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

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Yes, INDEED...Most people don't understand the "particulars" of my constipation. It's not diet, exercise or need for more fiber. I have a surgically altered stomach pouch/intestinal routing. I've had multiple surgeries and chemotherapy to remove/suppress growth of disease, including removal of uterus/tubes/ovaries.

Basically, there is a failure to absorb nutrients/some meds. There is slowed motility (constipation) without opiates for PM. Of course, now the opiates are causing more severe constipation.

Trust me...this tummy issue has terrorized me for most of my adult life. This isn't a case of "eat more bran, raisins and flax seeds". I avoided opiates for decades because of this very SE. My lifelong regimen to move bowels has been everything from Kondremul to Mineral Oil, Senna, Magnesium Citrate, Ducosate, Cascara Sagrada, Miralax, glycerin suppositories, enemas...Basically name it, I've done it.

I have a splenic flecture in my left descending colon (much like a kink in a garden hose). It feels as though the right is twisting and closing off (choking) since I started pain management. My tummy is naturally flat. It bloats and distends as if I swallowed a basketball. I have suffered with hemorrhoids (internal/external, prolapsed) and anal fissures. I've already had 2 surgeries to remove hemis.

As I've said repeatedly, I fear additional surgery in my near future. The next step would be to resect colon and risk colostomy bag. I can't deal with even the thought.

Anna...The watermelon sounds YUMMY. We've had really sweet ones this year. Strangely, watermelon has been a lifesaver for me throughout my GI nightmares.
 
:! Oh, sorry folks...I meant to add that Linzess and Movantik (sic) are prescription only meds for constipation. I tried the Linzess for IBD with constipation. It worked by drawing liquid into the stool to make it softer. It's about $258 per month.

The Movantik is specifically developed for OIC, but I'm told it's expensive also. I don't have prescription coverage as I once did, so I cannot afford the boutique meds for constipation. smh...bdip
 
I have ducolax for constipation if needed. I'm wondering if the doc started me too low w/the 15mg ER morphine replacing the total of 20mg oxycodone. I thought I heard that morphine had mental effects that oxy lacks, so in some ways is better.

How much morphine does an ER formulation like 15mg release. I know, simple question. Thanks everyone.
 
I went to my first pain management appointment today and though they didn't prescribe me anything(my primary still prescribes for now) he gave me his treatment plan. He wants to add 20mg methadone daily in addition to my oxy 10s which I take 4x daily,and my 350mg somas.But the worst part is he wants to continue my injections which I've been through and they were painful and of no help. I have been through the trigger point injections,the facet injections, and even an epidural. I feel like he's holding my meds as a carrot on conditions I have these injections done so he can bill my insurance,not to mention he has his own physical therapy and pharmacy. Isn't that a conflict of interest to send a patient to your own physical therapy? I mean why wouldn't he get as many hours as the insurance would pay out of me?

Anyhow, I wasn't looking to get my dose increased and I damn sure don't want any injections but my doctor after 4 years will not treat anymore patients for chronic pain.He had given me a urine and it cameback clean of all drugs and when it was learned(by me) he ordered a generic test that doesn't test for my rx he ordered a more specific one and even though results showed I take my meds he still cut me and all his patients he treats for pain(he must've got into trouble).

Most people would be happy to get their dose increased but I don't want to be on methadone I was a junky about a decade ago and was on methadone maintenance and I don't want to get back on it. I'm afraid if I tell my pain management doc my fears he will cut me as a patient for having been hooked on drugs before.
What are my options?
 
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Shout out to my chronic pain buddies. You guys have really helped when I've been going through this system and feeling like it's hopeless.

SKR said:
Well done Six! I really hope you get some relief soon. My PM Doc is proving to be expensive and useless. My GP wants him to dictate my meds and he had his way he would take away all scripts especially the opiates from me. I'm taking 6-10 times what I'm prescribed - if my docs knew this they'd be thrilled cos they would cut me off, label me a junkie ( that's my right) and get me on maintainence and wave goodbye to me. Maybe i should start drinking again.
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Ugh PM docs who abuse their power should be shot into the sun. So many medical professionals seem to have skipped the bit in their induction where it's explained that medicine is a CARING PROFESSION.

Runtoparadise said:
@Sixbuckets, hallelujah woman, it's not for lack of participation on your side is it?!
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I was starting to feel like I was on some weird, extremely long, extremely sadistic hidden camera show. "Let's see how many hoops we can make this woman jump through before she cries in the doctor's office!"

I truly hope, even though you have to wait another fortnight, that you do find some relief. ESP with codeine not OTC here much longer. Can you not call your GP for the script?
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GP appointment is on Friday! I've luckily had a good couple of weeks with my pain not being too bad, so the wait isn't as bad as it could have been. Let's hope I haven't jinxed myself and the next few days remain tolerable.

My GP will only do anything - scripts, medical certificates, even renewing referrals to specialists - with a consultation of at least 15 minutes. She's bulk billing (for non-Aussies, "bulk billing" is what we call it when the doctor doesn't charge an additional fee on top of the government Medicare subsidy, so you don't have an out of pocket cost for the doctor visit) so not a super high earner in doctor terms (where "low earner" is still a high six figure income).

I recognise that Australia's health care system is a fucking utopia compared to some other countries, but accessing either GP or specialist care through publicly funded/no gap services still involves a lot of waiting lists and hoop-jumping and trying out a lot of shit doctors and specialists until you find one who will actually do a decent job.

SKR said:
And Meth can make you feel a million bucks, no pain no care in the world, but all the damage you do to yourself on meth days becomes apparent the next day when you find yourself more crippled than before.
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Seconding this! It's a really fun way of getting temporary relief from neuropathic pain and fatigue, but my god you pay for it the next day. Fibromyalgia + meth hangover = debilitating fatigue, agonising widespread pain, and a huge pile of regret.
 
namnoc...I empathize with what you're going through, along with so many others including me. Question: Did you explain to your new PM doctor that you have tried the injections? Did you explain that you really did not have good results?

It sounds as if he's seeing your insurance as a cash cow, but what else would we expect?

First, do no harm.:| The spinal injections can exacerbate your issues. I, like you, agreed to injections in my cervical and lumbar spine on 3 separate occasions (separate series). The injections did NOTHING to relieve my pain. My current PM, who is also an anesthesiologist, said "If previous injections brought no relief, there's no point in repeating". Whe-e-e-w! I will not allow ANYONE near my spine with a needle again. That would have been a deal breaker for me.

Others will not feel the same, as many have gotten relief from spinal injections/ablations. My sister gets them frequently, but I can't see any benefit for her. It's your choice...your decision ultimately.

I don't know about the Methadone. I've heard raves and I've heard rants. I can't speak from experience. Maybe others will chime in.

I'm sorry for the suffering of so many here, and the hoops we CPPs must jump (limp) through. The stress of seeking PM caused SHINGLES in my eye/face. Words cannot describe the "added" HELL this virus caused. I call it "the cherry on top of my shit sundae of pain". My doctor is more than a "sprinkling" of NUTS!

I, like you, am looking for alternative methods for pain relief. Opiates are making my GI issues even WORSE. I'd like to take the doctor and the pharmacy out of the equation, but I don't know if it's possible.
 
Speed King said:
I have ducolax for constipation if needed. I'm wondering if the doc started me too low w/the 15mg ER morphine replacing the total of 20mg oxycodone. I thought I heard that morphine had mental effects that oxy lacks, so in some ways is better.

How much morphine does an ER formulation like 15mg release. I know, simple question. Thanks everyone.
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Hey SK, do you mean 15mgs bd? Am & Pm, or just one daily dose of 15mgs?

Oxy is 1.5 times stronger,-20mgs is equivalent to 30mgs morphine total daily dosage.

Cross tolerance is likely to have been taken into account by your doctor. Usually when changing or rotating opiates the prescribing dr will start you on a lower dose than the equivalent of what you were previously taking.

Hope that helps. How's it working for your pain, or too soon to tell?

Rtp
 
It is mellow and feels like the pain is easing up. I don't understand why the dosage is started lower then equivalent to other medication. Btw, new dose is 15 mg ER every 12 hours. I'm trying not to complain, but understand. I find the dose weak. If cross tolerance is considered, I still don't get starting low. I bet this stuff is great at 60 mg, but 15 mg seems low.
 
Whosajigga- IME, orally swallowed ER meds, non chewed, last about 9-10 hours. Some doctors know about the 8-10 hour of effectiveness thing. Most choose to not do thrice daily dosing, but the rare doctor does. I did bring up to mine about the gap in relief and he didn't go to thrice dosing, he added IRs PRN. Better than nothing.

So, on days I have things to do, I dose 3 times a day- 8am, 430pm, and bedtime.

When I don't , I just suffer in the am and when I can, stay in bed until the med starts working. On these days, I take 8am and 430pm. It doesn't make sense for me to dose exactly as prescribed. If I did that , I would have 5 hours a day during my busiest / most hectic hours with no pain relief. Instead, I choose to have my pain relief gap during my sleep time. As long as there's enough drug in my system to prevent WDs (there is), I won't wake up early due to pain.

Dixichik- I hear you girl. I have a pouch. I don't kind oxy constpiating , only codeine and dilaudid. when I am constipated, most laxatives don't work- especially the kind to bulk up the stool. That just makes it worse. I swer by Milk of Magnesia. It works for me. And not too gross if you get cherry.

As far as avoiding, drinking lots is a given. Maybe taking one of the stool softener a on the daily who's job it is to take less water from your intestines. Combo that with a low residue diet. When I eat a low residue diet- I barely ever have BM and then when I do it's small . Really is low residue :)
 
Oh right dixichik/ it's a given but don't forget you don't take regular pills if you can help it. If you have absorption issues you need to buy every liquid or chewable form of everything.
When I'm flaring/ I live on Ovol. (Simethicone) for cramping and bloating, and that filled like a balloon feeling. When I got non chewable they didn't work at all. You really need to give yourself the highest chance for success. Other meds can usually be turned into a liquid suspension by a compounding pharmacy. What's the point in taking something if it's going right through you?
 
@Dixi-I also have had the injections twice, epidural and both times I had this terrible reaction. My pain was so bad I had to use my walker, come to learn I'm allergic to the preservative in the injection so no more epidural for me. PM doc just tried trigger point injections, I haven't noticed a difference really, not sure if they take time to work or not.
 
Speed King said:
It is mellow and feels like the pain is easing up. I don't understand why the dosage is started lower then equivalent to other medication. Btw, new dose is 15 mg ER every 12 hours. I'm trying not to complain, but understand. I find the dose weak. If cross tolerance is considered, I still don't get starting low. I bet this stuff is great at 60 mg, but 15 mg seems low.
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Well, now you've clarified that it is 15mg twice a day, you're actually on equianalgesic dose of morphine to what you were of oxycodone.

Sometimes one opiate works better than another for particular people. Generally a change of med is preferred to a dose increase. You could use ibuprofen or paracetamol If a BT med hasn't also been prescribed while the morphine takes a cpl of days to reach peak plasma.

I'm glad the doctor listened to your request to change from oxy IR to a long acting med, pleased that you're being heard!!

Rtp
 
Whosajiggawaaa said:
Hey guys. I'm trying to go back to taking my prescribed oxycontins whole (unchewed) cos the time release makes em less addictive whilst providing excellent pain relief.

In your experience how long you reckon they REALLY act for when you swallow em whole ?
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I'd say about 7-8hrs, definitely not 12hrs that's for sure lol
 
Rtp, glad to hear the clarafacation about the meds. I didnt know what to think. I will do what you said and give it time to do its thing, without complaint of course.
 
Runtoparadise said:
Well, now you've clarified that it is 15mg twice a day, you're actually on equianalgesic dose of morphine to what you were of oxycodone.

Sometimes one opiate works better than another for particular people. Generally a change of med is preferred to a dose increase. You could use ibuprofen or paracetamol If a BT med hasn't also been prescribed while the morphine takes a cpl of days to reach peak plasma.

I'm glad the doctor listened to your request to change from oxy IR to a long acting med, pleased that you're being heard!!

Rtp
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@RTP do you think if I asked my PM doc to change me to the same dose of oxycodone based meds that he would label me a drug seeker? I believe I have a tolerance to the ms contin and the hydro because I have been on those same two meds since 2012. Am I grasping at straws or do u think a change would give me better pain relief? I'm just trying to find SOMETHING that works so I can drop my daily pain number from 6/7:to even a 3/4.
 
@dixi
As far as constipation goes caused by the opioids ive also tried everything to ease my stools. Oxycontin was the worst for me it made a rock out of my poo, so much that I had to .. Mechanicaly remove my stool..
Nothing worked ate dulcolax like candy and my bum ate the supps. Then my sister suggested I tried aloevera bitters. Me not really into natural products I was sceptical. But man did that stuff work!! Im shure they should stock it somewhere by you or even online? Just give it a try? I took more than recommended but still it was magic!!
 
@speedking
If they swop your opioids they usually start with a 25% reduction that the opioids are equal to. Don't know why exactly but think its cause all of them work a little different. Some work for others, others dont. But its standard protocol to do 25% reduction.. Hope it helps
 
thanks stefx85. I now am starting to understand why they do that. I still think it's a "little" light, but I'll give it a shot. I keep being told the effects pick up after awhile.
 
I have a hypothetical, non abuse question. If I had a 15mg morphine ER tablet, and say chew it up, how much morphine is released? Any chance any of the time release gets defeated by fine chewing? I'm just asking, because the first tablet I put in my mouth crumbled up. I was like wtf. That clearly wasn't my intention, but since that line was crossed, I might as well have an idea. Any answers appreciated.
 
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