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Harm Reduction The Pain Management Mega Thread Version 4

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Although not 100% most opiates have cross tollerance so switching wont really prevent tollerance from raising. Im from the UK where healthcare is different and cost isnt such an issue. I really feel for you though in having to buy from the street just tp keep your pain at bay. Obviously thats not sustainable long term because of cost and getting cut of etc. Another doc elsewhere may be your only option. Can you not get referred to a specific pain management clinic? Although things like NDAIDs. May not help on their own, ive had the best success with mixing everything together...i.e. Methadone, ibuprofen, naproxen, Feldene gel, paracetamol, lyrica to get s kind of synergistic approach.
 
I was under the impression methadone wasn't an opiate and that it triggers receptors in the brain in a similar way as opiates kinda like suboxone or subutex which I thought was why they are used in rehabs n whatnot but I could be wrong but that's what comes to my mind ill look into it, and honestly idk how to go about the whole doctor or insurance thing ive never had to deal with anything like that I need to figure it out for sure, I didn't know about a pain management clinic sounds like what I need though thanks for the info
 
^Opiates are natural alkaloids from the opium poppy such as morphine and codeine, drugs that are derived from those opiates (semi-synthetics) or simply created in labs (full synthetics) that work on the same receptors as opiates are called opioids.

Examples of opioids include hydrocodone (vicodin), oxycodone (percocet, OxyContin), oxymorphone (opana) and yes, methadone. A lot of people use the terms opiate and opioid interchangeably and so while you're correct in that's it's not an opiate by definition, it certainly works on the exact same receptors (but also produces NMDA antagonism).

Buprenorphine is a little bit different. In low doses, it functions identically to full agonist opioids but there is a ceiling on it's effects due to it's strong affinity for the receptors but very low activity so it's termed a partial agonist or mixed agonist-antagonist rather than a full agonist such as all of the opioids and opiates listed above. In larger doses, buprenorphine blocks other opioids from having an effect unlike full agonists whose effects increase linearly taken alone or when combined with other full agonists.
 
Cane2theLeft said:
^Opiates are natural alkaloids from the opium poppy such as morphine and codeine, drugs that are derived from those opiates (semi-synthetics) or simply created in labs (full synthetics) that work on the same receptors as opiates are called opioids.

Examples of opioids include hydrocodone (vicodin), oxycodone (percocet, OxyContin), oxymorphone (opana) and yes, methadone. A lot of people use the terms opiate and opioid interchangeably and so while you're correct in that's it's not an opiate by definition, it certainly works on the exact same receptors (but also produces NMDA antagonism).

Buprenorphine is a little bit different. In low doses, it functions identically to full agonist opioids but there is a ceiling on it's effects due to it's strong affinity for the receptors but very low activity so it's termed a partial agonist or mixed agonist-antagonist rather than a full agonist such as all of the opioids and opiates listed above. In larger doses, buprenorphine blocks other opioids from having an effect unlike full agonists whose effects increase linearly taken alone or when combined with other full agonists.
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The above is completely right and just to complicate things further when one is taking methadone above a certain dose (thought to be around 80mg) it has a blockade effect which prevents a narcotic high from being obtained if thebperson tskes another full mu receptor agonist such as morphine or heroin. It is worth doing some backg round reading into opiates/opioids, opiate receptors and mechanisms of action as a full understanding of these can help hetter manage your pain.
 
^ there is a lot of debate/discussion over methadone having a blockade effect (especially around here). Methadone being a full agonist, it doesn't have a complete blockade effect like buprenorphine does. The prevailing thought on the subject is that high-dose methadone simply raises the tolerance thus reducing the efficacy of other opioids. Another aspect of this is that so much of the pleasure and rush from opioid use (especially intravenously) is derived from going from baseline (or below in withdrawals) to the full effects. If methadone keeps you elevated well-above the baseline, if you do add other opioids on top of it, they won't be nearly as pleasurable.

There is substantial documentation of people on large doses of methadone overdosing by using opioids on top of this (especially heroin) so it's clear that it is not a complete blockade like buprenorphine but there is evidence that demonstrates at minimum it does greatly reduce the ability for people to derive the desired effects from other opioids. The main issue - and why I wanted to comment - is that there is contention whether this phenomenon should be referred to as a 'blockade' effect. Because buprenorphine's blockade is more widely discussed contemporarily, when people hear that methadone has a blockade effect they tend to incorrectly think it functions like buprenorphine's.
 
thanks for the info I was prescribed 1 methadone 4 times a day as needed for severe pain and for whatever the reason I would always have meds of both leftover every month but when the dones were dropped I started running out of my oxycodones half the month through in my opinion the methadone were a better pain med and seemed to last longer, I wish my doctor would just trust me ive never given a reason not too although I understand that he may be in the hot seat if I would abuse mistreat my meds im sure other patients have lied in the past but why couldn't he give it a go and do a med count or something after all my first doc presibed the combo and I know what works for me
 
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Some doctors are very stubborn about what they will prescribe and who they will prescribe it to and patients suffer. Also, as you alluded to, there is pressure from regulatory agencies and law enforcement that can affect prescribing decisions. This of course shouldn't be the case and the government and police should really not interfere with a physician treating a patient.

Trends and media hype can influence prescription practices as well. When the media (in the US) started extensively reporting on OxyContin abuse in the early 2000's, a substantial amount of doctors switched their patients to other drugs, most commonly methadone. Many doctors were ill-informed however about how long methadone lasts and how it accumulates and as a result, there were notable cases reported on of people dying from doses of methadone they were prescribed.

Methadone is seen by a lot of doctors as carrying a disproportionate amount of risk relative to other opioids and some won't prescribe it. It can be very useful in treating chronic pain because of it's duration and NMDA antagonism, but there is a somewhat elevated risk (mostly when it comes to other sedating medication a patients may use, fearing the patient will drink while on it, etc.)
 
I can tell he's testing me attempting to play mind games which I find somewhat offensive, my last visit he tried to say that narcotic pain meds only work for a few minutes ...which I feel he was referring to getting high testing whether I was using for pain or for pleasure n he's had several lil addict traps like that im not sure if ifs normal for a doctor to feel a patient out in such a way, anyway im going in for a catscan then in for surgery redoing the bolts plates and rod in my leg prolly a bone graphed on the femur since they put too large of which in the first time any ideas on on what to say or how to get more trust from this guy cuz im not doing well hurting all the time missing sleep taking its tol all the way around or do you think its a waste of my time and should seek other doctor I greatly appreciate the help I just wanted another opinion the last thing I want is to be cut off all together cuz I took my meds to quick but I feel im not doing wrong its not like im drooling out the mouth nodding simply just trying to not be so damn miserable hurting all the time extended release meds I feel would be more appropriate for my condition
 
I don't deny that I like the feel of opiates (who doesn't?) and I HAVE chewed or insufflated my meds before. But I was being honest when I said I never took them unless I really needed them for pain.
I do have an addictive nature (I was an alcoholic for several years and have been bulimic for 12) but I make sure I don't end up that way with my pain pills as they are something I NEED. Without them I'm on my back in bed in agony.
I have taken all my meds exactly as directed for several weeks now and promised myself to do so in future. It isn't worth it. I just don't want to be in pain any more.
I still abuse benzos sometimes, but nothing else and that's only because I suffer acute anxiety and panic attacks and doctors never prescribe benzos long-term in the UK so I buy my own.
An increase in methadone and a script for pregablin is fine by me. ANYTHING to stop hurting.
 
Cane2theLeft - You make some very interesting points about methadone and its so called "blockade" effeft. As you say this is a different phenomena to the blocking effect exhibited by partial agonist/antagonists like buprenorphine and nalbuphine. It is thought that above certain doses mathadone simply blocks the narcotic high but not the respiratory depression or alalgesic effects. Whether this is simply due to high dose methadone raising tloerance to the point that the high from other opiates is no longer felt. Having been on high dose methadone for 10 years then changing to fentanyl I found that as soon as the methadone gad left my system I could then feel the effects of the fentanyl. Your point that the high may just be felt when a person initiates their dose from at or below baseline is interesting as I know when ive been without my methadone for a couple of days and then take a dose I get a strong narcotic effect from it whereas if I dose steadily I dont feel it at all (all oral use btw). It may well be then that the reason methadone blocks the high from other opiates (again im not talking about an antagonist blocking effect) is the state of relative opioid "intoxication" a person is at when they take a dose. Although from my years at medical school the consensus was that methadone does cause some blocking of the euphoric efdects of other opiates by other means......a very interesting debate nonetheless.
Oxy8_8 said:
Hi. I'm a long-time opiate user/abuser (I have legitimate severe chronic pain but use opiate recreationally, too).

Im sorry mate but your story changes every 5 minutes. To say you have only ever used for pain when you have literally hundreds of past posts detailing what can only be described as pure recreational use is rediculous. In one post you even say your pain is now virtually gone and you were only using to stave of wds. I spent about an hour reading a load of your old posts.and for you to say this is crazy. BTW doctors do prescribe benzos long term in the uk as ive been prescribed the for 17 years. The reason for them not prescribing to you is probably your admission of alcoholism.
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Oxy mate, the thing that kills me is I warned you that your doctor thought you were abusing... never got a reply on that one >.<

Luckily methadone is great for pain, and hopefully it can be increased to a point where it works for you.
 
Exactly...and you cant write 480+ posts 95% of which are about abusing and getting high (and admitting it) then say you have only ever used for pain and expect to be taken seriously.
And in one post you say the minute you started using more for your pain you went straight to your doc and told him and in another you say he found you out by phoning your home and speaking to your mam and demanded a meeting with you and your parents and you were terrified at being found out??? You seem a nice bloke and im not trying to be nasty but you can't post two diametrically different things all the time. I was your age when I started using opiates ostensibly for pain but soon became addicted because i couldnt admit i had a problem and my pain justified my overuse..... Dont make the same mistakes. Read your old posts first and try to remember what youve previously said so you dont constantly contradict yourself....... And good luck. I genuinely hope things improve for you. You have the benefit of a loving caring family to support you a luxury some would give anything to have.
Anyway back to the main subject in hand. Has anyone had much success with topical gels lile voltarol, Feldene or ibuleve? Just got some Feldene and when i wake up at night with my shoulder in a agony.I. Rub some on and it seems to help. My big problem is that no matter how much methadone I was taking ( up to 500+ mg.. My pain was still of the charts. My solution tp this was to al tp pick up my physeptone ( methadone) tabs and temazepam daily to limit my use and attempt a slow taper while exploring other options for pain relief. I came to the conclusion that it is almost impossible for an addict to pick up monthly or even early and successfully ration my use. Every script I have the best intentions but run out early every time and go through wds. After 27 years of this I realised enough was enough.Einstein said the definition of insanity is doing y the same thing over and over and expecting different results. Tapering from 180 will be tough but I've very everything in place to make this work pick up 7 days a week and no access to buy anything from the street. During my bodybuilding carrear I prided my self in being more disciplined than the other guys and hopefully this will give me the mental strength to succeed and deal with my pain in other ways.
 
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As you taper down from any dose its helpful to change up your routine. Anything to take your mind away from the cravings whether its job changes or moving somewhere new. It all helps to increase your natural chemical balance while lowering the tolerance. Your brain has to heal and taking away the chemical you depended on for soo long is a mental and physical battle.
 
Your telling me its a battle rod!!! But its one im determined to win.

How are things with you Rod? How are you managing your pain opiate free? I know things were very tough for you a while back.
 
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I am now up to 70mg of Nortryptyline taken at night and pain levels are continuing to diminish, with about a 3-4 week lag time between the time I started the meds and when I perceive pain reduction changes from the adjusted dose. The 10mg capsules seem to cause less somnolence than the 50mg capsules. There is a significant difference between 7x10mg capsules and one 50mg capsule with two 10mg ones. The 10mg ones are easier for me. The manufacturer is the same for both. It is very odd but consistent.

The side effects tend to abate after about three days as I adjust to a new dose. It doesn't seem to do much for anxiety though -- had some family drama recently and was super down about it for days.

A reality that took me awhile to realize: narcotic opioids are nearly useless for nerve pain with me. I was up to 4x7.5/325mg vicodin tablets a day which did almost nothing for the pain. They work fine for muscle soreness and for teeth pain, but just don't work for back nerve related pain. I have backed down to two tablets a day as needed. I have to say most of the people I know with chronic pain issues don't seem to abuse the meds or use them recreationally. They are tools and little else, and I am prepared to toss out the ones that don't work (tramadol, oxy, vicodin).

I am pretty relieved that nortryptyline is working, but you have to take it at least three weeks for significant benefits, which arrive subtly.
 
Are perhaps the 50mg ones controlled release and the 10mg ones immediate? If thery are the same manufacturer and the same tablet release mechanism then they will be identcal. I worked in the pharmaceutical industry for several years and the quality control standards are incredibly tight so if there is no difference other than the strength then any perceived differences between 7x10mg caps and 1x50mg + 2x10mg must be psychosomatic. T this effect can be incredibly powerful so please dont think i sm being dismissive.
 
Professer said:
I got a question about meds to treat my really bad muscular pains. All the muscle relaxants I have tried make my RLS 100 times worse. I was thinking maybe lyrica. What do you guys think?
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No responses yet. I went back to a new pain management doc to switch from my tramadol to a different med. She was nice and seemed to want to help, thank God. Last guy treated me like complete shit, kept repeating he cant legally rx me opiates with a harsh tone, told me there's nothing he can do for me in different ways in a rude manner, and literally walked out on me, loudly talking over me repeating the same shit while I was trying to say I don't even want opiates/opioids as they do nothing for my pain and am trying to explore other options. Followed by a nurse coming back with a refill for the 100mg ER Tramadol script that was doing nothing for me before... even when I'd take 400mg out of desperation.

Anyways, this better new doc didn't understand how much pain im in. She is trying to help, but she sent me home with a rx for 5mg baclofen twice a day. This obviously wont do crap. I didn't communicate too well with her for that visit as my social anxiety was bothering me and I didn't express everything I needed to. I took 40mg of baclofen at first try out of desperation. Didn't help really. I don't know what to say or do when I go back to her.

I'm really at the end of my line here. I'm sitting here on 60mg baclofen, a Xanax bar (no tolerance), my maintenance opioid dose, a bit of vodka. Still in my normal spine pain with my back muscles still hurting with regular spasms/contractions. I've been in pain for two years now. Its just getting worse and worse. All I can do is lie in bed in pain and do anything to try and cope with it every day. I'm desperate for treatment and relief. Not sure what to tell y doctor. I don't want to resort to other things. They're
 
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Ive had my share of muscular and joint pain and I've found naproxen and Feldenegel to be helpfully or voltarol gel. I also found baclafen useless. Be careful with the dose mate as you can od on it if I remember correctly. Alao acupuncture, deep tissue massage....all things to look into. Hope you get some releif soo
 
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