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

[Rybee]

Ask for 10x12cm waterproof me pore patches to stick on over the top, works like a charm for me. Are you under a pain management dr? Then I can give you some suggestions the more I know

Also always put the patches above heart level for maximum pain relief

Thanks - I bought some tegaderm patches today to stick over the top and they're working well, helps the fentanyl stay in places so much better.

I've currently got them on my thigh(s) which is working really well.

Sorry to sound silly but do you mean higher on the body than the heart? If so, why? The pharmacist specifically told me NOT to stick them on my chest so I went for the thighs.

I'm not seeing a pain doc just yet - been referred but waiting for an appt. Just being treated by my doctor in the mean while. He's pretty good and isn't shy in prescribing stronger medications where they're needed.

These patches have been brilliant for my pain, much better than oramorph. Been able to move about so much more since starting them, I must say, I'm very impressed! Was quite skeptical at using patches before... would've preferred to take something orally so I know it gets metabolised properly but yeah... very happy with them so far!

 

[Doomed2pain]

Above the heart means it has less of a journey to travel so you get maximum strength, I stick them on my chest with no problems and my pm dr advised me to do so.

Depending on which nhs trust you are under depends on what can be prescribed as there is a traffic light system. Extended release medication be it patches or tablets, keep your pain levels stable where as oramorph is for break through pain and when used alone causes peaks and valleys in your pain as they only work for a few hours.

 

[xtcgrrrl]

Hi everyone, I've posted in this thread before but I just want to vent a little, I guess. I have 5 herniated discs, one of which is pressing against my spinal cord causing excruciating pain. I have tried everything short of surgery to correct the problem: physical therapy, epidural steroid shots, ever-increasing pain medications, etc. I am finally scheduled for a surgery on Jan 2nd. However they say I will have to remain on pain meds as the BEST CASE scenario post-surgery is an 80% recovery. I was switched from Tramadol to Vicodin to Percocet. The Percocet doesn't even help all that much. I have begged them for better pain meds but NYC is VERY strict and they don't give out these meds for anything short of cancer. I really don't know what to do. I don't sleep, I don't eat, I can't walk far, I can't drive, can't even be in a car for a long period of time (anything more than 10-15 minutes is agony) I can't use the subway, I can't do anything helpful or productive in the house. I've become REALLY depressed about it. I guess I just need some sympathy and maybe some suggestions on how to feel like my life is worth it? Sigh...I'm sorry for the negativity I just feel very bleak and hopeless.

 

[Doomed2pain]

Have you tried meditating? It helps me a lot. I'm bed bound a lot of the time so I understand how you feel, I can no longer walk I can't eat or sleep etc. I meditate for 30 min 4x day, start small though, 5 min here and there until you get the hang of it. Google meditation and you will find guides for each different technique. Hope your surgery goes well and you make a speedy recovery. Pm me if you need anything or just to vent

 

[ganeal]

Has anyone had the experience where their doctor told them he didn't think more opioids would help with their pain? Doc has been telling me this, even when I'm not asking for an increase. I suppose it's possible, but seems rather illogical to me. I'm on a bit of dilaudid, 40mgs daily, but I'm nowhere close to being topped-out dosewise at that level.

omg yes! my last pain dr told me that 20mg methadone a day was the most opiods that would help and just accept that the pain I live with being 28 was what I had to live with the rest of my life. Oh then he threw a bottle of Effexor at me and said that may help...that was the last time I saw him, I was lucky enough to get into a new PM dr the next month who immediately put me on 80mg's of methadone a day... he said I was being under medicated and treated for 3 years! it's awful what a lot of PM patients have to endure...its bad enough to be young and can't do anything because of pain!!

 

[Felonious Monk]

Have you tried meditating? It helps me a lot. I'm bed bound a lot of the time so I understand how you feel, I can no longer walk I can't eat or sleep etc. I meditate for 30 min 4x day, start small though, 5 min here and there until you get the hang of it.

I definitely agree, or acupuncture if you can afford it (might be covered by insurance). There are community centers around that have discounted services as well. I've found it's like an intense session of meditation, and can be the catalyst to really turning around a bad day.
Meditating really helps me to center my thoughts and remember that the pain isn't everything, because if I wake up with it I have a tendency to get caught up in it and just give up the whole day.

As to the question of fentanyl patches, my doctor said on the chest was fine. I found the best spots were those with least skin movement (side of stomach, inside of upper arm), then covered with a band-aid or one of the tagderm (sp?) patches. If you call customer service they'll hook you up with free ones (Mylan did anyway).

Ganeal, that's terrible, doctors can have such differing opinions on this though that if you really feel like you're not getting adequate treatment you have to be willing to take it into your own hands. NOT doctor shopping obviously, but building a relationship with a new doctor who will take you seriously if your current doctor is unresponsive. It's a relationship, which means it's a two-way street, and trust is important.

 

[Doomed2pain]

Unfortunately acupuncture didn't help me. I'm seeing a private pm dr on the 30th so hopefully he will help me, should do for the price of the consultation. I've seen him twice before when I was majorly under prescribed and he did a lot for me, so fingers crossed

 

[Rybee]

Above the heart means it has less of a journey to travel so you get maximum strength, I stick them on my chest with no problems and my pm dr advised me to do so.

Depending on which nhs trust you are under depends on what can be prescribed as there is a traffic light system. Extended release medication be it patches or tablets, keep your pain levels stable where as oramorph is for break through pain and when used alone causes peaks and valleys in your pain as they only work for a few hours.

Interesting! I'm changing my patch tomorrow so will give this trick a try!

 

[Doomed2pain]

Yeah it works much better above heart, it even says it in most of the info sheets that come with the patches

 

[Rybee]

Just out of interest, what non-opioid medications do you guys use?

I've had very good results with Pregabalin (sciatic nerve pain) but it leaves me cognitively constipated and just very zoned out.

I used to take amitriptyline for migraine prophylaxis and I couldn't handle the side effects.

Because I had very good results with Pregabain I might look at trying Gabapentin as they're very similar. Just not keen on being on Fentanyl 24/7, although it has provided me with so much relief.

 

[BigG]

Ive found with Pregabalin the side effects tend to dissipate if you make sure you takebit regularly however miss a few days and then g oo b saddo to your previous maximum dose (generally 2 x 300mg day) and you will be properly fucked up......unable to walk, talk or even think just awful but stick to taking it regularly and generally you are ok. The side effects of amitriptyline

 

[ganeal]

I take 900 mg's Pregabalin daily. 300mg's morning ,noon, and pm. I also find that after 3 or 4 days the side effects go away. If I miss a few doses however the withdrawal I find is as bad as opiate withdrawal...I have been on it since my last back surgery 3 years ago and find it works amazing for my leg pain as well as restless legs syndrome. I also take 80mg of methadone daily. And If I still hurt after all off that I will take 2 advil they help amazingly too!

 

[Rybee]

I'm currently using 100mg of MS Contin and Oramorph for breakthrough but due to see my pain doctor sometime soon.

Fentanyl is out of the question for me.

From the UK and we don't seem to have the range of opioids that the US has, as a painkiller, what is better, morphine or methadone? I like the fact that methadone has such a long half life in comparison to morphine, even the slow release tabs - I have to take twice a day.

 

[Kittycat5]

The analgesic duration of methadone is usually much shorter than its half-life and still usually will require multiple doses per day.

 

[incomplete]

^that, which essentially gives it only so much leeway depending on your condition, pain levels and an array of other factors.

ive heard of many people taking an extra pill of their methadone as the pain killing properties had all but dissipated, but the serum levels of the methadone has plateaued while the serum still being at high levels in the bloodstream. the extra methadone pill is enough to cause unexpected respiratory depression, possibly leading to a fatal overdose.

From the UK and we don't seem to have the range of opioids that the US has, as a painkiller, what is better, morphine or methadone?

aye, i use MSContin as my main XR med and after using pretty much everything available to me in the way of narctotics, it (morphine) and my stint of fentanyl patches have been the best of opioids ive trialled; i think the only common opioid i havent used is oxymorphone.

i havent used methadone for pain management, though, have used it a fair amount to make the judgement for me that morphine is the better for continuous pain relief.

there are a lot of articles and studies about the use of methadone in pain management. check out the search engine here, the methadone mega thread and google a few studies to get a rounded view. dont lay your decision to switch to methadone solely on the fact that it has a longer halflife, as its a moot point.

 

[tricomb]

I've found rotating meds every so often helps a lot with my pain managemnt, like I usually transition over the months from morphine --> oxycodone --> methadone --morphine --> oxycodone, etc. My most effective ER med would definitely be Morphine Sulphate Extended Release Tablets with Roxicodone as BT meds, it's working better than usual lately actually, but I'm trying extra hard to maintain my pain on a dose that's reasonable and so that I never run out early, and when I've got MS-ER with MS-IR and/or Roxicodone as my regimen, I rarely if ever run out early. I'm lucky I guess that I can get my MS ER to last 36-48h so it's kind of like a fentanyl patch except for the joys of me not having to wear a fentanyl patch. Win win win IMO. Very steady analgesia with ER morphine and a good BT med, dilaudid/hydromorphone is another effective BT med for me but Roxicodone gives me the least side effects of any opioid but I'm pretty tolerant to the side effects of opioids even the naturally occurring morphine that most people struggle with and complain about, but I prefer MS ER over OxyContin, so long as I have the oxycodone hcl instant release for breakthrough. Can't be beat IMO, when used in combination with other non-medication forms of pain management.

 

[Rybee]

Thanks for the replies, and tricomb I agree with you re: ER Morphine Sulphate with Roxicodone (although I use Oramorph) for BT pain. That current mix is doing me pretty well at the moment and I've been able to get back up on my feet and in the gym to start working on repairing my back. Think I'll stick with MS Contin then, seems to be doing me quite well anyway.

'If it aint broken don't fix it' - I guess!

I just wish we had other options for BT pain than Oramorph in the UK, no oxycodone, hydrocodone, oxymorphone, hydromorphone etc... The Oramorph is so sickly and I hate carrying around a 300ml bottle of liquids and a spoon/syringe everywhere I go. A small packet of pills would be much easier!

tricomb - do you mind me asking what causes your chronic pain?

 

[incomplete]

^you guys have access to oxy and, i think, hydromorphone, though, its to my understanding that theyre used rather conservatively by prescribing docs. im well aware that it usually goes codeine or tramadol to dihydrocodeine then onto morphine and from there to the oxy, fent, etc. and youre right, if it aint broke, dont fix it. you might end up screwing the good run of being able to controlling your pain with the current regime youre on if you go swapping and changing things around.

great to hear youre able to get out and about to exercise and are having a win currently. i hope it continues. good luck.

i'm exactly like you, tricomb, though i do favour swithing my morphine extended release to oxycontin every 6-12 months but, its dependent on a few factors. i havent switched for near 18 months now and dont think i will be anytime soon.

i also use IR oxycodone for my breakthroug meds and easily have access to codeine forte or tramadol IR if needed. very rarely run out but if i do there's another source to pain meds in my household i can always replace as soon as my script is refilled.

 

[Felonious Monk]

Anybody have problems with OxyIR (Roxicodone) tablets that don't work properly unless they're broken before oral consumption?

I have these Zydus brand pills right now that have a very hard, almost shell-like exterior, and I've found they're only 30-50% effective if I don't break them in half. I have a fairly low tolerance, my script is only 3x10mg/day, which I sometimes don't take all of--but I noticed from taking 30mg at once orally on Friday that I was barely felt it at all, not really compelled to close my eyes at all, though nice euphoria if I closed my eyes. Compare this to last night where I took 10mg broken in half and couldn't keep my eyes open, or this afternoon when I took 20mg and couldn't keep my eyes open... So it seems to happen every time. And it's not like it lasts longer by not being broken in half, it's like it's not even working (haven't spotted any pills come out the other end).
It annoys me that it took me most of the month to figure out that half a pill was more effective than a whole one...

 

[incomplete]

^i had a similar experience a month ago when i went to get my morphine script filled. there are now an apotex generic and they gel as soon as humidity touches them once the coating is wiped off. so they're all but pretty useless when trying to inject but, also rather ineffective compared to MSContin when using as prescribed. my doc wasnt even aware of there being a generic now. so i request no generic alternative.

might be worth trying another generic or sticking to the original if they're a persistent problem in relation to your pain. unless you dont mind having to crush them despite supposedly being a IR pill.