me on my way. Even when it got to the point that I had been given the same treatment many, many times at the same hospital and had a note from my doctor with the same suggestion, I had ER docs trying all sorts of things they were “certain” would do the trick. Ironic quotes.


I’m sure this was conflated by the fact that I have a condition that, while extraordinarily painful, doesn’t typically respond well to opioids. Of course I’m the anomaly, I always am… though it’s not as if I’m the only person with cluster headaches who has taken a narcotic and felt better. We are the minority, though. I can’t tell you how many stories I’ve read on cluster support boards of people going to the hospital in immense pain, getting a medium-fast drip of 2mg of Dilaudid as an opioid-naive person, and being in no less pain when finished, just totally and completely doped up. Neurological pain has a super complicated relationship with opioids. So while I do realize there was at least a partial reason for resistance from ER docs in my case, it got super old when I had more than enough evidence to support what was coming out of my mouth.

Of course there were good doctors who would come in and say, "I see you've been here a lot. Do you know what helps, or did you feel better last time?" and this happened more and more the longer it went on. However, the nervousness surrounding what kind of doctor I would find when I finally got to the hospital didn't go away until I simply stopped having to go.

Anyway, I mostly responded to follow as I’ve been at the rodeo for a while now and I like to help when I can… but I couldn’t resist sharing that.
 
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First time posting here -- and really quite relieved to have a place to speak openly - at least I hope. There aren't a lot of places one can speak about their narcotics use and not be judged. To top it off, not a lot of folks can hang in there with you if you speak about cancer, cancer treatments, the resulting damage and coping with that -- along with living with a chronic form of cancer that at this time isn't curable. Okay, so now that I've laid it all on the table - here's what brings me here to you kind souls traveling in similar boats as mine down a similar river - uh, minus the cancer shit hopefully - but then, y'all probably have other shit that's just as challenging - cuz everybody's got something, right?

9 yrs ago was my initial cancer treatment for lymphoma that left me with some severe neuropathy that gradually grew worse until by a few years later I was a mess. I found a doc who specialized in post-treatment cancer patients with pain issues. Ding-ding-ding-ding! We were a match - or so i thought. Let's just say she turned out to be the MOST demoralizing, cruel, egocentric, shaming doctor I've ever met. But she gave me initial relief. Relief through methadone and neurontin. I wasn't thrilled, but I was desperate - trusted her and found relief. Short term - she and the meds gave me my life back -- with function.

Five yrs later, I'm attempting to wean off methadone. I've been steadily on 15 mg/daily for the pain and weakness from neuropathy. I attempted once before - with disastrous results. I had been steadily asking the doc, "Could I begin to taper off?" Each time I asked infuriated her, I guess because it questioned her. Frustrated with me she said, "Okay, why don't you try that? Go and cut it by half." I did. The only thing I learned was that I didn't have a life worth living without methadone cushioning it for me. It took me many more months, reading on the internet from others, and really learning about methadone and how to titrate it to learn how cruel her little experiment with me was - just to prove herself 'right.' Now I'm with a different doc - and have wanted to try again. After reading on line forums such as this and advice to titrate incredibly slowly if you want success, I've started trying again since last Sept. - so I guess it's been 6 months and I've gone from 15 mg down to 6 mg. The lower I've gone, the more symptoms seem to arise, but tolerable, and dependable like clockwork. It just concerns me as it's shifted into a longer stretch of some of the discomforts between stepdowns. So far, the neuropathy isn't flaring any worse and I'm introducing some other new non-drug treatments for that so hopefully I'll have other scaffolding in place as I slowly remove the methadone scaffold.

Reading some of the reality here for others -- the challenges, the fact that methadone is the hardest of all to kick in many folks' opinion -- it all kind of freaks me out. Once upon a time I had to accept the fact I'd probably be a life-long narcotics user out of 'quality of life' necessity. That took some work in my brain having never been there before. Now I'm going the other way, having never been here before, balancing tapering with withdrawal symptoms with life after cancer treatment - which easily I may have to face again [I've had two relapses and 3 rounds of treatment total, getting checked regularly for any further relapse which then would entail future treatment and the potential of further leg damage. But I'm encouraged at the moment with a steady improvement rather than any sliding backwards - but it's a slippery slope.

All to say, I'm looking for any assistance with keeping my footing on this slippery slope. Any suggestions? Thank you.
 
Hey all, I'm just about to change from Oxycodone to Methadone for chronic neuropathic pain management and I don't really know what to expect and what the process involves? It seems like it's going to be pretty intensive to start off with, but I'm not really sure, and I'd really appreciate any advice from someone who knows about the initial process and how they start you off on it?

My thread is here.

Thanks
 
I did that at one point and as long as your doc gives you enough mg to match the oxy you were taking, you should feel ok. It did, however, make me too tired
 
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