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

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Kechara said:
Yep I know about the possibility of liver damage, which is part of the reason I want to work on the tolerance issue. Since the pain would be manageable on 6-8 pills a day without the tolerance, I would prefer see if I can decrease tolerance rather than going with stronger opiates but I cannot take NSAIDS due to Hx of GI Bleeds so I'm pretty much stuck with formulations of Tylenol... I have been without the Vicodin for up to 5 days at a time but I'm pretty much useless and unable to work without it, due to pain from the RA.

At this point we aren't talking about a possibility of liver damage. You more than likely have it. Period. To be honest I wouldn't be surprised if you already have cirrhosis.

If you do not cut your dose asap, you could die from this. Wd is hard. You will wd. But that is better than death.

Additionally, if you are filling these scripts on insurance, you will get caught for doctor shopping eventually. And you will more than likely go to jail, and the DEA has a pretty tough stance against what they perceive as doctor manipulation.
 
Well, according to the liver function tests from my Rheumy visit last month, there are no issues yet....in regards to insurance, I've been filling one through ins and paying cash for the other. These are the two main reasons I'm looking for other alternatives btw...
 
Kechara said:
Well, according to the liver function tests from my Rheumy visit last month, there are no issues yet....in regards to insurance, I've been filling one through ins and paying cash for the other. These are the two main reasons I'm looking for other alternatives btw...

Sigh.

Best alternative? Find a PM doc that will adequately adjust your pain medication. If you were taking Norcos instead (10/325) you could get the exact same amount of pain medication with less than 1/3rd of the APAP. As it stands you are a classic addict due to your dishonest behaviour in obtaining pain medication, and if any doctor finds out you could be blacklisted so that you would be unable to receive ANY pain medication legally.
 
Kechara said:
I've been on Vicodin 5/500 for the past 5 years, due to Rheumatoid Arthritis. In that time I've seen my Vicodin use jump from 100 tab/month to 450ish tab/month (between GP and Rheumatologist)...more to do with tolerance than an actual increase in pain. At this point, I really want to see if I can lower my tolerance to hydrocodone back down to more manageable levels but am unsure of the best way to go about it. Tramadol has worked okayish for me in the past, so I'm curious, if I were to switch to tramadol, would it lower the tolerance and how long would I need to go before I'd get back to a more normal level of tolerance to hydrocodone?

do some research on COAT (chronic opiod analgesic therapy)....there are meds you can use that will not create tolerance.....

Types of Opioids
There are a variety of types of opioids, categorized according to which types of receptors in the brain they attach to, and how they work there. There are three categories of opioids:

Full Agonists: Full agonist opioids do not have a ceiling – that means that they will continue increasing in efficacy over time and work fully on the receptors in your brain. Also, full agonists will not interfere with the effects of other opioids you may be taking. Types of full agonist opiates include morphine, codeine, oxycodone, methadone, and fentanyl.

Partial Agonists: Partial agonist opioids will eventually reach a ceiling and stop being effective. Unlike the full agonists, they are not as efficient at blocking pain messages at brain receptors. A common partial agonist is buprenorphine.

Mixed Agonists-Antagonists: Mixed agonists-antagonists are opioids that will also reach an eventual ceiling to their efficacy. They only work on one receptor site in your brain, called the "mu" receptor. They should never be combined with a full agonist. Mixed agonists-antagonists include pentazocine and dezocine.

link: http://www.fibromyalgia-symptoms.org/fibromyalgia_opioid.html

chronic pain is a difficult situation to treat, but it can be done without abuse of opiods...there is a difference between abusing a drug and using it for pain management......
 
^
In fact full agonists get less effective over time earlier if you compare them with mixed agonists

that article you posted is full of errors , a partial agonist is the same as a mixed agonist , also they do not only work on the mu receptor , they don't saturate it like the full agonists do though

the ceiling is the dose where taking more doesn't increase effects , some full agonists have a ceiling (ie codeine because it's a prodrug) but that's debatable
 
William1985.....A doctor can prescribe himself anything within reason. For example, my Dad scripts himself liptor and metroprolol (blood pressure). Also, he could THEORETICALLY script himself norco or morphine or something; however, only for a short period of time (being how long it would take to get into another doctor). However, he a doctor is scripting himself norco or whatever he is likely going to get reported by the pharmicist and will need a good explanation for the medical board.

also, a dr. wont script themselves narcs cuz of the unnecessary attention it would bring them, e.g. having the medical board review all his scripting practices and possibly loose his/her license. Especially when they could have another dr. in the hospital or office, that they dont work with directly, script them the stuff. Like my dad's friend scripted him vicodin for a few weeks after he had some oral surgery/dentist stuff done.
 
i've been suffering from chronic pain for a little over a year. was diagnosed w/ Fibromyalgia last November. chronic pain sucks.

after going through about 8 doctors, i finally found a wonderful, compassionate Nurse Practioner who finally helped with pain meds.she prescribes me 3-4 7.5 lortab per day and 3 soma per day.

she recently gave me a referral to a pain management doctor whom i go see on the 24th of this month.

i'm nervous because of the bad treatment i've gotten from doctors since the start of getting this.

do you think asking my NP for a letter of some sort, explaining she has been treating me, and what has helped, would be a good idea to take to the pain management doc?

also, although i am extremely appreciative for the little relief i get from the lortab, the relief only last for 2-3 hours. it's hard to decide when to take it, because i am still left with pain throughout the day.

how do i appraoch this situation? i don't want to mess up what i already get, because even though it doesn't help me all the time, it's way better than being in pain all the time.

also, i just don't think the soma is helping at all. i still have extreme muscle tension throughout my body i've tried flexeril, skelaxin, robaxin, soma, and 1 other i can't remember right now. are there any others out there? i think if i could get the muscle tension down, the need for pain meds would decrease some.

any help would be appreciated.
 
Thanks for the input everyone...I guess to focus the question more, does anyone know of an analgesic for moderate to severe pain that:

1) is not an NSAID
2) is not Acetaminophen based
3) Does not work off the MU receptor?

Does such an animal exist?
 
BingeBoy said:
^
In fact full agonists get less effective over time earlier if you compare them with mixed agonists

that article you posted is full of errors , a partial agonist is the same as a mixed agonist , also they do not only work on the mu receptor , they don't saturate it like the full agonists do though

the ceiling is the dose where taking more doesn't increase effects , some full agonists have a ceiling (ie codeine because it's a prodrug) but that's debatable

huh. thanks for the info. so, how is it that some people with chronic pain stay on the same dose of their opioid meds for years without having to up the dose?
 
sweetbeatlvr said:
i've been suffering from chronic pain for a little over a year. was diagnosed w/ Fibromyalgia last November. chronic pain sucks.

after going through about 8 doctors, i finally found a wonderful, compassionate Nurse Practioner who finally helped with pain meds.she prescribes me 3-4 7.5 lortab per day and 3 soma per day.

she recently gave me a referral to a pain management doctor whom i go see on the 24th of this month.

i'm nervous because of the bad treatment i've gotten from doctors since the start of getting this.

do you think asking my NP for a letter of some sort, explaining she has been treating me, and what has helped, would be a good idea to take to the pain management doc?

also, although i am extremely appreciative for the little relief i get from the lortab, the relief only last for 2-3 hours. it's hard to decide when to take it, because i am still left with pain throughout the day.

how do i appraoch this situation? i don't want to mess up what i already get, because even though it doesn't help me all the time, it's way better than being in pain all the time.

also, i just don't think the soma is helping at all. i still have extreme muscle tension throughout my body i've tried flexeril, skelaxin, robaxin, soma, and 1 other i can't remember right now. are there any others out there? i think if i could get the muscle tension down, the need for pain meds would decrease some.

any help would be appreciated.

i have also had doctors who are not compassionate at all. they either think i am a drug seeker because of all the tattoos i have or they act like my pain can't be that bad. i actually had a doctor that said "everybody has pain from time to time" like i should just deal with being in so much pain that i would cry everyday.

my rheumatologist refused to script anything but NSAID's. which i cannot take.

my current doctor has referred me to pain management also. but when she did, she warned me that there would be unsavory characters there who were "drug seekers".....i kinda felt like she was incenuating that i was too....

i take tramadol. i have been on it for about 6 months and it has stopped working as well. i now take the maximum dose of 400mgs/day.....as far as muscle relaxers i take zanaflex but can only take it at night because of the drowsiness.....one thing that has really helped me is gabapentin.....or nuerontin....it helps with my anxiety levels and the nerve pain i have.....you should do a google search on it....a lot of people find relief from it...
 
Hmmm, I've been reading up on gabapentin a bit. I thought it was more for diabetic/nerve pain but there is some anecdotal evidence now that it may also help with hyperalgesia from long term opioid use. At this point, I'm certainly willing to give it a try...thank you for mentioning it.

Sweetbeatlvr/Alicat: I understand completely about feeling that Dr's can seem uncompassionate when it comes to pain. I'm at the point now of needing a knee replacement (I have no cartilage left in my right knee) but still hate even having to bring the pain issue up. I think part of it is that I worked at a Dr's office in my early 20's and a day didn't go by that I didn't hear comments, made by co-workers in the office, to the effect of 'Oh he/she is just a drug seeker' so I've done everything I can not to be seen in that light.
 
All ya gotta do is remember to be thankful for what you got now because anything is better than being in pain all day .. i would take having breaks over constant pain . but at the same time what alot of people dont realise and what normally gets them in trouble is the medication is only meant to help manage the pain , not take it ALL away .. and doctors are keen on that as well as it usually leads to pill popping ive seen a fair share of my friends do the same thing .

i just managed to find myself a good doctor as well im just waiting for him to finally take me on as a patient .. and i can understand why they dont like scripting the meds , just think about how many people do go in their faking pain just because they dont want to pay street prices . it almost makes me sick that someone can do that and take advantage of someone whos honestly thinking their helping the person .

and the street maket for the stuff alone is tempting enough for someone just barley able to afford their meds .

Honesty is always your best policy even if you think it will get you nowhere . i just had a sit down with this doctor (who ive see before here and there) told him what my current doctor was doing how i was sick of being treated like a drug seeker and looked down on upon because of my age even when i have a medical chart to support substantial pain . and he agreed , i told him my quality of life was at an alltime low because of all this shit , let him know my job was beginning to suffer and when you can the doctor to feel your pain rather than see it they will normally try to lend a helping hand .

just keeping trying and sooner or later things will look up .
 
Suggestions on what to obtain from Doctor

I've basically been given the choice of the following for chronic lower back pain. I like to dabble for fun, but actually need them. I'm looking for something that will actually treat the pain, but also allow for a little fun once in awhile.

Which would you opt for?


Fentanyl 25ug
Oxycontin 20mg
MS Contin (not sure the dosage)
Kadian
Other (Explain)
 
Ask the doctor what he thinks is best to treat your pain. That should be what you're most concerned about here. All of the medications you mentioned will get you high at the right dose, but you better put the treatment of your back before anything else in this situation.
 
Merged

I don't want discussions on using Pain Medication recreationally in this thread, so if you're going to answer Black Baby Jesus's question, please focus on the PM aspect.
 
Getting high should be the last thing from your mind if you really are in pain because when you take your meds your not going to feel much of a high to begin with due to the pain , unlike if you werent in any pain .

and all your going to do is if you start having fun once in a while is fuck your tolerance , continue to go back to your doctor saying your meds arent working just because you cant get high off them anymore ..

my advice is stick to what the directions on your bottle state. and dont change them , even tho its hard .

when you first start treatment you may feel a little bit of a high but dont go searching for one or using more than your prescribed .. believe it or not doctors can tell . then you also have to worry about running out early as well .. not to mention dont tell anyone else your taking them , not even your friends because you will be asked CONSTANTLY by them wanting to purchase some .. i didnt even make it to the pharmacy with my oxycontin script before a whole shitton of people knew because someone i trusted blabbed their fucking mouth .
 
My friends know I take for pain. But the recreational use of pain killers / hypnotics here is so frowned upon that they never ask me for anything. They'd rather rail tons of coke, methcathinone and X than take a darvocet. It's a good thing we don't have such a huge problem here with prescription pharms, my doc at leasts trusts me and can rx whatever she wants without worrying about the police coming to lock her up.

Chronic methcathinone abuse is terrible though, it makes people mad. I tell them it's as bad as meth but they don't listen. Sorry for the off topic.
 
just got my oxy upped to 3 and a half roxicodones a day (5mg ethex brand). i'm happy as hell because now i have energy and happiness and relaxation all day i'm awake. so no more 40mg of valium a day (down to 10-20mg), no more focalin (quit it b/c i get energy from oxy), and no more imodium (i was taking 6-8 , 2mg tabs a day for the shits, but oxy cured that).

my pain, after 8 years is finally managed... here is my cocktail daily:

17.5mg oxycodone IR
0.75g cannabis indica (sativa's increase anxiety, but help pain also)
10-20mg valium
15-30mg temazepam (3-4 nights a week MAX)


i was able to quit focalin, imodium, ambien/sonata, marinol, vicodin, morphine and codeine by going on oxycodone. and my IBS, chronic pain, chronic fatigue and nausea, is gone. appetite is doing much better. and i'm finally happy. tried 15 anti-d's and none worked. i found one that does :) or at least the right combo.
 
Mines currently at

40mg oxycontin morning followed 5 hours later with a 2x532 percocet/baclofen 10mg combo , then at the 10-12 hour mark 40mg again followed by another 10mg baclofen 2-3 hours later before bed sometimes with 1-2 5/325 percocet.

works pretty good right now , i have gabapentin but im suppose to take it at night but im pretty drowsy as it as night to begin with and normally just fall asleep and i dont like my breathing too shallow because then i end up worring if its too low..

i may end up having it upped though ... i had an appointment with the knee surgeon over my knee jamming/dislocating and they want to try moving the tendon that covers my knee cap using a bone graft to the right , then testing the flexibility and if its still too flexible surgically tighten the muscles right above the knee cap and to the right .. and i can already see the hospital just putting me on a fent patch instead of trying to break through my oxycodone dosage which sucks because it will toss off my whole tolerance .
 
Does anyone have anything good to say about Avinza(morphine sulfate)? I'm on 3 x 30mg Ms Contin a day right now for degenerative disc disease with disc's pushing on spinal cord.
 
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