Harm Reduction The Pain Management Mega Thread - for all your questions on dealing with chronic pain

youll enjoy the fent more for sure. i dont know what sulphate means but it sure ruins morphine if you ask me 8)

keygen said:

i dont know what sulphate mean

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morphine sulphate = normal morphine!

I_Stay_Dead said:

Or please suggest another opioid if you think there's a more effective one.

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Methadone has some of the most analgesic effects imo out of the opioids mentioned in this thread, up there with a 25mcg/hr fent patch imho....it's deffinetly worth a try. also, if you dont like going the transdermal route, with having to wear a patch and the adhesives etc etc...it could be a plus
has your doctor offered that up as an option? or have you ever been able to try methadone before for pain management?

^^ No they've not mentioned methadone. It's not something I've heard of anyone else I know with chronic pain using - just oxycodone, fentanyl, and morphine. Also, I'm not sure why some people use oxycodone instead or morphine.

I_Stay_Dead said:

morphine sulphate = normal morphine!

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well morphine sulphate pills suck any way you do them. cant bang them, nasty to snort. taste awful. i guess u can parachute or plug them. i dunno when i had lots of them id give them away is all i know.

keygen said:

well morphine sulphate pills suck any way you do them. cant bang them, nasty to snort. taste awful. i guess u can parachute or plug them. i dunno when i had lots of them id give them away is all i know.

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This is about pain management, the poster has stated repeatedly that he wants to be pain free, not high!

Not to sound harsh, but please read the text.

I_Stay_Dead said:

^^ No they've not mentioned methadone. It's not something I've heard of anyone else I know with chronic pain using - just oxycodone, fentanyl, and morphine. Also, I'm not sure why some people use oxycodone instead or morphine.

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Well then you should definitely ask about it. It is a very powerful analgesic with a very long half-life so most people only have to take it once a day. There are a lot more PM options than oxy, fent, and morphine...opana ir (oxymorphone ir), dilaudid (hydromorphone) opana er (oxymorphone er) etc. etc. just to name a couple off the top of my head
As for your question about people using oxycodone instead of morphine, well, different strokes for different fokes everyones body responds differently to different drugs, using equal-analgesic doses of oxy and morphine, there will always be people that prefer one over another

i was also gonna say what taitpeter just did, that methadone is excellent for pain management and it last quite awhile giving you more pain free time between doses. so i'd say fentanyl or methadone would be great to try

keygen said:

well morphine sulphate pills suck any way you do them. cant bang them, nasty to snort. taste awful. i guess u can parachute or plug them. i dunno when i had lots of them id give them away is all i know.

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You can bang morphine sulphate. Its just the salts they use. If MSIR had morphine hydrochloride, it would be the same thing.

Oral Morphine has way to many side effects for long term use.

Go with the fent patch. You will have less dosing problems, and less side effects.

^^ What are the side effects of oral morphine during long-term use that fentanyl doesn't have? (Or methadone?)

Sorry to bump, but does anyone know the difference in side-effects from long-term morphine, methadone and fentanyl use? From what I've researched, the long-term effects seem pretty much the same - hormone changes and physical dependence.

Merging question about morphine or fent for pain management into the pain management mega thread.

I'm really not sure what the previous poster meant about long term morphine side effect- from my experience and understanding, you quickly get used to most all side effects if you are using a stable, appropriate dose. With opioids, really the only side effect that never goes away with appropriate dosing is constipation but an OTC laxative like Senna-S and you are golden (I was more regular on morphine w/ senna than ever in my life!). Different people get more pain relief from equianalgesic doses of one or another medication, or one may cause a bit more nausea, etc. but that's really about it.

People will argue about down-regulation of receptors, tolerance and dependence but if you are already using opioids for pain management I doubt you are worried about those.... and you shouldn't be. Hopefully you understand that addiction and physical dependence are not the same thing and you shouldn't worry about dependence but only about having your pain managed appropriately and adequately. If/when the time comes to get off the meds, a medically supervised taper and/or supplemental meds to taper more quickly can make the transition painless. Just make sure you have your pain managed and no one can really tell you which opioid analgesic will work better for you, it's all preference and individual chemistry.... see what works for you.

take care man!

Cane2theLeft said:

Its a tight rope to walk trying to get pain relief. Have you heard the term pseudoaddiction? He wasn't looking for a high ( he was just trying to get pain relief). Pseudoaddiction is where someone behaves like an addict in their desperation to get pain relief, a desperation rivaling people with large habits. The difference is that when the pain patient finds relief, this behavior stops but it generally doesn't for the addict.

Some doctors understand pain management, addiction, pseudoaddiction and other related topics while others do not at all. I saw one doctor who told me I was an addict because I took tramadol and 2 vicodin daily- some are just uneducated or biased.

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Beautifully put mate and totally sums my situation up: I've recently moved houses (to a different area of the UK and hence a different doctor) and am prescribed 75mg of methadone daily and 90mg of the Cox2 inhibitor etoricoxcib. My new doctor happily prescribed for 2 months and then last time I went to collect my new script I got summoned in front of the Head Doctor of the practise: this old-skool Pakistani guy who was very concerned about the methadone because he'd never heard of it being prescribed for pain before and just thought I was a smackhead chasing a high.

Wtf?

So he basically filled the script and it was unclear whether or not I HAD to make an appointment to see him do discuss alternative treatments (which I'm shit scared might only be to give me dihydrocodeine or tramadol or codeine - and the maximum daily doses in the UK of dihydrocodeine (240mg daily - equivalent to 500mg of codeine) and tramadol (400mg daily) - would come nowhere close to matching the pain relief I get from 75 mg of methadone (which I believe is equivalent to between 200 and 350mg of oral morphine daily, depending on what percentage of dose reduction you use to account for incomplete cross-tolerance).

And now I'm almost out of methadone and will have to get hold of some new meds within the next 4 days or be in a world of pain.

I mean it's possible he may happily prescribe me morphine or fentanyl to the approximate correct equivalent doseage of my methadone but I tend to err on the side of caution in my dealings with doctors and controlled drugs: hope for the best but expect the worst

Anyone got any advice for me?

Cane2theLeft said:

People will argue about down-regulation of receptors, tolerance and dependence but if you are already using opioids for pain management I doubt you are worried about those.... and you shouldn't be.

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I don't get it... down-regulation of opioid receptors can also cause tolerance to analgesia, not just euphoria/sedation.

^That is true but there is no comparison of the speed of tolerance to the euphoric/sedative effects and the analgesia. With appropriate and stable dosing, tolerance to euphoria and sedation can develop within days, weeks at most. Pain that is not getting worse can be treated with stable doses for months to years, indefinitely for some.

Also if someone is in pain, they should worry about relieving their pain, not about down-regulation of opioid receptors- that was the purpose of why I posted that.

Cane2theLeft said:

Also if someone is in pain, they should worry about relieving their pain, not about down-regulation of opioid receptors- that was the purpose of why I posted that.

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Ah OK I dig... yes and I totally agree with that.

I just started seeing an Interventional Pain Management Specialist (an Anesthesiologist who did undergrad at Duke and then Oxford Med School... smart guy) after my orthopedic doc, a physiologist, no longer thought that I "should be in any pain" and wanted me to stop cold-turkey from 20mg OxyContin 3x/day.

I haven't seen anyone mention Interventional Treatment-based practices, and maybe I just got lucky, but the doctor was more than willing to take on my case and is treating me fairly aggressively.

I'm 20 years old, and have a history of joint problems. This past summer, I was in an MVA in which I was hit from behind and then slammed into a guardrail at 65mph, coming to a stop from that speed in less than 30ft. I had really bad whiplash in my cervical and my lumbar spine. It went away after about a month, and then I was scheduled for knee surgery (unrelated). The knee surgery was to remove 40% of my meniscus, which had deteriorated and torn length-wise in two places, and had been causing me constant pain for 2+ years. Now, the pain in my knee is the same, but it is no longer "progressive".

I have used opiates to self-medicate/for-recreation for the past year. My tolerance became astronomical, so after Suboxone, and a couple relapses, I got it under control. Now, even hydrocodone is effective in relieving pain, to a degree, whereas three months ago it would have been sugar pills.

Most recently, 5 weeks ago I awoke with SEVERE pain in my lower-right back, shooting down through my buttocks and through my thigh, and also radiating into/from my tail-bone area. I saw my GP the first day, and she thought it was just sciatica, and gave me 500mg Methocarbomal 3x/day and 7.5/500mg Percocet 3x/day. Neither provided much relief. With no meds, I was at a constant 8/10 on the pain scale (yes... THAT bad! I have had multiple broken bones incl. a spiral fracture of the tibia, surgeries, burns, etc... THIS IS THE WORST) with the "shooting/burning"-pain spiking at a full-out 10/10 up to 15x a day. I was literally bed-ridden, and I had to have assistance even to get up to go to the bathroom.
She referred me to a physiologist at the orthopedic center where I had my knee surgery, and they took X-rays the first visit. The X-Ray showed a couple things:
1) I have an extra set of "floating" ribs
2) We don't know if I have 5 or 6 lumbar vertebrae, due to reason No1, and I have yet to have a full-spinal X-Ray
3) The spacing between my L5-S1 (or L6-S1?) is about 1/4-1/6 the size of the space between all other vertebrae, indicating compression, herniation, or just another physiological abnormality

The doc gave me a 7-day Prednisone-taper along with #60 7.5/325 Percocet to be taken 1-2tab TID, which when taken as directed, dropped the pain from an 8/10 to maybe a 7/10... MAYBE. I could get up and take a shit on my own, and I could sit at my computer for up to 10 minutes without debilitating pain, but otherwise, I was still couched. If I took 5-8 Percocet at once (only took 8 one time), I could walk well enough to make my way around the house. However, what little pain relief I DID get was short-lived, due most likely to my previous tolerance causing my body to rapidly metabolize the drug, and three, maybe, MAYBE, four hours after dosing it was back to as if I'd never taken them at all. A big problem, also, was that I couldn't sleep. I'm already Rx'd Temazepam (60mg/night; my Psych upped it from 45mg/night after the back-pain started), and had to take 120-150mg just to fall asleep (the muscle-relaxant quality helped a bit, I'm sure). I was NOT taking these meds in this fashion in order to "abuse" them; I was truly just seeking the ability to even move or sleep. I was awakening 10-20x/night in pain, and for 13 days, I never slept for more than 113 minutes at a time (yes, I counted; that was my record), but most often it was more like 30-45 minutes of light sleep and then I'd be WIDE awake, my back spasm-ing and my buttocks/tailbone/thigh feeling like someone was slowly slicing them apart with a red-hot butter knife.

After 5 days, I had another appointment. This time, I brought my mom along. SHE told the doctor that I couldn't sleep, and neither could she because she could hear me in the other room crying during the night because the pain was so bad. He gave me #30 OxyContin 20mg to be taken 1 tablet QHS (at night), hoping that it would allow me to make it longer than 1-2hrs of sleep at a time. Well, it did help a little, as my night-time awakenings went from 10-20 to 7-15 a night. However, as any other Pain Patient knows, even the slightest bit of relief is IMMENSELY appreciated!

After another week, the doctor gave me a script for #60 20mg OxyContin to be taken 1 tab q8h (every 8 hours), on top of the 1tab at night. I also had ~20 Percocet 7.5/325 and 7.5/500 left, which I used for "breakthrough pain". So, in two weeks, I went from no legally prescribed narcotics, to 80mgs of OxyContin/day as well as whatever Percocet I had left. I was trying to make the Percocet last for when I really needed it, and never took more than 2 in an 8hr period (I limited it to 3/day, or 4 if it was absolutely imperative). That comes out to a grand-total of 102.5mg of oxycodone/day, or up to 110mg. Combined with the 1500mg Methocarbamol (trade-name Robaxin), the completed prednisone-taper, and the occasional use of IV Dilaudid (obtained, ahem, "elsewhere"... I, uh, found 'em in a little baggy... On the street... Ya...) in 4mg doses when the Percocet couldn't "break through", I had my pain down to a more tolerable 6.5-7/10 with flare-ups still being a full 10/10 but occurring less-often, maybe 5-7x/day.

Backtracking a bit... 8 days after this initially started, I had an appointment with my shrink. She upped my Temazepam to 60mg/night to help me sleep, and Rx'd me Lyrica 75mg 3x/day (total of 225mg/day) for the nerve-pain. The Lyrica helped make it less "burning/shooting" and more "frostbite-like-sharp/tingling/aching/shooting", which while sounding worse, was actually an improvement. Unfortunately, it did not improve the amount of times this was happening (everytime I moved...). Still, I am grateful to have it, and it has certainly done more good than bad, as I've had no negative side-effects what-so-ever, and it helps me fall asleep somewhat.

Back to the current...

Anyway, I was doing my PT exercises 5x/day everyday (and going in to work with a trainer 3x/week for 1.5hrs/session), and while they do improve my mobility, they caused the pain to increase the whole time I was doing them, and then it obviously decreased when I was done. So, I can't really say if they helped with the pain, or if I was just glad to be stopping, lol.

On my own, I have been taking Ibuprofen 800mg 3x/day to help with any inflammation, and as an adjunct to opiates, it is certainly helpful. I notice a difference when I take it and when I don't, although I can't say it's truly significant. It is enough, though, that I am sure not to miss a dose. I switch up the Ibuprofen with Naproxen Sodium 440mg 2-3x/day occasionally (I'd say 5/7 days I'm on Ibuprofen, the other I taken the Naprosyn). Ironically, while Naproxen has proven to be the better NSAID for me in every other situation, especially with my knee, it is weaker here. I just have to give my stomach a break from the Ibuprofen. Two days a week I only take it 2x/day to give my stomach a break.

I use heat every night, via heat-pad, to help as well. It's done 1hr on, 1/2hr off, repeat. Usually it's for about 5 hours. Ice does not help; in fact, about 10 minutes after removing an ice pack, I hurt worse than I did before.

I am using a TENS unit as well (again, doing so "pro-actively"; without the doctor ordering it or anything), as my mom (an RN, MSN, MEd, PhD-student in nursing theory, and a Pathophysiology Professor at the best nursing school in the MidWest) was able to snag one from her school's nursing lab. I use it 3x/day every day. It provides a little relief, but it's short-lasting (30-90 minutes) and inconvenient. However, I have nothing else to do but lay around, so I might as well do something helpful...

I have to walk with a cane, as I can't bear more than 30% of the normal amount of weight on my right leg. Getting in and out of cars is quite tricky (and painful), especially as I drive a newer BMW 3-Series coupe, which have a low-seating-position and loooong, heavy doors. It's also a manual transmission, so luckily it's not my left leg.

SOOOOOOOOO.....

My first visit at this pain clinic, I had my X-Rays and MRI (forgot to mention the MRI; it is "clean for a 35-40 year old... a little dirty for a 20 year old" as my doc said, but no disc damage visible), as well as my FULL medical history, including Suboxone treatment Hx, transferred over. I completed the Subs about 5-6 months ago, so it's not really pertinent, but I wanted to be straightforward with these guys.
The first thing the nurse said (she did the initial physical exam, which was quite extensive) is that "This amount of OxyContin... it's not supposed to be Rx'd like this at all. The FDA says 12hrs a pill. Just so you know, we do NOT prescribe like this here." I didn't care, as long as they do SOMETHING to get rid of the pain, and I figure the last part was to discourage drug-seekers. This clinic focuses on medical treatment to reduce/eliminate pain as well as to reduce or, if possible, eliminate the need for pain medication (I assume they mean opiates by "pain medication"). That sounded fantastic to me, as the OxyContin were doing a crappy job (way too up-down-up-down for me, and I was lucky to even get 8 hours out of a pill). The place had Avinza and Kadian posters/paper-pads/calenders everywhere, and Opana pens/charts/etc as well. There was also a LOT of advertisement for the MedTronic Intrathecal Pain Pump, which they are apparently big proponents of (every physician in the practice, all 7, are anesthesiologists).

After the physical exam, I finally met the doctor. Of all of the doctors I have seen in my life (at least 20, probably a good amount more than that even...), my new doctor has the best bedside manner BY FAR (apart from my previous psychiatrist... but they kinda have to, yaknow?). He looked me in the eyes when he talked, shook my hand when he met me and when he left, told me that he couldn't stand to see someone so young in so much pain and that he was going to do everything within his power to get me back to leading a normal life (get back in school and get back to working, those are the biggest two dilemmas this has caused so far). He joked around with me about a few things, and I asked him whether or not they do any psychological works, specifically Cognitive Behavioral Therapy. This caught him off-guard, and he was like "Actually, yes... We have a staff psychologist who I would be more than happy to have you start seeing for CBT. It's an excellent idea, actually; as I know pain can cause lots of mental 'problems', and overcoming the psychological aspect can help immensely." He then said "You are the first patient to ever actually ask to see the psychologist, much less specifically for CTB. I'm impressed!".

He spent just over 30 minutes with me, and it wasn't until the end that I brought up me being out of pain meds, and that I wanted to have them be my sole "source" (not the word I used) so that it could be more carefully monitored, as I didn't feel my previous doctor was paying any attention to how he was writing for me. The doctor said absolutely, and told me the nurse would have to get the necessary paperwork ready, I would have some things to fill out, and I would have to get the previous doc's office to fax over a "Narcotic Cancellation Form", which would state that their office would not Rx me ANY narcotic medication.
I figured this would take days, as they said it can and often does, and when I called the orthopedic center to get the transfer of rx exclusivity, the lady on the phone blew me off and told me she didn't really know what I was talking about but that she would "look into it". This pissed me off, and so the nurse who was taking care of me told me "wait 10 minutes", and she went and called them herself, and after 8 minutes came back with a bunch of paperwork in her hands. After I signed the narcotic's contract, she gave me a prescription.

It was for #10 Opana ER 20mg tablets to be taken 1tab Q12H (every 12 hours), and they wanted to give me a "test run" on the new med, so they only wrote for ten as my next appointment was five days later (today). No breakthrough med, but I was so happy to finally have something I knew would work, I didn't care.

The past five days have been so much better it's unbelievable. I was able to actually go out on a date with my girlfriend, I am using my cane to get around only 40-50% of the time as opposed to 80-90%, my depression as related to the pain has been lifted, I have my mental energy back, I don't feel "cloudy" at all mentally like I did on the OC, and much much more. My quality of life has improved 500% in the last 5 days. I was so pleased with not only this, but also the compassion of the doctor/nurse and how well I was treated, especially considering my age, that I called the office 3 days ago and left a voicemail for the physician telling him how grateful I was, and that he had no idea how positively he impacted my life, and that I am finally seeing the light at the end of the tunnel (also told him little things, like that I took my girlfriend to the movies). At that point, I was so happy, I could cry. My pain was down to a constant 5.5-6/10 with flare-ups hitting 9/10, but only happening 2-4x a day, and I wasn't waking up more than 3x/night, and I actually had my first full-nights sleep two days ago. Not one awakening! I am still sore when I get out of bed in the AM, but that's to be expected.

Today I went in to have a procedure done so that the doctor would have an idea of where specifically in my spine the pain was emanating from. This consisted of inserting needles into the joints between two vertebrae, and injecting both a short-acting (4-6hrs) local anesthetic and a longer-acting steroid (3-4 days). I was under conscious anesthesia for this, as they administered IV Alfenta (alfentanil). It's funny... They gave me the first injection, and told me it would take a minute to take full effect. They asked me if I felt anything, and I didn't feel a single thing, so I said no. The doc said "give him another one", which the nurse did, and after another minute, I was again questioned as to my state. I said "umm... maybe i feel it? I'm not really sure...". Well, I guess that was enough, as that's when I started getting poked. It was NOT enough Alfenta, as this hurt like a sonofabitch! It wasn't until 10 minutes AFTER the procedure that I felt sedated, and Alfenta sure gives an odd feeling... Kinda spacey, but very care-free and pain-killing.

I brought my old pill bottle for the Opana in, having taken the last one that morning per-directions, as I wanted the doc to see I was willing to bring in my meds whenever, if they required. He seemed surprised, but said "nah, don't even worry about it". I asked something like "I talked to my pharmacist about the few flare-ups of pain I have a day (I already told him they were down to 1/10 of the frequency they were at prior to being switched to Opana), and the pharmacist told me they make an instant release version that's used for that reason, saying something about blood levels staying constant by using the same drug for long and short term relief. What's your opinion, doc, as the flare-ups are really the only thing keeping me from resuming work and/or school?". He told me that they try to keep the BTP-meds exclusively to cancer pain, as it just increases tolerance, but that they do switch to IR meds when tapering off or tapering down opiate use, which he said he hopes "is soon, because I want to figure out what the hell the problem is so I can fix it for you!". Oh well. He gave me 28 Opana ER 20mg, 1 tab Q12h, as my next appt is in 14 days.

I am lucky to have the Opana at all, especially being started at 20mg BID, so I can't complain.

Is there any way you guys think I could get him to give me some BTP meds? I don't ask because I want to abuse them, I ask because, like I said above, the pain flare-ups are the ONLY real problem I'm having anymore, with the Opana ER being an incredible analgesic for me (I've always done better with -morphones than -codones).

My current meds are:
Opana ER 20mg 1 ever 12hrs
Desoxyn 5mg 2 2x/day
Klonopin 1mg 2 in AM/1 in PM
Lyrica 75mg 1 3x/day OR 3 at bedtime
Temazepam 30mg 2 tabs 1x/bedtime
Methocarbamol 500mg 1 3x/day
Ibuprofen 800mg 3x/day

Can you believe I'm only 20? Me either...

Anyways, any advice is much appreciated! Especially if you can help me with the end questions, or if you've been through anything similar or just have any general advice!

Sorry for the long, rambling post. But that's my story, and I'm stickin' to it..

^^^

Dude, that looks like the kind of shit I was on at your age. You might want to be careful. I went through some really awful withdrawl that nearly killed me when I got off that shit.