The Pain Management Mega Thread v2.0

[helium-4]

I really want to see if I can switch my clonazepam script into a 10mg oxycodone w/o APAP. I like my 20mg methadone script, but I don't think after using it for a month and half (first 10mgs a day, then 15mgs a day, and now 20mgs a day), it actually gives me the sedation I need at bed time. It works great for keeping me a sleep, and doesn't leave me feeling sleepy headed/missing alarms like clonazepam. Clonazepam also doesn't have the most enjoyable headspace. I'm trying to not be seen as a drug seeker by upping my dose for methadone so often, as it does help with my RLS, and I'm not in a lot of neurological pain (just minor to moderate), so I'm not really sure I should ask to raise it up to 25 or 30mgs. I've gotten rid of 24mgs of my 60mgs total clonazepam for the month to lower my daily dose to 1 (I didn't just give them a way, but not relevant) to see if this helps with the side-effects, but ultimately I kinda want it completely gone. I don't need a benzodiazepine addiction along with an opioid addiction. So I'm thinking I might ask for 10mgs of oxycodone, 20mgs of hydrocodone, or 4mg of hydromorphone taken a hour before bed, with the 20mgs of methadone a day. I guess I could also see I could switch the clonazepam to temazepam (less negative effects on sleep cycle and a bit shorter half-life), or valium (a lot nicer on my body).

I dunno, I guess I should just let him know that I prefer using opioids only but would like the sedation to be higher at night, rather than the steady state sedation of methadone. Maybe try to see if I could switch to just using levorphanol 4mg around noon, and 8mgs at night before bed. This could be possible, but I imagine for one it will be hard to find some where it in stock and I'm not sure who expensive it would be. I think it would be as good as methadone as it also has NDMA-antagonism, stronger SNRI effect than methadone, more potent than morphine, and lasts 8-16 hours apparently. If I could have just the light sedation and RLS benefits during the day and heavy sedation from a higher dose at night, it would be like magic. When I take amphetamine during the day methadone isn't the best at making it easy tof all asleep when ever I want.

Anyone have experience with levorphanol? Anyone think that it would be be ok to try to up my dose to 25 or 30mgs? I never have been scripted pain medication for any other purpose than post hospital pain, so I'm not sure if it would look weird having a 22 year old ask to raise the dose of methadone up again. Especially when 20mgs of methadone should be a high dose for a opiate naive individual. I just wnat some heavy sedation before bed that isn't from a benzo (gabapentin doesn't work, ambien doesn't work for me, cyclobenzaprine doesn't make me tired anymore, and I will not touch any stupid anti-psychs they stupidly script for sleeping ). I feel a opioid sedation would be the best option other than weed. If I had some weed I'd totally be happy.

I also don't want to switch the methadone to oxycodone, hydrocodone, oxymorphone, or morphine (the ERs are expensive, and I'd abuse them, especially when I'd probably get 20mg of oxycodone twice a day). i don't want to abuse my scripts.

 

[Doomed2pain]

I'm surprised they are prescribing methadone for RLS to behonest, not common practise in the uk. Would diazepam not be better? Longer half life so it's not AS addictive as shorted acting benzos. Obviously there is tolerance and physical dependence but i don't think the psychological addiction is as bad as other benzos and diazepam is great for muscle seizures,i am on 4 mg a day for the muscle seizures i get. No where near enough to control it, but it isn't as bad as what i am like without them.

I wouldnt out right ask him to change it to a specific med, maybe just say you are having trouble falling asleep and would he maybe change some of your meds to make your evening dose the most sedatory?

Have you ever tried taking otc antihistamines at bed time? When i take the syrup with my night time dose of meds it does help relax me a little, but now I am back on olanzapine i should see a big difference with my sleep now, i hope anyway.

 

[Captain.Heroin]

I HATE Xanax. Why dont u.s docs just presribe 5 mg valium or .5 ativan ? Much less problematic drugs than alprazolam. I'm sure it's a very useful drug when taken in small doses, work your way up for a few days or a week depedning on the level of stress your under then titrate you off within 2/3 weeks. Sounds pretty bloody right to me.

I prefer alprazolam to diazepam and lorazepam; they are much more troublesome for me.

If anything, benzos and their effects widely vary among different individuals so it's hard to say things like you do - doctors DO prescribe 5mg diazepam (I have received this before) as well as 1mg ativan (I have also received this before) but NEITHER worked well for me - nor would I ask for EITHER again.

 

[Doomed2pain]

I used to just take diazepam occassionally for my panic disorder, important things etc but now since the crps spread i have been having these awful seizure like things going on, they are so painful. The diazepam really helps with the seizures and when i was using them for panic attacks i'd still be riddled with anxiety but they stopped the full blown attacks which is good.

Each to their own though as you said CH. some people find morphine great for pain, with me, it is like taking paracetamol for small children lol

 

[helium-4]

I'm surprised they are prescribing methadone for RLS to behonest, not common practise in the uk. Would diazepam not be better? Longer half life so it's not AS addictive as shorted acting benzos. Obviously there is tolerance and physical dependence but i don't think the psychological addiction is as bad as other benzos and diazepam is great for muscle seizures,i am on 4 mg a day for the muscle seizures i get. No where near enough to control it, but it isn't as bad as what i am like without them.

I wouldnt out right ask him to change it to a specific med, maybe just say you are having trouble falling asleep and would he maybe change some of your meds to make your evening dose the most sedatory?

Have you ever tried taking otc antihistamines at bed time? When i take the syrup with my night time dose of meds it does help relax me a little, but now I am back on olanzapine i should see a big difference with my sleep now, i hope anyway.

Look at the TDS social thread and I have explain explained my script for methadone, and alot of great info on RLS. But quickly I'll say, methadone is a very very good RLS medication and is one of the best RLS medications (thought it is used only after trying weaker opioids like tramadol. Opioids are used for RLS when all the other RLS medication classes [dopamine agonists, anti-convulsants, benzos, and occasionally alpha2 agonists] show a lack of efficiency and/or when the RLS symptoms are severe and painful. My RLS is severe. It is a occures daily, starts mid to late afternoon and sometimes morning, and mild to moderately painful). Methadone is a fantastic medication for my RLS, but I just wish I could get more sedation right before I go to be, espcially when I take amphetamines during the day. Methadone and amphetamine isn't a very good mix imo. The amphetamine makes methadone not really sedating, which is frustrating at night.

Also, I want to avoid benzos because they all have physical dependence and they actually don't do anything for RLS or PLMS. They are just scripted because of a lack of understanding about RLS/PLMS and to allow one to fall asleep easy/stay asleep (its a pretty recently investigated medical condition because it can be pretty debilitating for ones life, and not taken as seriously as it really should, which also causes a problem). Diazepam is one of my choices for another benzo if I want to go that route, but I'm already getting a physical dependence for opioids. Having a opioid and benzo dependency just sounds like trouble, even if they are medically scripted.

A lot of anti-histamines are not good for RLS. Diphenhydramine for example makes RLS a lot worse. Not to mention anti-histamines (and anti-cholinergics which a lot are) for me also have some of the same side-effects as benzos, where I rather just stay on a benzo. I wake up groggy on them, and they can play around with my mood which I rather avoid being depressed as it is.

I really don't want to get off methadone, I just want a side-effect free way to get a heavier sedation right before bed. Taking a part of my dose of methadone ever right before bed isn't going to increase the sedation that much. The only other opioid I'd consider switching to would be the levorphanol as it should work as well as methadone, though there aren't the large number of studies for it and RLS like there are for methadone. He has it on his web page as one of the drugs used to treat RLS for severe cases (I wouldn't choose to ever be on a opioid with out nmda-antagonism as my RLS medication, only would accept a traditional opioid like oxy just for a supplement on top, similar to a break through medication. I really doubt this would happen).

I guess in a week or so I'll give him a call expressing some concerns. I legitly do have problems so I'm not trying to scam him in anyway. In a handful of months I'm going to suggest a drug holiday from methadone (this should be ok, and benefical to keep the methadone tolerance down) and trying another opioid to see how it works. Maybe if he'll go for it levorphanol.

 

[muvolution]

There are alot of new faces in this thread (figuratively) but I will try to respond to everyone individually.

I need some advice actually, i stopped taking citalopram sunday after 3 months, i'm taking tramadol everyday now which is an SNRI so can i expects to avoid withdrawal symptoms from citalopram if i'm taking tramadol, an antidepressant in my mind

Tramadol is, for me, a very effective antidepressant. Functionally, the SNRI action should not wear off for up to 24 hours - after taking tramadol for about a week, you retain active plasma levels for quite a while, and the bioavailability actually increases. Regardless, I have found it very easy to taper of SSRI's using tramadol.

I'm trying to not be seen as a drug seeker by upping my dose for methadone so often, as it does help with my RLS, and I'm not in a lot of neurological pain (just minor to moderate), so I'm not really sure I should ask to raise it up to 25 or 30mgs.

Hey man, I know that you are used to getting scripts for heavy opiates, but you should step back and evaluate your situation from an objective observers perspective. Levorphanol is one of the strongest opiates in the modern pharmacoepia, prescribing it for rls is an insane idea. And minor to moderate Neurological pain should not require 30mg of methadone a day. Moderate to Severe debilitating pain requires that kind of dose of methadone. RLS is successfully treated with tramadol alone, I highly doubt that these other opiates are doing much for you.

This whole thing is kind of like hitting a fly with a hammer, and in the process you are ravaging your body, dulling your mind, and creating your own justifications for using. Listen to your post - you are a drug seeker. Your doctors might not know that or think so, but just because they don't acknowledge it doesn't mean it isn't true. I'm not trying to be harsh on you man, I HAVE BEEN THERE MYSELF. I am just trying to get you to see how insane this is. PLUS opiates are so much better when taken occasionally. Why would you submit yourself to the torture of dependence and addiction? btw, if you have rls and you are still taking amphetamines, even occasionally, you are totally fucking yourself over.

I understand that your RLS is severe, but if you are not trying every other option available to you, you shouldn't be on all the dope. Do you exercise at least 30 minutes on a daily basis? Have you tried yoga or pilates to tone your muscles and activate blood flow to nerves and muscles that are key in preventing rls? Acupuncture, diet, exercise, meditation, cannabis, etc...
I would really encourage you to explore other options.

 

[helium-4]

There are alot of new faces in this thread (figuratively) but I will try to respond to everyone individually.


Tramadol is, for me, a very effective antidepressant. Functionally, the SNRI action should not wear off for up to 24 hours - after taking tramadol for about a week, you retain active plasma levels for quite a while, and the bioavailability actually increases. Regardless, I have found it very easy to taper of SSRI's using tramadol.


Hey man, I know that you are used to getting scripts for heavy opiates, but you should step back and evaluate your situation from an objective observers perspective. Levorphanol is one of the strongest opiates in the modern pharmacoepia, prescribing it for rls is an insane idea. And minor to moderate Neurological pain should not require 30mg of methadone a day. Moderate to Severe debilitating pain requires that kind of dose of methadone. RLS is successfully treated with tramadol alone, I highly doubt that these other opiates are doing much for you.

This whole thing is kind of like hitting a fly with a hammer, and in the process you are ravaging your body, dulling your mind, and creating your own justifications for using. Listen to your post - you are a drug seeker. Your doctors might not know that or think so, but just because they don't acknowledge it doesn't mean it isn't true. I'm not trying to be harsh on you man, I HAVE BEEN THERE MYSELF. I am just trying to get you to see how insane this is. PLUS opiates are so much better when taken occasionally. Why would you submit yourself to the torture of dependence and addiction? btw, if you have rls and you are still taking amphetamines, even occasionally, you are totally fucking yourself over.

I understand that your RLS is severe, but if you are not trying every other option available to you, you shouldn't be on all the dope. Do you exercise at least 30 minutes on a daily basis? Have you tried yoga or pilates to tone your muscles and activate blood flow to nerves and muscles that are key in preventing rls? Acupuncture, diet, exercise, meditation, cannabis, etc...
I would really encourage you to explore other options.

You obviously have no idea what my situation is, so don't make such large assumptions. Nor know shit about RLS from your posts. So I appreciate you kept your ignorant opinions to yourself from now on if you don't bother ask me about my problems. Your advice isn't helpful when you are trying to save me from problems that aren't actually problems...

Also I am not used to being scripted strong opioids. The only strong opioid I've been scripted is methadone. Nor am I'm a drug seeker, I'm trying to find the right combination or better yet single medication for my RLS/PLMS.

I've tried all other lines of medication for RLS and none worked (dopamine agonists, gabapentin, clonazepam, tramadol). I've alsoofcourse tried all the non-pharmacological approaches to helping RLS and PLMS, and none of them work. Also, levorphanol is scripted for RLS, just because you can't understand the practice, as you aren't educated in the condition of RLS/PLMS, or aren't a neurologist, you should ask questions rather than try and save me from things you don't completely understand. The doses I listed are reasonable doses (maybe the nighttime dose could be slightly decrease to 6mg), which as equivalent to the amount of methadone I'm scripted today just fyi.

The reason for scripting methadone (or other opioids) isn't solely for the pain. Yes strong opioids like methadone, oxycodone, levorphanol are scripted for other conditions for moderate to severe pain, but for RLS this is not all ways the case. RLS untreated or improperly treated i can be very debilitating. Some patients have really bad neurological pain, others have such severe uncomfortable sensations, that opioids are the best course of action, particularly ones with NMDA-antagonism. Read some patient letters here http://www.rlshelp.org/

And yes methadone is fantastic for my RLS compared to all the other opioids I've tried for RLS (tramadol, hydrocodone). I could have gotten oxycodone I wanted to, but I don't want oxy because it lacks some of the beneficial qualities that are very good for treating neurological conditions, and the abuse potential. Methadone doesn't have much abuse potential at all. I don't get high from my daily dose of methadone. I get a full day of relief, which I need due to my RLS being refractory. Taking methadone daily only continues to make it impossible to get high off of. I'm hardly drug seeking when I chose to go with methadone.

With a proper taper from my doctor I can avoid much of the negative aspects of a physical dependence as well. That is true for other opioids used to treat RLS with like oxycodone as well. The physical dependence built by opioids are also better to have imo than a benzodiazepine script. I'm trying to increase my dose to be able to rely on my methadone for both the RLS and PLMS. That means I'm trying to get rid of my clonazepam script. I've already lowered my dose from 2mgs to 1mg. The dose increase I want, to allow me to be painfree and comfortable, along with able to fall asleep and stay asleep with out the aid of a benzodiazepine. Methadone can actually decrease the number of limb movements per hour, treating the PLMS, which benzos can't making it a great solo drug to treat all of my conditions. (they just mask the symptoms and can even make your sleep cycle screwed up).

One thing about scripting opioids to RLS patients is the fact that the dose once established for the individual patients needs, is kept constant unlike other chronic pain conditions over a long period of time, where chronic pain patients may need to increase their dose. So a patient can remain on a 20mg methadone dose for years with 75% of the symptoms of RLS treated. The doses used do not get ridiculous either. They don't script over 40mg of methadone usually, dont script over 30mg of oxycodone usually, etc. Keeping the doses at reasonable levels, that produce minimal physical dependence if discontinued with care.

My methadone is scripted by my neurologist, who has experience dealing with RLS. And I'm not just talking about treating RLS produced by opioid detoxification (secondary RLS), I'm talking about primary RLS that I'll carry with my for the rest of my life. This decision was made with my neurologist, and will continue to be made with him. If he has no problem with prescribing me methadone, you should no be worried. I don't also want to go to high with my methadone dosage either, but I still want to get the best relief I can out of it. I feel that isn't to much to ask, whether or not you find it to be drug seeking.

Maybe my posts early might sound a little off, but I was enjoying a slightly higher dose of clonazepam since I have nothing to do, and have a couple extra laying around. Nothing wrong with getting high once in a while when I've been responsible and lowered my daily consumption from 2mg to 1mg.

Also, there isn't anything wrong with scripting amphetamine to someone with RLS. Amphetamines don't make RLS worse. They can make it harder to sleep if I take it to late in the afternoon, but that is my own fault in reality. Also, I'm not receiving amphetamine that often anymore, and making this script my last one. The last time I took amphetamine before friday was 2 months ago. I even took a day off today because I didn't need it. This is how I'm going to be taking it for the rest of the prescription. Only as needed, as I'm extremely ADHD and am in the process of getting therapy to learn to work through my ADHD with out drugs. So also once again, you don't know anything about why I'm taking amphetamine or my history with it.


Restless legs syndrome: diagnosis and review of management options
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2671772/

Treatment of restless legs syndrome: An evidence-based review and implications for clinical practice
http://onlinelibrary.wiley.com/doi/10.1002/mds.22254/full

Restless leg syndrome: is it a real problem?
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1936366/

Methadone for refractory restless legs syndrome
http://onlinelibrary.wiley.com/doi/10.1002/mds.20359/abstract

Sorry if I'm going off as a dick, but I'm tired of people who are ignorant about RLS and the severity it can be for some people. Alot of drug users here only see it from there own opioid detoxification induced RLS, which isn't the same as the RLS that I have. People make to man assumptions on the subject and I've taken already alot of flack from people, who haven't actually done the research to make such judgements or statements. I'm getting my medication from a neurologist and my condition diagnosed by the same doctor. He is not going to put me in a terrible situation like you are making it out to be. And I'm not a drug seeker and I find that extremely offensive. I chose methadone with avoiding drug abuse as one of my reasons to go with it over the other opioid options. Hell, taking methadone everyday is going to even raise my tolerance to other opioids preventing me from getting on them if Iwanted to, unless I wanted to spend an arm and a leg to meet my opioid tolerance. So I'm actually helping my opioid problems. Anyway, I rushed through this post as I got somewhere to be.

 

[Brian242]

I just have a question;

I'm 18 years old and last year I had Scoliosis correction surgery with 2 bars and 12 bolts in my back and I fear i'm addicted to my Hydrocodone 10-325's. I hurt and take more than i'm supposed to sometimes so instead of taking 2 every 4 hours I take 3. i'm now on 4 and I don't feel a thing. I don't feel dopey, and there's no pain relief. How should I get off of these and take a T break?

 

[lptrax]

I just have a question;

I'm 18 years old and last year I had Scoliosis correction surgery with 2 bars and 12 bolts in my back and I fear i'm addicted to my Hydrocodone 10-325's. I hurt and take more than i'm supposed to sometimes so instead of taking 2 every 4 hours I take 3. i'm now on 4 and I don't feel a thing. I don't feel dopey, and there's no pain relief. How should I get off of these and take a T break?

fuck it bro with all that metal in you just get the opana/roxi combo


or if you need a break use subs for a few days then go back to the hydro

 

[Brian242]

fuck it bro with all that metal in you just get the opana/roxi combo


or if you need a break use subs for a few days then go back to the hydro

I would but my Dr. doesn't want to give me anything stronger because i'm "Too young" for anything stronger, and I have no idea where to get suboxone

 

[Brian242]

You obviously have no idea what my situation is, so don't make such large assumptions. Nor know shit about RLS from your posts. So I appreciate you kept your ignorant opinions to yourself from now on if you don't bother ask me about my problems. Your advice isn't helpful when you are trying to save me from problems that aren't actually problems...

Also I am not used to being scripted strong opioids. The only strong opioid I've been scripted is methadone. Nor am I'm a drug seeker, I'm trying to find the right combination or better yet single medication for my RLS/PLMS.

I've tried all other lines of medication for RLS and none worked (dopamine agonists, gabapentin, clonazepam, tramadol). I've alsoofcourse tried all the non-pharmacological approaches to helping RLS and PLMS, and none of them work. Also, levorphanol is scripted for RLS, just because you can't understand the practice, as you aren't educated in the condition of RLS/PLMS, or aren't a neurologist, you should ask questions rather than try and save me from things you don't completely understand. The doses I listed are reasonable doses (maybe the nighttime dose could be slightly decrease to 6mg), which as equivalent to the amount of methadone I'm scripted today just fyi.

The reason for scripting methadone (or other opioids) isn't solely for the pain. Yes strong opioids like methadone, oxycodone, levorphanol are scripted for other conditions for moderate to severe pain, but for RLS this is not all ways the case. RLS untreated or improperly treated i can be very debilitating. Some patients have really bad neurological pain, others have such severe uncomfortable sensations, that opioids are the best course of action, particularly ones with NMDA-antagonism. Read some patient letters here http://www.rlshelp.org/

And yes methadone is fantastic for my RLS compared to all the other opioids I've tried for RLS (tramadol, hydrocodone). I could have gotten oxycodone I wanted to, but I don't want oxy because it lacks some of the beneficial qualities that are very good for treating neurological conditions, and the abuse potential. Methadone doesn't have much abuse potential at all. I don't get high from my daily dose of methadone. I get a full day of relief, which I need due to my RLS being refractory. Taking methadone daily only continues to make it impossible to get high off of. I'm hardly drug seeking when I chose to go with methadone.

With a proper taper from my doctor I can avoid much of the negative aspects of a physical dependence as well. That is true for other opioids used to treat RLS with like oxycodone as well. The physical dependence built by opioids are also better to have imo than a benzodiazepine script. I'm trying to increase my dose to be able to rely on my methadone for both the RLS and PLMS. That means I'm trying to get rid of my clonazepam script. I've already lowered my dose from 2mgs to 1mg. The dose increase I want, to allow me to be painfree and comfortable, along with able to fall asleep and stay asleep with out the aid of a benzodiazepine. Methadone can actually decrease the number of limb movements per hour, treating the PLMS, which benzos can't making it a great solo drug to treat all of my conditions. (they just mask the symptoms and can even make your sleep cycle screwed up).

One thing about scripting opioids to RLS patients is the fact that the dose once established for the individual patients needs, is kept constant unlike other chronic pain conditions over a long period of time, where chronic pain patients may need to increase their dose. So a patient can remain on a 20mg methadone dose for years with 75% of the symptoms of RLS treated. The doses used do not get ridiculous either. They don't script over 40mg of methadone usually, dont script over 30mg of oxycodone usually, etc. Keeping the doses at reasonable levels, that produce minimal physical dependence if discontinued with care.

My methadone is scripted by my neurologist, who has experience dealing with RLS. And I'm not just talking about treating RLS produced by opioid detoxification (secondary RLS), I'm talking about primary RLS that I'll carry with my for the rest of my life. This decision was made with my neurologist, and will continue to be made with him. If he has no problem with prescribing me methadone, you should no be worried. I don't also want to go to high with my methadone dosage either, but I still want to get the best relief I can out of it. I feel that isn't to much to ask, whether or not you find it to be drug seeking.

Maybe my posts early might sound a little off, but I was enjoying a slightly higher dose of clonazepam since I have nothing to do, and have a couple extra laying around. Nothing wrong with getting high once in a while when I've been responsible and lowered my daily consumption from 2mg to 1mg.

Also, there isn't anything wrong with scripting amphetamine to someone with RLS. Amphetamines don't make RLS worse. They can make it harder to sleep if I take it to late in the afternoon, but that is my own fault in reality. Also, I'm not receiving amphetamine that often anymore, and making this script my last one. The last time I took amphetamine before friday was 2 months ago. I even took a day off today because I didn't need it. This is how I'm going to be taking it for the rest of the prescription. Only as needed, as I'm extremely ADHD and am in the process of getting therapy to learn to work through my ADHD with out drugs. So also once again, you don't know anything about why I'm taking amphetamine or my history with it.


Restless legs syndrome: diagnosis and review of management options
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2671772/

Treatment of restless legs syndrome: An evidence-based review and implications for clinical practice
http://onlinelibrary.wiley.com/doi/10.1002/mds.22254/full

Restless leg syndrome: is it a real problem?
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1936366/

Methadone for refractory restless legs syndrome
http://onlinelibrary.wiley.com/doi/10.1002/mds.20359/abstract

Sorry if I'm going off as a dick, but I'm tired of people who are ignorant about RLS and the severity it can be for some people. Alot of drug users here only see it from there own opioid detoxification induced RLS, which isn't the same as the RLS that I have. People make to man assumptions on the subject and I've taken already alot of flack from people, who haven't actually done the research to make such judgements or statements. I'm getting my medication from a neurologist and my condition diagnosed by the same doctor. He is not going to put me in a terrible situation like you are making it out to be. And I'm not a drug seeker and I find that extremely offensive. I chose methadone with avoiding drug abuse as one of my reasons to go with it over the other opioid options. Hell, taking methadone everyday is going to even raise my tolerance to other opioids preventing me from getting on them if Iwanted to, unless I wanted to spend an arm and a leg to meet my opioid tolerance. So I'm actually helping my opioid problems. Anyway, I rushed through this post as I got somewhere to be.

Ok, it's not a smart idea to talk to a senior Moderator like that, and say he doesn't know shit. Muvolution is a good person and very smart. And I do agree with him that you seem to be seeking strong drugs. I only get Hydrocodone for my scoliosis correction surgery with two 1 1/2 foot titanium bars and 12 6" bolts in my back with a 2 and a half foot scar on my back (See profile pic). I should be getting something stronger but guess what? I can't. You have to learn to live with your RLS. There are people in WAY worse shape then you. Hell, might as well name off all the shit that's wrong with me; Deformed anvil bone in my left ear, meaning I can't hear out of it, and the right ear has 30% hearing loss. I can't stand for more than 5 minutes. I probably won't get to do all the things I wanted to do in my life. I have a replacement kneecap. That shit sucks.

I understand that your RLS may be bad, but you sure got defensive when called a drug seeker!

I fucking hurt, and Hydro's don't do shit for me and there's nothing I can really do because i'm 18.

 

[Drifter74]

You obviously have no idea what my situation is, so don't make such large assumptions. Nor know shit about RLS from your posts. So I appreciate you kept your ignorant opinions to yourself from now on if you don't bother ask me about my problems. Your advice isn't helpful when you are trying to save me from problems that aren't actually problems...

Also I am not used to being scripted strong opioids. The only strong opioid I've been scripted is methadone. Nor am I'm a drug seeker, I'm trying to find the right combination or better yet single medication for my RLS/PLMS.

I've tried all other lines of medication for RLS and none worked (dopamine agonists, gabapentin, clonazepam, tramadol). I've alsoofcourse tried all the non-pharmacological approaches to helping RLS and PLMS, and none of them work. Also, levorphanol is scripted for RLS, just because you can't understand the practice, as you aren't educated in the condition of RLS/PLMS, or aren't a neurologist, you should ask questions rather than try and save me from things you don't completely understand. The doses I listed are reasonable doses (maybe the nighttime dose could be slightly decrease to 6mg), which as equivalent to the amount of methadone I'm scripted today just fyi.

The reason for scripting methadone (or other opioids) isn't solely for the pain. Yes strong opioids like methadone, oxycodone, levorphanol are scripted for other conditions for moderate to severe pain, but for RLS this is not all ways the case. RLS untreated or improperly treated i can be very debilitating. Some patients have really bad neurological pain, others have such severe uncomfortable sensations, that opioids are the best course of action, particularly ones with NMDA-antagonism. Read some patient letters here http://www.rlshelp.org/

And yes methadone is fantastic for my RLS compared to all the other opioids I've tried for RLS (tramadol, hydrocodone). I could have gotten oxycodone I wanted to, but I don't want oxy because it lacks some of the beneficial qualities that are very good for treating neurological conditions, and the abuse potential. Methadone doesn't have much abuse potential at all. I don't get high from my daily dose of methadone. I get a full day of relief, which I need due to my RLS being refractory. Taking methadone daily only continues to make it impossible to get high off of. I'm hardly drug seeking when I chose to go with methadone.

With a proper taper from my doctor I can avoid much of the negative aspects of a physical dependence as well. That is true for other opioids used to treat RLS with like oxycodone as well. The physical dependence built by opioids are also better to have imo than a benzodiazepine script. I'm trying to increase my dose to be able to rely on my methadone for both the RLS and PLMS. That means I'm trying to get rid of my clonazepam script. I've already lowered my dose from 2mgs to 1mg. The dose increase I want, to allow me to be painfree and comfortable, along with able to fall asleep and stay asleep with out the aid of a benzodiazepine. Methadone can actually decrease the number of limb movements per hour, treating the PLMS, which benzos can't making it a great solo drug to treat all of my conditions. (they just mask the symptoms and can even make your sleep cycle screwed up).

One thing about scripting opioids to RLS patients is the fact that the dose once established for the individual patients needs, is kept constant unlike other chronic pain conditions over a long period of time, where chronic pain patients may need to increase their dose. So a patient can remain on a 20mg methadone dose for years with 75% of the symptoms of RLS treated. The doses used do not get ridiculous either. They don't script over 40mg of methadone usually, dont script over 30mg of oxycodone usually, etc. Keeping the doses at reasonable levels, that produce minimal physical dependence if discontinued with care.

My methadone is scripted by my neurologist, who has experience dealing with RLS. And I'm not just talking about treating RLS produced by opioid detoxification (secondary RLS), I'm talking about primary RLS that I'll carry with my for the rest of my life. This decision was made with my neurologist, and will continue to be made with him. If he has no problem with prescribing me methadone, you should no be worried. I don't also want to go to high with my methadone dosage either, but I still want to get the best relief I can out of it. I feel that isn't to much to ask, whether or not you find it to be drug seeking.

Maybe my posts early might sound a little off, but I was enjoying a slightly higher dose of clonazepam since I have nothing to do, and have a couple extra laying around. Nothing wrong with getting high once in a while when I've been responsible and lowered my daily consumption from 2mg to 1mg.

Also, there isn't anything wrong with scripting amphetamine to someone with RLS. Amphetamines don't make RLS worse. They can make it harder to sleep if I take it to late in the afternoon, but that is my own fault in reality. Also, I'm not receiving amphetamine that often anymore, and making this script my last one. The last time I took amphetamine before friday was 2 months ago. I even took a day off today because I didn't need it. This is how I'm going to be taking it for the rest of the prescription. Only as needed, as I'm extremely ADHD and am in the process of getting therapy to learn to work through my ADHD with out drugs. So also once again, you don't know anything about why I'm taking amphetamine or my history with it.


Restless legs syndrome: diagnosis and review of management options
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2671772/

Treatment of restless legs syndrome: An evidence-based review and implications for clinical practice
http://onlinelibrary.wiley.com/doi/10.1002/mds.22254/full

Restless leg syndrome: is it a real problem?
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1936366/

Methadone for refractory restless legs syndrome
http://onlinelibrary.wiley.com/doi/10.1002/mds.20359/abstract

Sorry if I'm going off as a dick, but I'm tired of people who are ignorant about RLS and the severity it can be for some people. Alot of drug users here only see it from there own opioid detoxification induced RLS, which isn't the same as the RLS that I have. People make to man assumptions on the subject and I've taken already alot of flack from people, who haven't actually done the research to make such judgements or statements. I'm getting my medication from a neurologist and my condition diagnosed by the same doctor. He is not going to put me in a terrible situation like you are making it out to be. And I'm not a drug seeker and I find that extremely offensive. I chose methadone with avoiding drug abuse as one of my reasons to go with it over the other opioid options. Hell, taking methadone everyday is going to even raise my tolerance to other opioids preventing me from getting on them if Iwanted to, unless I wanted to spend an arm and a leg to meet my opioid tolerance. So I'm actually helping my opioid problems. Anyway, I rushed through this post as I got somewhere to be.

How come you didn't answer any of Muvolution's questions instead of ranting about how much he doesn't know?

You are ABSOLUTELY a drug seeker, no doubt, doing what we all do --ATTEMPTING TO JUSTIFY IT IN ANY WAY POSSIBLE.

That we understand. Being a jerk about it, well.. that's just rude..

 

[helium-4]

Ok, it's not a smart idea to talk to a senior Moderator like that, and say he doesn't know shit. Muvolution is a good person and very smart. And I do agree with him that you seem to be seeking strong drugs. I only get Hydrocodone for my scoliosis correction surgery with two 1 1/2 foot titanium bars and 12 6" bolts in my back with a 2 and a half foot scar on my back (See profile pic). I should be getting something stronger but guess what? I can't. You have to learn to live with your RLS. There are people in WAY worse shape then you. Hell, might as well name off all the shit that's wrong with me; Deformed anvil bone in my left ear, meaning I can't hear out of it, and the right ear has 30% hearing loss. I can't stand for more than 5 minutes. I probably won't get to do all the things I wanted to do in my life. I have a replacement kneecap. That shit sucks.

I understand that your RLS may be bad, but you sure got defensive when called a drug seeker!

I fucking hurt, and Hydro's don't do shit for me and there's nothing I can really do because i'm 18.

Nothing I said was more inappropriate than anything her said, and imo even less so. Being condenscending about someones medical condition which they know nothing about (you can't argue that they do when they do not know me), or show little knowledge about RLS, is really ignorant. So I called him out on it. Being a moderator or even very smart doesn't mean they are all knowing. I've been a moderator for a rather similar large drug forum, so I I'm sorry if I may have came off as a little harsh, but I was in a rush at the moment to type out of a bunch of information. It would have been a little more organized and presented a little better if I had more time. If you guys would like I could rewrite my response when I have a bit more time when I'm home from work. For information purposes I will also post a post that I wrote up in TDS social going over RLS and PLMS, as well as some info on my current situation. It is a good read, and very informative for those who don't quite understand RLS/PMS and how serious it can be (it can be asdebilitating as many chronic pain problems, neurological or non-neurological - RLS can be a extremely painful neurological condition, and in my case a mild to moderate pain condition that is unable to be treated with weaker opioids). I tried tramadol with my neurologist for 2 months and it was very ineffective, and prescribing hydrocodone was the only other weak opioid option. Hydrocodone isn't as benefical towards neurological disorders as it is just a mu-opioid agonist with little no pharmacological properties that add to non-nociceptive pain, as well as a short duration, and daily APAP consumption is not good. NMDA-antagonism and SNRI actions can play a postive role in neurological pain, which tradition opiates (natural alkoloids or semisynthetic opiates) do not possess). Strong opioids are common for severe RLS patients, namely methadone, but occasionally oxycodone (or levorphanol if the doc is willing to script a rather rarely stock opioid, it is a very good one for neurological pain because of it's NDMA-antagonism and stronger SNRI action than methadone [methadone has light SNRI]). Oxycodone is seen used alot for RLS especially when doctors are afriad of methadone due to the stigma behind it, however it doesn't have the other pharmacological properties that may be very beneficial for long-term use as well as helping with neurological disorders. I chose to not even bother asking for it because its duration is too short (my RLS starts in the mid afternoon, and even in the morning occasionally, leaving me with only half the day or less with out pain/discomfort), it is very abusable (i admit I had a oxy addiction this year that I stopped, so want to avoid it), and expensive. Other opiates like oxymorphone, morphine, etc haven't been really used in RLS studies, but have been tried by doctors , and they can work, but they still have the problems like oxy. Dextropropoxyphene actually used to be a very very good RLS drug. It has some chemical similarity to methadone, some other mode of actions that tradition opioids doen't have (like nmda-antagonism once again), and my neurologist has very goood results with it. I would have tried that after the tramadol but I can't get it in the US anymore due to the law.

Also, I did answer his questions. I've tried non-pharmacological treatments, and still do ontop of my methadone treatment. I always take a walk 2 hours before bed. I take hot baths at night. I do not drink alcohol besides once in a blue moon (a class or two of wine or a beer), caffeine is still something I drink sadly but I love it, and I stretch my legs before bed. They do not work, not has all the other pharmacological treatments like dopamine agonists pramipexole and ropinirole, gabapentin, clonazepam (that I'm lowering my dose down over time, I'm at 1mg right now), and tramadol. None of them work. The clonazepam helps fall asleep and stay asleep to help the PLMS but it doesn't do anything for RLS (all studies support this), and actually just masks the PLMS symptoms. Its very addictiveand shouldn't be used for PLMS in all honesty. Methadone preforms better than all other treatment options (like dopamine agonists used as first line, I could go on and on about this, but i did in another post I will copy later). In long term studies, it retains a 75% effieceny in eleminating the symptoms of RLS. This has been seen even up to 10 years in one study, and you know what? The dosages were not increased over the study. The Roughly the same was seen with oxy, but the study was short, i think 6-18months, but with the same results. No augmentation was found either with opioids compared to long term dopamine agonists or other treatments. The avg dosage for methadone used in studies for RLS was ~15mg, with a range of 5-40mgs. Not a bad range. Being methadone, it is pretty safe for extended period of time with those doses. The abuse potential becomes next to nothing after even a few weeks, let alone months of use, it raises your tolerance to other opioids making it harder to get high on other drugs (which i love since I'm not buying drugs off the street anymore, not even weed), it has a steady state concentration used especially with duel dosing to prevent a dip over the 24 hour peroid, it can be tapered reasonably with the neurologists supervision, and has minimal side-effects for me. The side-effects are non-existant compared to the first line drug, dopamine agonists. In a post I will copy over here, it talks about my experience with those.

Also because people with unfortunate conditions arn't able to get scripts that they desire or feel they need to treat their problems doesn't invalidate the fact that I need treatment too. IF the best treatment is an opioid, especially a reasonable safe, abuse free one like methadone, why shouldn't I have access to it with proper supervision like I have with my neurologist.

I don't see how trying to elminate my benzo script/use with a higher dose of methadone or another opioid is considered drug seeking. For the most part methadone works extremely well, it just isn't enough to help me fall asleep/stay asleep at my current dose. A slightly higher dose might be fine, but i think it would be nice to have something to use at night to help allow my to fallasleep quicker and stay asleep, with that drug not being a benzo. I don't need benzo dependence along with a opioid dependence. So honestly thats kinda more like harm reduction. trying to get rid of med is not so much drug seeking. I already lowered my dose to 1mg from 2mg, which I didn't have to do. So tell me how is that drug seeking? Please point out to me where in my post there seems to be something indicating this? I'd love to see.

My frustrations which may seem annoying to you guys are from a lack of understanding about RLS and PLMS. They can be very severe neurological conditions. They are not alone either. They are most often seen with mental disorders (chemical imbalences), other physical problems (secondary RLS which sometimes can be cured when the other problem is treated), etc. Most people rub it off as an exaggeration or call me a drug seeker which I find offense. My RLS is considered severe. It is daily, last half or more than half of my day, can be pretty painful, ultra uncomfortable, destroys my sleep patterns, causes hardship in my life (makes work difficult to go to and perform at), makes me ADHD extremely terrible (I dropped out of college because how severe my ADHD was - Im getting therapy on this btw, so I don't need amphetamines ever again), prevents me from even sitting down at night to watch tv, let alone do the things I love to do, or basic chores, etc. People are so ignorant about the condition and it really pisses me off. They know RLS as a result of opioid detox, SSRI cescation, etc., not that it can be a life long condition that can get progressively worse. It isn't as common among people my age, but there a lot out there like me. Once people get over the age of 30 it becomes a lot more common.

I'm on a drug web site, if I wanted to drug seek, I wouldn't be offended to say I get my shit from a doc who doesn't know I'm lying. Plenty of people here takeadvantage of the system, I'm currently not. I was asking for advice in a pain management thread. I wish people would take it more serious and offer legit advice, rather than stories about what they feel should work, and how dangeruous drug addiction can be (I've been here for 6 years active as shit on BL, I know this), or how their condition is so serious and they only get T3s or hydrocodone, etc. Its really annnoying and stupid. IT isn't productive in anyway. IF you don't completely understand a condition either don't post a response on it, ask questions, or do your own research. It will avoid little issues like this.

 

[muvolution]

You asked for my pain management advice. It is : quit relying so much onopiates and do some work to get better. ( that doesn't mean try other drugs)

 

[helium-4]

I'll have to respond when I get back from class as I'm late, but the post you just wrote is very ignorant imo. I'd like to express to you when I'm home why that is.

Lets have a reasonable discussion if we could, and not have any hostility or being condescending. This goes for me as well. Im open to well thought out posts regarding my questions, but this requires a better understanding of my situation, the condition, and a genuine desire to understand where I'm coming from. Aka no assumptions, and opinions based on just what you'd do as a patient.

 

[muvolution]

Only one of us is being condescending and it certainly is not me. Pain management is a complicated buusiness. The most relief you can expect from opiates is about 20%. That means if your discomfort or pain is at a 9, you might get down to a 7. If you have "mild to moderate" neurological pain, like a 4, you might get down to a 3. So there is diminishing returns with opiates.

If you can't understand that it is your responsibility to try diet, exercise, alternative therapies, etc before you try drugs, then you are beyond help. My guess as to why you didn't respond to my first statement about diet and exercise is probably that you eat shitty foods, you don't exercise, and I can tell from the tone of your posts that you are mostly just high a lot. To be honest, everyone I know with rls is unhealthy or just plain fat. Its not ok, man.

As a pain patient it is your responsibility to not abuse your medication, to not "get high once in a while" on your klonipin, and definitely not to sell your k-pins. You are abusing the system and you are a drug seeker. I'm not telling you this for my benefit, I am trying to help you see that what you and your doctor think are acceptable treatments are way overkill and if you saw any other doctor, I'm sure they would concur.

I don't really want to get into an argument about rls, since it is a pretty recently discovered "disorder" and I don't want to offend you. Suffice to say that you find that it interferes with sleeping, sex, socializing, learning and cognition, weight control, motivation, emotion, and your relations? Because those are the areas of your life that suffer when you are an opiate addict, and even moreso, a polydrug abuser such as yourself.

So really, really take a hard look at what you are trading for what and why.

 

[Brian242]

Only one of us is being condescending and it certainly is not me. Pain management is a complicated buusiness. The most relief you can expect from opiates is about 20%. That means if your discomfort or pain is at a 9, you might get down to a 7. If you have "mild to moderate" neurological pain, like a 4, you might get down to a 3. So there is diminishing returns with opiates.

If you can't understand that it is your responsibility to try diet, exercise, alternative therapies, etc before you try drugs, then you are beyond help. My guess as to why you didn't respond to my first statement about diet and exercise is probably that you eat shitty foods, you don't exercise, and I can tell from the tone of your posts that you are mostly just high a lot. To be honest, everyone I know with rls is unhealthy or just plain fat. Its not ok, man.

As a pain patient it is your responsibility to not abuse your medication, to not "get high once in a while" on your klonipin, and definitely not to sell your k-pins. You are abusing the system and you are a drug seeker. I'm not telling you this for my benefit, I am trying to help you see that what you and your doctor think are acceptable treatments are way overkill and if you saw any other doctor, I'm sure they would concur.

I don't really want to get into an argument about rls, since it is a pretty recently discovered "disorder" and I don't want to offend you. Suffice to say that you find that it interferes with sleeping, sex, socializing, learning and cognition, weight control, motivation, emotion, and your relations? Because those are the areas of your life that suffer when you are an opiate addict, and even moreso, a polydrug abuser such as yourself.

So really, really take a hard look at what you are trading for what and why.

I couldn't agree more, Muvolution. SplatChrome, I do understand what you're going through. Believe me lol I do. But he's right. It's not a good idea to be selling your pills or to get high off of them every once in a while (Even though i'm sure all of us have at one point or another) because that's "Abuse". Do you go to physical therapy or a pain management clinic?

 

[helium-4]

How about we agree that both of us are being a little condescending. I mean I think it would be quite silly to assume that their wasn't a little bit of self-righteousness (or whatever word/phrase you'd like to use) from both of us, even if there was genuine desire to be supportive or informative. I know I may have come off in that way, especially as there is a personal tie to this topic, neurologically as well as emotionally, as I had a friend who struggled to understand the problems/treatments and looked me in a negative light because of my RLS. I'm not trying to make this an issue like it seems to sort have become, or the bad discussion that it is at the moment. My issue right now is none of my information is being considered (or at least used in any sort of discussion) to create an intellectual conversation, and I may not be addressing everything you've said either, playing a role in this as well. I think that this could be a very informative and interesting conversation that many users could learn a lot from. If you don't agree with this on some sort of level than I'm sorry, I enjoy a good conversation.

(to mulovation)^


to the guy above me,

I didn't say i was selling any pills. I was getting rid of clonazepam, essentially downing my script to 1mg a day from 2mg a day. Thats hardly abusing anything as I'm not even consuming what I'm scripted legally. If I wanted to abuse my medication I would have kept the 30 or mgs and use them for whatever I want.

Also, excuse me for being on a drug forum and taking 1mg or 2mg more than the 1mg I lowered myself to, just once in a blue moon. Taking more benzos that I don't need for fun on a day that I don't have responsibilities is my call, and imo is not that ridiculously. It also has nothing to do with methadone, the drug that that people who know nothing about RLS/PLMS are freaking out about. I haven't sold any of my methadone, and I still have enough for all of the 30 days I need them. I did skip my dose yesterday and just took my amphetamine with clonazepam at the end, as I found methadone and clonazepam is not a great mix. I'm not in WDs and it still helps with my RLS, but I'll be dosing my 20mg methadone dose here in a minute. This still doesn't seem like I'm abusing my medication. Seem likes when you run out early on the medication you are scripted that would be considered abuse but that is just me..

Abuse is such a subjective term, and imo, if abuse constitutes consuming a "recreational" doses of a drug (in the case of a scripted one) that I am prescribed, once or twice in a month, while still maintaining 30 days of 1mg pills (1mg below the scripted amount ), is abuse then yes. I am abusing my clonazepam. God damn me for taking my scripted dose and wanting to be a little more relaxed.

Anyway, I'm still working on a nice response, that will be in a nice tone for everyone (I thought my tone was just fine, though maybe being in a rush for both the posts made it come off as a little harsh, my bad.). I'll put up a long educational post, and if anyone would actually like to have a friendly intellecual conversation, I'd appreciate it. I do enjoy talking about drugs just on a level beyond just taking it to get faded.

I'm about to take a shit, get somethings done for class, and I'll write up a solid post. Just be prepared to read a good little bit of information. I'll make sure I source everything too, as I feel some people are having trouble trusting some of the information I'm presenting, so I'll try to fix that. Hope we can get this away from a tense conversation and into a fun intellectual discussion. I don't expect us to agree on everything, but It would be nice if we all can acknowledge each others opinions (that goes for me, you Mulovation, and everyone else who'd like to participate). None of my posts were actually gone through and discussed. Every response was a short blip with out going into anything I said, asking me anyone questions, etc. I hope that changes because it only show ignorance towards those responding to my posts. I wrote 15x as much information as every response towards my 3 large posts. Having a two paragraph post, not addressing anything I said, is rather frustrating because I want to have a real discussion.

 

[Brian242]

Ah hell, I don't feel like arguing with you dude, just take a Kpin and chill out..

 

[muvolution]

Like I said, I'm not here to argue whther or not rls is a real thing.

Simply saying that ALL pain patients should endeavor to lower their opiate doses as much as possible and to at least try out alternative treatments.