That hasn't been my experience in the U.S. at all being in the hospital for acute flare-ups of chronic pain, and unfortunately there was a stretch of time I was going really often. Most of the time if your regular doctor doesn't send you with a note suggesting what the ER physician do-- which they don't have to follow-- the ER doctor will do whatever they think is best for your symptoms regardless of what you’re already on. Maybe that's narcotics, maybe it's not. To be fair, there is really terrible acute pain that responds better to other drugs than narcotics (mostly neurological and it still depends on the person), but god forbid the doc decide that's what's going on if you really need an opioid. It's absolutely ridiculous with chronic pain patients; it's like reinventing the wheel every time. It doesn't matter if you can tell them conclusively it would work. It doesn't matter if you've been at the same hospital and have been given narcotics before for the same complaints and condition. It doesn't matter if you're on them already at home and in fact this sometimes makes it even less likely because I've actually had doctors say "well if all that oxycodone isn't working, why do you think a [big, fat] shot of hydromorphone will?" If that physician thinks something besides a narcotic will work to get you out of pain, and often they do, you can damn well be sure that’s what’s happening first. This makes perfect sense if someone is presenting for the first time with an unknown complaint but not when it is completely counterintuitive to a patient’s documented medical history.
I can feel this turning into a really long post so I’m going to try to curb it, but as much as I hate it I have literally been in hospitals around the country and it’s always the same. I can’t tell you how many grueling eight hour Emergency Room visits I’ve had that could have been done in two hours or less if they would have just given a shot of hydromorphone and sent me on my way. Even when it got to the point that I had been given the same treatment many, many times at the same hospital and had a note from my doctor with the same suggestion, I had ER docs trying all sorts of things they were “certain” would do the trick. Ironic quotes.
I’m sure this was conflated by the fact that I have a condition that, while extraordinarily painful, doesn’t typically respond well to opioids. Of course I’m the anomaly, I always am… though it’s not as if I’m the only person with cluster headaches who has taken a narcotic and felt better. We are the minority, though. I can’t tell you how many stories I’ve read on cluster support boards of people going to the hospital in immense pain, getting a medium-fast drip of 2mg of Dilaudid as an opioid-naive person, and being in no less pain when finished, just totally and completely doped up. Neurological pain has a super complicated relationship with opioids. So while I do realize there was at least a partial reason for resistance from ER docs in my case, it got super old when I had more than enough evidence to support what was coming out of my mouth.
Of course there were good doctors who would come in and say, "I see you've been here a lot. Do you know what helps, or did you feel better last time?" and this happened more and more the longer it went on. However, the nervousness surrounding what kind of doctor I would find when I finally got to the hospital didn't go away until I simply stopped having to go.
Anyway, I mostly responded to follow as I’ve been at the rodeo for a while now and I like to help when I can… but I couldn’t resist sharing that.
I haven't had a Pain Management doctor in over a year, but when I did have one, the ER would always call him to ask what he would prefer me to receive.
I too suffer from Chronic Migraines, but I also have the Episodic Cluster headache maybe once or twice a month with slightly less severe migraines in between attacks (like it will be the one where I'd rather be kicked in the nuts repeatedly for about an hour or 2, and then it will back off from a 10 down to an 8 for 3-4 hours before going back to Freddy Krueger's finger blade digging an inch deep into my temple just above my eye). I, like you, respond well to IV opioids, but triptans don't do a goddamn thing. Compazine and Reglan help a little, but I cannot stand the side effects of them - they're fucking horrible even when administered with Diphenhydramine (Benadryl). For some reason, they always wanna give me Buprenex instead of a full agonist which doesn't work as well as Morphine or Dilaudid. Hell I think Nubain might actually work better.
Other things that help me tons are a high-flow oxygen mask and IV benzodiazepines. I'm sure IV Barbiturates would do better than anything else considering how Butalbital in pill form (examples of compounds containing Butalbital: Fioricet, Fiorinal, Fioricet #3 with Codeine, Fiorinal #3 with Codeine, Bupap) works better than any other oral medication (at least in my experience). I honestly don't see why they don't consider using IV Secobarbital Sodium (Seconal Sodium) (in hypo-anesthetic doses), IV Pentobarbital Sodium (Nembutal Sodium) (in hypo-anesthetic doses), IV Amobarbital Sodium (Amytal Sodium), or IV Phenobarbital Sodium (Luminal Sodium) at all when nothing else works.
Imitrex is bullshit; Relpax is bullshit; Compazine/Reglan help a little, but I can't stand the side effects; and Benadryl/Phenergan is a fucking joke.
One thing you might want to consider trying as a prophylactic of cluster headaches is Namenda. It's actually a medication for dementia; it's mechanism of action is through NMDA-antagonism. It reduced the frequency of my cluster headaches when Propranolol and Topiramate only reduced the frequency of my migraines.
^^Not to add anything new to the above posts, just IME in pain mgmt it's widely accepted that the morphone/morphones have a much heavier, lethargic feeling to then then Oxy & derivatives. Again not really a "why", just saying.
I've posted about trialling other opiates than Oxy & it's never been that great in terms of pain relief or euphoria. So, obv the slight action on different receptors does play a big part, as well as genetic makeup, Metabolism & dopamine release. Oxycodone in particular is known to hit the "reward centre" in the brain, making it particularly more addictive.
Actually fellow Cpp's, I've come across a number of ppl that swear by morphine, (oral), for chronic pain but now that I'm thinking on it,- it's pretty much older ppl. Maybe they've never tried oxy, it being much newer?? Any observations or thoughts?
Any pain patients that can say morphine is their drug of choice?
Rtp
Oral Morphine is actually my preferred opioid over all other opioids, and I'm only 23 years of age. When given at comparable doses it does me better than Oxycodone, Hydromorphone (Dilaudid), and Hydrocodone. When it comes to Intravenous administration, Hydromorphone and Morphine are neck and neck. Hydromorphone hits quicker, harder, and provides slightly better analgesia, but Morphine lasts longer.
^respiratory depression would be doseage related not a side effect of your chosen opiate.
I experience "air hunger" at times, usually when I've missed a dose or am actually in full blown oxy wds. This can feel similar to anxiety attacks or respiratory depression. Rave, in your case I'd be concerned if that is actually what's happening with you. I believe you're incorrect in thinking that's far from ODing!
Anyone, cmiiw,
Rtp
Actually, different opioids cause varying amounts of respiratory depression as well as all other side effects. There are actually preferred opioids for specific conditions and situations because of the differences in which they treat the pain as well as the side effects and severity in which they are presented.
