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A question about neuropathic pain and opiod induced hyperalgesia

swilow

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So, I'm in an ever worsening pickle that I'd love some insight into. My story may be boring so I will try to condense (but will fail!).

7 years ago I emerged from a very painful heroin and benzo addiction. For me, the benzo withdrawal was immensely debilitating, I was psychotic, blacking out, seizures, catatonic/aggressive, and this was from a slow taper using diazepam. I have mild epilepsy, mainly effecting me as a child (I am 34 now) but was treated with anticonvulsants and GABAergic agents. The seizures stopped when I was about 12 and really never returned until my benzo addiction. Then it all went utterly nuts. I suspect kindling as the culpit behind the intensity of my withdrawal (I got diagnosed with multiple pathologies during my withdrawal, from BPD, dissociative identity disorder, bipolar, PTSD etc, all of which amounted to nought when I was finally a few months clean. Of course, sleep disturbances and odd somatic symptoms have remained but nothing too upsettting.

Anyway, through pain and fire and ayahuasca! I managed to beat both addictions- to an extent. I've continued to use some GABAergic agents (GHB mainly) with no issues and then 18 months ago I made the great choice to take some etizolam and diazepam, lost a good two weeks (good times!) and then emerged into mild but very present withdrawal. Of course, I swore off benzo's for a few weeks, and have for the last 12 months been taking temazepam for a few days a month (usually a packet of 25 x 10mg tabs). Every time, unless I TAPER for at least two days of 1 x 10mg I will get a recurrence of withdrawal. Once bitten, never shy. :\ I've also been using increasing amounts of codeine, because I am an addict at heart and cannot say no to drugs. :\

So, starting about 18 months ago, though originating from nodding out badly 8 years ago, I've been getting severe sciatic nerve pain, extending down the legs through the butt/hip/groin/knee/calves/ankle/sole-of-feet, burning/parathesia/crushing sensations. Pain at probably 5/10 which is tolerable, but things like sitting down for more than an hour are crippling. It extends into my abdomen, feels like there is immense pressure and numbness on my right side. I also have nerve pain through my shoulder and neck, extending down my right arm into my wrist and the tips of my fingers; typing can actually send electric shocks up my fingers, I even find holding a smartphone to be quite painful- my hands go numb :\ I get neurlagia pains across my scalp and in my jaw. All of this is on the right side of my body, though there are hints of it on the left too. I am incredibly sensitive to hot and cold, I get regular cold chills and hair standing on end for no reason, and random numbness through my face.

I'm on pregabalin, which helps to lessen the pain but only a bit. Codeine, of course mutes the pain but does not eradicate. The only thing that actually does remove it entirely is using a benzo. I basically have no nerve pain when on benzo's.

I use codeine too much, at least 5 times a week and in high doses, usually 1800mg a day. Hence, the days off codeine I experience withdrawal which increases the nerve/sciatic pain (and the suicide and loathing)

I feel like two things may be happening. One is opioid-induced hyperalgesia; I specualte that this is ocurring due to increasing levels of pain that have corresponded to my increasing use of the drug. I am incredibly sensitive to physical sensation, which seems hallmark of decreased internal pain management induced by opiate use. However, codeine is a really poor analgesic, but I am taking very large doses which actually do fuck all except cause my liver to hate me.

But I wonder if the actual issue is relating to my use of benzo's and a result of kindling phenomena. Given that they are a total cure for this pain, it seems they probably have a causal role in inducing it.*

*of note is that dissociatives such as MXE and 3MEOPCP have similar effect in reducing pain too, but I find these drugs to dsitracting to try and go to work on them. Sitting and typing long posts about my suffering nerves though, they are a real boon :D. High dose pregabalin helps a bit, but I am very wary of getting addicted (even though my doctor said it cannot be addictive because it doesn't cross the BBB which I know is utter bullshit, I can't imagine a peripherally acting anticonvulsant, can you??- doctor is but a GP though, very liberal with the script pad) but nothing removes 99% of the sensation like a benzo. Cannabis doesn't touch this pain.

Scans of my back have revealed a slightly prolapsed disk, putting some very light pressure on the nerve. Doctor does not believe that it should cause much pain though, so he assumes I am fishing for meds (I am, and he absoltuely complies with any request :\) There is no reason that a scan can reveal as to why I get pain in my shoulder/face/arms, though its described as RSI due to computer use- but, really, I don't use computers all that much, I purchase some expensive (and probably bullshit) ergonomic furniture for my man-cave/office, I adopt good posture, I am doing yoga and all that stuff!

I really think that I've combined a decreased ability to naturally offset pain through my opiate use, as well as hyperstimulated various nerves through physical trauma but mainly through repeated ingestions and withdrawal of nerve dampening agents like benzo's.

So my brief post is actually really long :D I'm sitting comfortably for once, that explains it! Hopefully you guys could see through my rambling and answer some of my queries.

Is my theory valid? Beucase, if so, this means that continuing abstinence from benzo's may cure this pain- I would forgo the recreational high, I don't even enjoy it but its a drug and that's usually appealing in itself. I am tapering down my codeine use too, it is soon no longer going to be OTC in Australia and I really don't want to desperately start seeking other opiates. I feel like there is light at the end of the void, it can be reached through suffering but I am used to sufferring and happy to undertake whatever I need to do to stop it getting worse. My doctor thinks I am being anxious, he think more pregabalin or diazepm will solve all.

Anyway, thanks if you managed to read this far. :)
 
I wouldn't always view pain as purely biochemical. Typically there are physical causes, such as nerve compression.

See for example thoracic outlet syndrome regarding your upper body symptoms. The issue is that stuff like thoracic outlet syndrome isn't very well known and can be very difficult to diagnose and treat. Lots of MDs are severely lacking when it comes to treating anything that isn't routine, and not all physical therapists are proficient.

Disk degeneration is checked for pretty regularly, so is carpal tunnel and ulnar neuropathy. Outside of stuff like that, even the physiatrists don't always do so well.

Opioids bind to and activate Toll Like Receptors located on microglia, when these microglia are activated they can cause nerves to get spun up and sensitized. This is supposedly how opioids cause pain amplification when given chronically.

Opioid antagonists (naltrexone) can block Toll Like Receptors and can be used at very low doses (where opioid receptor blockade is negligible) to treat pain syndromes

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3962576/

At even lower doses, naltrexone may be used to enhancd opioid analgesia

https://www.ncbi.nlm.nih.gov/m/pubmed/18027539/
 
An I.V Ketamine Infusion is defenately worth a shot. After my first one, I swore off opiates.

I take Lyrica, Valium and cannabis to keep me from hurting while I sort the Ketamine Infusion schedule out. It is worth a shot.
 
^What are you treating? Ketamine infusion is of huge interest to me. But I ultimately want to avoid using more drugs to treat this.

Cotcha, cheers for that info. I'm kinda stoned but have follow up questions to issue when brain turns back on. :)
 
the main pain is three buldging disks in my lower back. I also have fibromyalgia and siatica. The K has been shown to help your pain receptors recover and the disassociation helps your brain forget the pain. That is how I experienced it. Also I believe the fact that the dose of Ketamine ( usually 500mg I.V'ed slowly ) is one of the reasons it works well. As usual, talk to the pain doctor and YMMV.

Worst case you trip out :)
 
Disks can also heal wrong. Once the disk is injured and it starts healing nerve endings can grow into it (there aren't supposed to be any inside the disk). These nerve endings can then send pain signals to your brain which is a pretty fucked up situation.
 
Dissociatives. They are distracting and I lost control over both O-PCM and its use, the didn't-care state it induced was too self inforcing but I was also very destructive as I thought to having lost the love of life etc.. still, having experiences with opiates, pregabalin etc. I remain to be a strong advocate of dissos, either in very low dose with some social control or higher doses of short acting (K) to reduce opioid tolerance. Nothing ever remotely similar touches opioid receptors. Putting tolerance down without withdrawal, even memantine works (in supratherapeutic doses, the trials failed cause they dosed too conservatively but there is risk of mania, with all but specially memantine)

I actually wrote some of my best exams and online writings on dissociatives. They somehow unlock creativity for me, and switch out social anxiety like nothing (imho also remotely a sort of pain, just a mental one. Morphine worked great until its downstream effects began - depression, lethargy, decreased metabolism).
If you like pregabalin high dose, then dissos are for you. With some time and fine tuning you might find the sweet spot. It is a tiny line between increased creativity and fucked up memory. The potent RCs (O-PCM, 2F-O-PCM) are very forgiving physically in comparison to K. Just make SURE to get pure stuff, I nearly died off impurities from white-yellow brick O-PCM - I am sure it wasn't it itself because other batches did NOT have these horrible physical side effects. Unsure about excitotoxicity, some say it happens, other not. I tend to the point that it's at least not as worse in humans as in rats.

Also kratom actually has things to offer, even if you are on opioids. Switching to it feels like opening a can of energy. Maybe rotating with kratom might help too.
 
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I’d never heard of benzodiazepines being indicated for pain management so looked it up and found the below. Interesting new study if nothing else.

 
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