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

Pain pump

If you are on that much opiates by mouth and still lack good relief, I think you need to start thinking about a pain pump. These are surgically implanted and deliver opiates right into your cerebrospinal fluid so that you get much greater pain relief from much lower doses of opates (since the opiate is going ONLY to the part of your body where it is most potent) and side effects are much, much less.

I am surprised your pain doc has not recommended this already.

Pain pumps are used when people do not find relief from massive amounts of oral opioids. I don't think any doctor would consider switching from 20mg oxymorphone BID to surgically implanted intrathecal pain medication.

I am also young abd have neuropathic pain and use a cane so i can relate. Has your doctor discussed other treatments like epidural steroid injections or nerve blocks? When my pain became severe I had to start taking morphine but in the long run I'm glad I found alternatives to taking increasing amounts of opioids and was successful in decreasing my doses and keeping them down without sacrificing pain relief.

Unless I missed something in your post, it didn't sound like they definitively diagnosed the source of your pain- what is the differential? What tests are they doing next to find the source? This thread is a wonderful resource but I'd like to extend an invitation for you to PM/IM/email me if you ever have questions or want to discuss things less publically with someone who has been living with chronic nerve pain for almost three years. I'm glad you found relief and take care!

Hey guys and girls ,

I've taken on board your comments about methadone and fentanyl. Which strong opioid med. is the least sedating and least mentally impairing? I've done some research on this, and the answer seems to be fentanyl and methadone. Is oxycodone less impairing than morphine, at a regular pain-relieving dose? The other options are hydromorphone and Diconal - does anyone have any experience of using these meds. for chronic pain? I know Diconal is a strange one because it only comes in 10 mg tabs., and is compounded with an antihistamine. However, I'd be willing to try it. Another option is diamorphine tabs. I don't know what advantage there'd be over morphine tabs. Why do they even make diamorphine tabs. - there must be some reason, surely? I'd try these if they're better than morphine, although I'm a little reluctant to ask straight out for diamorphine (Heroin,) because, despite my clean record (no drug abuse or drug-seeking behaviour,) I'm concerned that I may raise a red flag.

I don't mind whether I take painkillers four times daily, or a controlled release preparation once or twice daily. I should point out, I'm scripted zolpidem 10 mg nightly for sleep, daizepam 5 mg as needed for muscle spasms, and escitalopram 20 mg daily. I'd like to point out again, I have no interest in getting high from my meds. I'd only take a higher than prescribed dose of meds. to achieve better pain relief. I believe there's a neuropathic element to my pain, although it's mainly non-neuropathic (nociceptive.) Methadone is supposedly good for both types. I take Lyrica for the neuropathic element to my pain. This causes some cognitive dysfunction, so I'd like to be able to reduce my dosage or change meds.

The opioids I'm on now are dihydrocodeine 240 mg and tramadol 400 mg daily. Yeah, I know a lot of people claim tramadol with my 20 mg of escitalopram will supposedly give me serotonin syndrome and/or convulsions. It doesn't - and I've been taking both together long-term. Side note: there is a lot of hype and paranoia about seizures from tramadol mixed with an SSRI. Tramadol CAN be taken with an SSRI - and is completely safe. It gives SOME people serotonin syndrome and convulsions; most people are fine. Anyway, back on topic, the options are;

Diconal,
(dia)morphine,
methadone,
hydromorphone,
oxycodone,
fentanyl patch.

All are tablets apart from the fentanyl patch, obviously.

I appreciate your replies.

Hey guys,

This is my first post here, but I've been a lurker/reader for quite some time.

I am a chronic pain patient and have been on oxy and dilaudid for about 2 years now. My normal dose is around 80mg oxy/pd and 6mg dilaudid/pd. This is usually enough to keep the break thru pain under control although as most pain patients know it is never really gone.

I am posting because I am moving to a new state this month and am worried about finding a doctor for my scripts. I've had the same doctor for years, but will be too far away for her to keep seeing me. I've had lots of mri's, cat scans and specialists who I've seen over the years all which have confirmed the cause of my pain, (l3, l4 and l5 herniations), so it is not like I'm just a guy with a toothache but it still feels like it might be strange to go to a brand new doctor and ask him/her to write my scripts.

Has anyone else had this kind of experience or have any advice?

^^ Just make sure you have the evidence showing your condition. Have your current doctor fax or post the scans and diagnosis papers over to your new doctor. Bring your current meds. and scripts to your new doctor. I'd actually ask my current doctor to write me a letter, explaining my condition, the meds. I've been on in the past (and for how long,) and my current meds. and how long I've been on them, and the reasons why I need strong opioids (i.e. other meds. tried and don't control my pain sufficiently.) Ask your current doctor to print two copies of the letter - one to be faxed from him/her straight to your new doc., the other to be given to you to take to your new doc. Then you'll have it pretty much covered. If you're unlucky, your new doc. will be some arsehole who, "doesn't prescribe opioids." If this is the case, you'll have to argue strongly your case, or find another doctor who actually has a brain. Good luck!

I saw my PM doc today

I was having WAY too many side effects with Morphine: awful headaches, terrible constipation, and nausea

Just this morning he switched me to OxyContin and Percocet. Hopefully it'll sit much better with me. I'm still feeling a horrible morphine headache right now

Unfortunately, my doc didn't right the quantity of OC on the prescription, so I have to wait for the pharmacy to get a hold of him

mseg said:

If you are on that much opiates by mouth and still lack good relief, I think you need to start thinking about a pain pump. These are surgically implanted and deliver opiates right into your cerebrospinal fluid so that you get much greater pain relief from much lower doses of opates (since the opiate is going ONLY to the part of your body where it is most potent) and side effects are much, much less.

I am surprised your pain doc has not recommended this already.

Click to expand...

Your are kidding right???? There is no way Nleksan is anywhere close to meeting the criteria to be a possible candidate for a pain pump. The pumps are for, as Cane2theleft explained, people who are at such high oral doses of opiates that they cant up the dose anymore. This is usually after exhausting all other pain meds, Oxycontin, MScontin, Methadone, Opana, Duragesic, and others. when those doeses become get too high because of the pain, a pump is then considered.

Your statement- "If you are on that much opiates by mouth and still lack good relief, I think you need to start thinking about a pain pump" doesnt make sense. The meds he listed that he's on 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

only 1 of which is an opiate (Opana).

An up date: I went too see the Head Doctor at my GPs' practie who basically said he'd happil keep me on my 75mg of methadone daily (with the option of dose increases as and when needed - so long as I didn't call in any early refills.

Also he'd a medication regime review every three months to see how things were going but essentially he was happy to stick to this regim for the next 2 - 5 - 10 years (essentially indefinitely) as long as my pain continuned to propoerly managed and that heand I were happy with the system.

So all in all I am very happy with how things are going.

Nleksan what exactly is a CBT? does pain really have that much of an effect on a persons mentality .. and inadvertenly cause depression .. because my parents are constantly on my case about my "behavior" .. my mom doesnt mention it because she knows it upsets me but my dad really likes to poke at it .. but i dont really notice it anymore .. but ive also had an overly aggressive attitude since i left elementary school.. so im not really sure .. or maybe ive just been so use to keeping suppressed i havnt really noticed .. what id like to know to is if it actually causes your body more pain inadvertenly .

sure the pain does get me down but at the same time its more that im really pissed off at being 22 and not being able to things my other friends can do .. im not sure if that could be causing it.

and i know what you mean by the up and down and "cloudy" feeling with the Oxycontin . ive started to notice this about a year after consistent controlled usage . that for about 3 hours or so after i take my dose i do feel cloudy and dont really want to pay attention to anything (this is also where im usually the most aggressive) and notice that sometimes the medication does last for the 12 hours and other days it works for 6-8 hours then end up having to turn to my BT meds.. (5/325 percocet) .

and istaydead ill let you know how fentanyl/dilaudid compare in drowsyness because i may end up having to change my medication from Oxycontin 20mg 2x q12h to an equalanalgesic dose due to a shortage of money due to being unemployed for about a month or so . i just cant decide which one to use and im going to talk about this with my doctor . as even some people that have used dilaudid orally legitmatly says it sucks for pain due to poor absorbtion ..

and the price for my montly dose is actually quite fair compared to the rediculous cost of my Oxycontin.

i can attest to chronic pain causing depression. i am generally a very happy person, but being in constant pain really brings me down, and drives me to tears often.

what sucks is, when i go to a new doctor, i often end up crying, due to the fact that i am "desperate" for someone to listen and take me seriously, but more often than not, i get the old "you're just depressed. get a therapist, and some physical therapy, and you'll be fine."

makes me so mad!

yes, i'm down, but i'm down because of the pain, not the other way around.

i have my second appointment with a pain management doctor, this wednesday. i so desperately need him to hear me, and help me.

i've done what he's suggested... physical therapy and made an appointment with a therapist (6 week waiting list). the physical therapy is actually awesome, and i'm very glad i went. they set me up with a TENS unit, and gave me some mild exercises to do.

i can cope most days on my own, with the TENS unit, heating pads, biofreeze, warm baths, and stretches. i still have pain, but i can manage ok. but the other days (2-3 X a week or more), i have a very hard time, and cannot manage the pain. i am reduced to laying in a ball, and crying. praying i would either die, or someone would knock me the heck out.

does anyone have any suggestions on what i can do to convince this doctor i am in pain, and my pain is just as real as all his other patients?

i would greatly appreciate any help.

Very lucky to have phisio therapy work .. i have tried it multiple times to no avail , which is how i have ended up on the narcotic train .. what gets me down is i see all these athletes getting seriously hurt to the point of death and they come back . yet i have a moderate injury that wasnt treated correctly and they cant manage to fix it ..

i cant snowboard (which i had great aspirations of doing one day) i have to be careful when i use motorized recreational vehicles such as ATVs (which i also had a rollover on and added to my constant pain) fuck i can barley even ride a bicycle without getting the feeling of nails being driven into my knee caps

I know its going to be rough, but I think you should wait. Your medication will work better. I once ran out of my oxy and had to wait 2 days. (my stupidity). I'm on 120mg a day. I was sick and my knees and ankles really hurt. I didn't get the shits. My w/d was mostly night sweating and sleeplessness. I'm saying you're going to be uncomfortable, but major w/d is at least the secound day if not the third. The first day is very minor.

I take whatever I can get mostly lortabs 10s cheapest I can get from a dealer. I don't really know what's wrong with my back it's been hurting ever since I had a horseriding accident. My mom doesn't believe I hurt like I do so I haven't been to a doctor to find out. This has lead me to opiate addiction now I'm fucked both ways.

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go see a doctor asap, you have a ligit accident it seems so theres no reason you shouldn't go, if you are in pain...

youve already become addicted to opioids buying them off the street, if you had a doctor at least you could be monitored, and your condition could be figured out, the solution to back pain is not always pills

I wanted to ask about developing a tolerance to the analgesic effect of opioids. Analesia and euphoria go hand in hand, and you cannot indefinitely get high on opioids, so does there come a point where you build up such a tolerance to opioids that no dose of an opioid will provide adquate pain relief if you suffer from a chronic pain condition?

^^ I'm not sure. Maybe if things got that bad I'd be on IV fentanyl or something similar. Considering 0.1 mg of fentanyl IV is a huge dose, there's a lot of scope there... I can't see anyone being so tolerant that 100 mg or 500 mg of IV fentanyl doesn't relieve their pain due to tolerance. Even if someone got to this stage, there are opioids that are stronger than fentanyl. I don't know of any cases where someone gets no affect from any opioid at any dose.

^^^^^
i agree, there are so many strong opioids out there you can always go up and up, as far as your body can go

In theory, yes. Unfortunately, not everyone's pockets are deep enough.

10mg of oxymorphone and 20mg of oxycodone should be equipotent. I understand what you're getting at, but I think they take BA into account when they create dosage charts.

This lingering feeling that oxycodone may help better might just be akin to a placebo effect... but if you really feel oxymorphone isn't cutting it, then talk to your doctor.

^^^^^^^
thanks for your reply Mr. Blond, your the man, anyways...

I see the dosage charts on opana.com and they say 10mg of oxymorphone is equal to 20mg of oxycodone, if BA is put into account wouldn't it be 10mg oxymorphone = ~ 40mg of oxycodone because the oral BA of oxymorphone is ~10% and oxycodone's oral BA is ~40%....it isn't makin much sense

any insite on this subject? personal expieriences? texts or anybody that can help with this topic would be very appreciated

im kinda worried about it

i hope you guys/gals can have some input, it would be much appreciated, thanks

-TP