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

^I totally hear what you are saying with your insurance situation. I am VERY lucky that my insurance covers everything I've ever been prescribed and that most I've ever paid is $30 for 1 month of a drug but most of mine are $15.

On another note, the rapidity of development in the field of chronic pain management is really encouraging. Endocet Pharmaceuticals really had a breakthrough with the lidoderm patches in my opinion and I am really excited to see what they do with NMDA antagonism, local anesthetics and possibly more widespread availability of opioids more efficacious for neuropathic pain (i.e. levorphanol). Unfortunately though right now the options for treatment are so limited and ineffective that we have to have a thread like this.

It's amazing how so many people are still given Gabapentin for neuropathic pain instead of Pregabalin. I needed huge amounts of Gabapentin to treat my neuralgia in my foot, I was taking 3000mg x 3 / day and even though I have the best insurance you can get (in my country), they would only pay for 800mg total / day because they had never heard of a higher amount. I ended up paying about equiv of $800 / month out of my own pocket.

It only even became effective after 1800mg x 3 but that was only just enough to keep me screaming out in pain when my foot brace was removed or put on. When I switched to Pregabalin, the difference was amazing, I only need 150 x 2 / day but I try get my doc to Rx me 3x daily especially since it's winter here and that increases the pain in all my plates and pins so I like to have a bit extra every now and then.

I'm also amazed to see people Rxed opiates for neuropathic pain, opiates didn't touch my pain, only neuropathic drugs worked (Elavil, Neurontin, Lyrica), even IV morphine didn't really make a difference to the neuralgia when I went into hospital for operations before it was treated with . Maybe some people are different??? I didn't know that opiates helped, with the exception of Methadone and maybe some other more exotic opiates.

I'm also scripted durogesic patches (25ug/hr) because I've had 3 botched operations on my arm and after the latest one (no 4), I shifted a screw and it was extremely painful. Although it treats my pain quite well I'm going to ask my PM doc to change it to something else, after about 48 hours of wearing the patch I start to go into minor w/d. By the 3rd day when I replace it I'm already experiencing minor muscle cramps, extreme anxiety, cold sweats and an upset stomach. The first time it happened I thought I had food poisoning or flu. After a pattern emerged, I worked out it was the patches. So I've been through minor w/ds practically 10x in the past month.

Sorry for the rambling on and the long post... Where is the best place to put on a patch? I put them on my wrists now, I've tried hip, chest (shaved a patch) and neck but all the other places were not very effective and once the patch fell off after a few hours and I went into full w/ds and 36 hours of hell before I noticed it was gone. I think I was actually past the worst part of w/d before I put another patch on I was already starting to feel better, but the pain was too much to cope with.

The patches are clear durogesic name brand, there's no gel in them. They look like clear stickers with red writing. I don't heat them up or try to abuse them, well not after I'd experienced some w/ds. I tried to heat one once and it didn't make a difference. These things are 24 hours shorter acting than they're supposed to be!

My pain that is treated with opiates is acute (roughly 10 months worth - but I've almost made it to no pain and 95% normal functioning a few times, before some setbacks and broken plates but I think I'm past the worst parts), the neuralgia is chronic but I think I could taper the Lyrica down to 150mg - 75mg / day and not be in unbearable or crippling pain.

Hiya Hexx.

I was scripted the duragesic patches (25ucg/hr like you) for a while and experienced identical problems to you: namely the patch only lasting 48 hours on average and the patches not staying properly stuck to my body.

Depending on which is cheapest for you either get your doctor to script you or just visit any pharmacy and buy over the counter Tegaderm Surgical Dressings.

These dressings come in all different sizes so you have to look and eyeball which one you want but they will keep your patch in place far more effectively than without. (I found the 12cm x 12 cm size to be fine but you can go smaller if you wish.)

Tegaderm Dressings. They're the way to go!

And as for the patches only lasting 48 hours, INFORM YOUR DOCTOR! It's not by any means a rare occurrence and if they have any compassion and trust you then hopefully you'll get yourself more scripted to you each month.

(With directions to apply every 48 hours - insetad of 72 hours)

I found a good place to attach the patches was on my side just below my rib cage or just above my breast plate. And wait half an hour after showering or taking a bath before applying and apply to naturally clean skin; also don't spray deodarant or use any kind of moisturiser on the patch of skin where the patch is going to go.

(My Mum uses oestrogen replacement therapy patches and recommended these approaches to me and I found them to be effective)

All these things helped me and I hope they'll help you too. Best of luck.

Cane2theLeft said:

^I complete agree with bingeboy. Modafinil, adderall and ritalin have all tested pretty similarly in treating OIS except modafinil has the lowest side effect profile and fewest people leaving the studies due to side effects.

I imagine if your doctor is open to prescribing a drug to treat OIS, they would start with modafinil and precede to methylphenidate or amphetamines if modafinil is insufficient just like they start treating pain with drugs like tramadol before escalating to fentanyl, morphine, methadone, etc.

Are you seeing your doctor soon? I will be keeping an eye on this threat (the PM threads are why I originally joined BL) so please keep us updated!

Click to expand...

Thanks for your advice Cane2theLeft - and if my Doctor is as reasonable as I think he is then hopefully he'll be open to prescribing something to treat the OIS.

I don't have a particular appointment to see him yet (but I can get a same-day appointment anytime) and i'm very tempted when I get paid on Friday to wire some cash and simply get hold of some modafinil via an I.O.P.

I'm just not sure...... I'm just too scared of getting my methadone doesage reduced and coming off as a drug-seeker.

I will definitely keep y'all informed in this thread what I end up doing and imagine I'll be a regular poster in this thread in any case due to many of the pain management questions falling into my spherer of personal experience and interest.

Thanks again to all of you who've been kind enough to share your thoughts on stimulants and opioid induced sedation with me. I certainly feel a lot more informed on the topic than I was a few days ago!

dhcdavid said:

Hiya Hexx.

I was scripted the duragesic patches (25ucg/hr like you) for a while and experienced identical problems to you: namely the patch only lasting 48 hours on average and the patches not staying properly stuck to my body.

Depending on which is cheapest for you either get your doctor to script you or just visit any pharmacy and buy over the counter Tegaderm Surgical Dressings.

These dressings come in all different sizes so you have to look and eyeball which one you want but they will keep your patch in place far more effectively than without. (I found the 12cm x 12 cm size to be fine but you can go smaller if you wish.)

Tegaderm Dressings. They're the way to go!

And as for the patches only lasting 48 hours, INFORM YOUR DOCTOR! It's not by any means a rare occurrence and if they have any compassion and trust you then hopefully you'll get yourself more scripted to you each month.

(With directions to apply every 48 hours - insetad of 72 hours)

I found a good place to attach the patches was on my side just below my rib cage or just above my breast plate. And wait half an hour after showering or taking a bath before applying and apply to naturally clean skin; also don't spray deodarant or use any kind of moisturiser on the patch of skin where the patch is going to go.

(My Mum uses oestrogen replacement therapy patches and recommended these approaches to me and I found them to be effective)

All these things helped me and I hope they'll help you too. Best of luck.

Click to expand...

Thank you so much for this information - I'm glad I'm not the only one having this problem so my doctor won't look at me funny. :D

I also have the problem of my Mylan fentanyl patches not sticking properly, which is why I'm going to ask my doctor (when I see him today) if I can be switched to something that is a sustained-release but not a patch (which I figure leaves me with only morphine, oxycodone, or oxymorphone).

I tried using surgical tape to keep the patches on, but that tended to be a real nuisance having a jumble of tape sticking on me all the time. That, and having prickly chest hairs on my shirt due to having to shave to put on these things is rather annoying.

My tip is to put them on a part of the upper body at which the skin does not expand/contract very much. I've put them on my pectorals before, which makes the patch fall off very easily due to the skin expanding and contracting from the muscle movement every time I'd move my arm. A more "inactive" area like the center of your back or something would be a good place I suppose.

Hydrocodone and gabapentin question important!

So according to many recources..ill list one....http://www.crazymeds.us/neurontin.html

So my gabapentin is fucking with my hydrocodone effects....how can i stop this...and i also need my vics for major pain relief that gabapentin CANNNOT provide (left orbital fracture....seizure......entierly a bloody mess literally). What can i do? I need the full effects of the hydrocodone and my doctors wont prescribe me anything higher then 10mg on hydrocodone cuase there redneck quacks that dont know shit about medication infact there on opiates there selfs when i walk into the clinic. I even asked for codiene which they denied....WTF? I need some help with this i have about 363MG of hydrocodone but i dont wanna waste it on some bullshit drug that fucks with its effects. Im in pain..pissed off...and need help....from OTHER sources then insurance milking doctors who dont give a fuck about someones proplems. I havnt touched any opiods or opiates for that matter in months......im not a addict i just need to kill this god damn pain i have.

Someone knowledgable and experinced with this help me out please...and that link/website is VERY helpful for information on medications. Please respond it hurts to type...as i said...bleeding from hands...elbows...fucked up thumb....fingers etc....someone HELP! Even one day of getting the full effects of hydrocodone for a single day would help me out ALOT...this gabapentin is a nice drug except for this fucked up situation im in and hydrocodone interaction it likes to fuck with. If i took a picture of my wounds u would know the pain im in.

has anyone had experience with bupe (patches in particular, see my gallery for reference), diazepam and lyrica? i also take tramadol but have a patch on regardless. the tramadol can be sporadic use or constant as well, but ill generally take 1-200mg a day

i have been on the patches for 6 months or so now(20mcg/hr), and the valium(somedays none, somedays up to and over 100mg) a little longer and the tramadol going on over 4 years. i was discussing other possible solutions for the nerve pain i still get no matter what im on and he gave me a starter pack of lyrica at 2 x 75mg a day. ive been reading into pregabalin a bit lately and it seems like it may be of use.

Dx is ulnar neuropathy, degenerative disc disease from C-2 to C-6, sacroiliac dysfunction, fibromyalgia, osteoarthritis of knees, t4-t5 herniated disc, lumbar herniated discs (don't even remember which),Restless Leg Syndrome, TMJ, and I don't remember what else. I was thrown out of a rollover.

Meds 40mg Opana ER a.m. 20mg Opana ER noon 40mg Opana ER p.m. 5 mg Opana Ir 4 times a day for breakthrough pain, Soma 350mg 2 a day, Xanax 2mg 3 times a day, neurontin 2400mg a day,Ambien CR for sleep, Seroquel for insomnia, diclofenac 3 times a day.Can't remember if any more meds. Can ya blame me?

Just underwent ulnar nerve transpositioning and cervical laminectomy with two surgeries to go.

Pain Sucks!!!

Bumping this cuase i need some help!

I read the page that you sent me... thanks for the info. It says it decreases hydrocodone's bioavailability by up to 22%... I have no idea how to get around this odd interaction. I would contact your doctor with this information. I also suggestion adding other analgesics like NSAIDs (ibuprofen, naproxen, etc.), drinking grapefruit juice and taking tagamet.

I would suggest switching to pregabalin from the neurontin but that would take time that you don't really have. I highly suggest smoking marijuana (preferably an indica) for its analgesic and opioid-sparing effect.

This is a shitty situation that you're in and I really feel for you, unfortunately there isn't a whole lot that you can do. I NEVER advise people to do this, but if you can acquire pain medication via other means then definitely pursue that. If you can reduce your dose of gabapentin temporarily without experiencing adverse effects than I would recommend that as well but unfortunately you can not simply stop taking it immediately.

The best thing you can do is bring this information to the attention of your prescribing physician and ask for their recommendations. I'm sorry that I can not be more help but there simply isn't a known way to just boost hydrocodone's bioavailability and since the interaction is not well understood, I don't know how it could be bypassed.

Like C2TL said, talk to your doctor about it; does it really affect you? If so, alternate medication may be required.

Merging into the mega pain thread there are a few other people who seem to have similar problems

I have been on opioid therapy for 8 years. One of the things that have helped me in energy levels is taking testosterone. Long term opioid use suppresses your bodys ability to create testosterone. You should ask your Dr to test your levels.

So just a quick update, I saw the doc and he recommended methadone. Yikes. SO I stayed with the morphine but changed the oxycontin to dilaudid and added Valium to boost the baclofen. I'm afraid I have the potential to abuse the valium more than anything else, it chills me right out!

2 or 3 years ago i was diagnosed with thoracic outlet syndrome (TOS), as i'd been experiencing debilitating pain & numbness in both of my arms with no apparent cause (no accidents or injuries). it was random & unpredictible, i'd never know when it would come on at first but when it did it made my arms/hands basically useless until it passed. eventually it evolved to where i'd wake up in the middle of the night screaming & crying in pain and not being able to feel my arms at all until i had been sitting up for at least 20 minutes & kept my arms in a specific position.

then anything that required lifting my arms above shoulder height would make them go numb- curling/blow drying my hair, riding a bike, and sometimes even just driving would do it. it was terrible but the doctors weren't in a hurry to script a 20 year old in otherwise good health anything for it, and i didn't push though i was frustrated.

looking back i realize that most of the time i was taking some kind of opiate, already- probably 50/50 between methadone and oxycodone, a modest habit of 20-60mg 4-7 times a week (of course i didn't realize it was the bud of my addiction at the time).

now i've been clean from oxy & dope (it had grown to a ~300-700mg/day of oxy or 6-10 bags of dope habit) for over a year and am on suboxone, and since i've been on suboxone the pain hasn't come back even once- i think opiates actually caused the neuropathy but due to it's unique properties suboxone doesn't do the same thing.

has anyone else had opiate-induced neuropathy, or heard of it happening? i guess i'm looking for peace of mind that it won't come back, providing i stay "clean"...

Well it's almost definitely neuropathic pain if it doesn't have an obvious cause and chemicals can cause it (like chemo, even years down the road) but I never heard of a opiate causing it.

Did you ever have an operation on your back? Or injure yourself quite badly? That could explain it and the opiates could have masked it's onset. Also neuropathic pain can occur very long after which makes it difficult to link it to an incident.

I've always thought that opiates are some of the least damaging drugs physically, especially when compared to stimulants like amphetamines and coke.

You should try Lyrica or Neurontin if it ever comes back. They made my debilitating neuralgia basically disappear.

nope, no surgeries or accidents at all but i have been "blessed" with a large chest all my life- when my weight went up a few years ago i was up to a 38DDD & still expanding- but now that i'm stable @ a healthy weight (130-139lbs) i'm still a 36DD, and have always hated it- but i guess that can cause TOS because of the added strain & weight from leaning forward more, naturally.

it's been gone for just about a year though, haven't even had slight tingling thru my arms, and i'm just wondering if it's because the opiates were causing it or maybe the suboxone is masking it... i just hope it doesn't come back though, because it really sucked- waking up nearly every night, screaming & crying in pain & having to just sit awake until it subsided... i'm lucky my boyfriend was so patient with me, i know he didn't appreciate being woken up by my sobbing every night and not being able to do anything but listen to me writhe in pain... i can't imagine what people who have more serious chronic conditions have to deal with on a daily basis, must be so hard...

I have an insane poppy pod tea tolerance. i drink it daily or every other day for pain releif. I have severe neck and back pain from an accident and am refused pain meds/ect. any suggestions? i love poppy tea but would rather get meds from a doctor that will help me manage my pain rather then suffering in silence. the most they gave me was a shitty musle relaxer... like skelaxin that did nothing whatsoever. damn doctors. its bullshit how i have to hit the streets to find pain meds and order tea off the net or grow pods rather than have a damn doctor help me. suggestions?

I also feel severly for people who are suffering with unbearable consistant, pain that there is no releif from except benzos or opiates. its hard to deal with. specially when my doctor looks at me like a stoner trying to cop a percription rather than trying to just find some damn relief. ive done accupuncture, ect. the only thing that works is opiates and this is what i am going to tell my doc on my next visit. i am blessed to have found ppt though