Harm Reduction The Pain Management Mega Thread Version 4

[Harrisment]

I'm curious why anyone would take synthetic testosterone instead of using something like Clomid to naturally raise your levels? I know that the synthetics shut down your sperm production, so I've never understood what the advantage to them was. I've gone on Clomid a few different times and it has always worked for me with no side effects.

 

[BigG]

Clomid (clomiphene) is a selective estrogen receptor modulator and not suitable for severely reduced testosterone levels or testosterone replacement therapy where sub physiological levels of testosterone are present. You might get a slight boost but not much to reverse severely depressed testosterone.

 

[bennyZA]

So maybe some of the regulars on this thread right remember my constant shoulder dislocations and the subsequent massive surgery I had. Afterwards I dropped off from this thread cause I found my perfect pain med, THC strain of weed mixed with a CBD strain... worked better than oxy, hydromorph, even fent.

Well, now there is a little hiccup in my problem. I wake up in so much pain cause I inevitably sleep in a position that is painful for my should despite all the pillow support I got. This happens every day, and I can't do the CBD/THC mix cause smoking that much CBD is a lot like a valium and you just want to sleep all day. So I now can't really smoke in the mornings. I really don't want to be opiated all day anymore like I used to be. What are people's experiences with severe morning pain. Also, in each of your opinions, which is the fastest acting but shortest lasting opiate with the least amount of sedation? I know that's asking a lot, but hopefully each one of you will have a unique opinion with unique facts that will help me form my own. Thanks.

 

[tricomb]

Fastest acting shortest lasting opiate: hydromorphone in my opinion.

 

[BigG]

Dextramoramide (although dont know if u can get it anymore)...old brand name was Palfium. Also dipipernone (diconal) which I used to get years ago. These two were both thought to be the fastest acting oral opioids. In terms of what is actually available nowerdays then probably hydromorphone. Most IR orals eng. oxynorm or oramorph are 4 hourly. You would find it difficult to find an ORAL med that is shorter acting than that. Most shorter ones are either extremely hard to locate or are for IV use.

I mix my morning 60mg methadone with 400mg caffine as I cant be dropping off to sleep at my desk.....at least not when the boss is watching. With my midday 60mg of methadone I add 200mg caffine and non with my final evening 60mg. I also add paracetamol to my methadone and caffine is suppose to speed up the action of paracetamol a bit...thats why its often included in paracetamol/codeine/ caffeine tabs which are OTC in the UK, Australia and a few other places but not in the USA I don't think. It helps me alot.
I have terrible shoulder pain at nite and wake up hurting every morning so I know it aint fun

Oh just thought remifentanyl is ULTRA short acting and quick when given IV but impossible to get hold off outside hospital setting.....Im not being much help here am I...lol!

 

[Morphling]

Hydromorphone, it's there and then...poof, it's gone! My doctor told me it's an enzyme inducer, but I've never heard that from anyone else...

Fent by any other ROA than dermal is worse....so, pretty much what Englandz said.

 

[Harrisment]

Clomid (clomiphene) is a selective estrogen receptor modulator and not suitable for severely reduced testosterone levels or testosterone replacement therapy where sub physiological levels of testosterone are present. You might get a slight boost but not much to reverse severely depressed testosterone.

I was at 269, and then after a month of Clomid was over 1,000. Don't know if that is considered severe though.

 

[bennyZA]

Hydromorph was my first thought, but that stuff just doesn't work on me for some strange reason. IV it barely worked in the hospital, and orally, it has never worked. Maybe I haven't given it enough of a chance.

 

[BigG]

I was at 269, and then after a month of Clomid was over 1,000. Don't know if that is considered severe though.

In healthy males it range from about 270 to 1070 nanograms per decilitre of blood so you sort of went from the lower to the upper end of the normal range. Often when people have severly depressed testosterone levels it is in the sub 50 range. In this case Clomid wouldnt be sufficient and synthetic testosterone wouls be needed.

Hydromorph was my first thought, but that stuff just doesn't work on me for some strange reason. IV it barely worked in the hospital, and orally, it has never worked. Maybe I haven't given it enough of a chance.

I have only been prescribed hydromorphone once and it was the hyrdomorph contin controlled release kind that we get over here and ithought it was utter shit (oral ROA). I never asked for it ever again and went immediately back to the oxy that i had been taking previously. Are fentanyl sublingual pills an option. I was speaking to Doomed2pain last night on the phone and she is currently receiving these along with her fent patches and says they are working well for her....... Maybe worth considering as your options are pretty limited

 

[bennyZA]

Yea, I was thinking about those sublingual pills from everything I've read, just the concept of going back on fent is a weird one. I really feel too young to be on the last line of defense pain treatment.

 

[BigG]

Yea, I was thinking about those sublingual pills from everything I've read, just the concept of going back on fent is a weird one. I really feel too young to be on the last line of defense pain treatment.

Don't necessarily think of fent as "the last line of defence" lots of people (including me) go on it then move to a different opiate e.g. Morphine, oxy, methadone etc. It doesn't have to be the end of the road. Just think of it as.another opiate to try to get your pain under control.. I must admit I used to think of fentanyl in this way too as sort of a last option where everything.else had failed but my pain doc emphatically disagreed. He said if anything methadone is considered the opiate of last resort. Some people have amazing success with fentanyl yet for some it is a disma lfailure. Personally may pain levels were the highest they have been in over 10 years during the period I was on fentanyl paches despite being on 300mcg/hour (it was meant to only be 150mcg/hour but ldue to a cock up by my gp he was presscribing me double the amount). I put this down to the fact that some people just cannot get away with transdermal patches rather than the ineffectiveness of the actual drug though. I wqs in so much pain that I ended up using 3 x 50mcg patches bucally per day and consuming god only knows how much fentanyl but going by the amount in the patches and the buccal BA, around12.6mg per day which is the equivalent on 1260mg of morphine. All this did for me was raise my allready sky high tollerance even further so than when I moved back to methadone pills I was taking anywhere from 500-600mg per day and have only now (10 months later) brought my consumption back under control and down to my prescribed amount of 180mg a day. Don't let my failure with fentanyl dissuade you though as if you can get the transdermal delivery system to work for you and get decent BT pain releif (my doc wouldn't provide breakthrough pain meds) the fentanyl could be a life saver....especially if you can get sublingual fentanyl for breakthrough or maybe even as your sole med if you plan to only use opioids for part of the day I.e. in the morning. I dont know how easy it would be to obtain the sublingual pills though either as part of a legitimate script or off the street but either those or the actiq fentalal lollipops would work. As I mentioned in a previous post, my freind is using the sublinguals and she finds then effeftive (she has the worst chronic pain situation I've ever come across too). Good luck Benny and if I can be of any assistance at all please pm me.

 

[benzoman12345]

There is an incredible amount of.disinformation around testosterone replacement. Firstly you would never use a shot of a short acting ester like propionate or even worse aqueous testosterone suspension every two weeks for testosterone replacement. The goal is to achieve STEADY testosterone levels and using a form of the hormone that lasts a day or two in the blood every 14 days would have ones test levels up and down like a rolercoster. This is why enanthate, cypionate or sustanon (testosterone blend) are.used. Also anabolic agents like deca or anavar (as oppose to pure testosterone) arnt used either. Also its prostate cancer than needs to be checked (due to high DHT conversion via 5 alph reductase enzyme NOT testicular cancer

The idea is to stimulate natural test with a little artificial boost, it works , I've done it plenty of times, just an idea, if the OP does not want to be on full time if would stop him from shutting his body down completely, instead just a little boost here and there.

 

[BigG]

But taking a shot of artificial test wont boost your own production...no matter how small or infrequent....it may not necessarily shut it down but it certainly wont make your body produce more.Drugs that stimulate (or mimic) LH or FSH production from the pituitary gland might....such as HCG or drugs that modulate or block estrogen (and estrogen receptors) or inhibit aromitase such as Clomid, tamoxifen or Arimidex may help also.

I studied endocrinology at medical school and have personally used androgens for over 20 years so I do have some background knowledge....we may however have to agree to disagree on this one though as its starting to drag the thread off topic

 

[Morphling]

Is there a patient advocacy lobby? We need to get all political and shit and fight these mofukkas keep fucking us over. F'real, yo.

Seriously tho, we spend enough money as it is, why not? Anyone have any experience with this sort of shit?

 

[tricomb]

Dextramoramide (although dont know if u can get it anymore)...old brand name was Palfium. Also dipipernone (diconal) which I used to get years ago. These two were both thought to be the fastest acting oral opioids. In terms of what is actually available nowerdays then probably hydromorphone. Most IR orals eng. oxynorm or oramorph are 4 hourly. You would find it difficult to find an ORAL med that is shorter acting than that. Most shorter ones are either extremely hard to locate or are for IV use.

I mix my morning 60mg methadone with 400mg caffine as I cant be dropping off to sleep at my desk.....at least not when the boss is watching. With my midday 60mg of methadone I add 200mg caffine and non with my final evening 60mg. I also add paracetamol to my methadone and caffine is suppose to speed up the action of paracetamol a bit...thats why its often included in paracetamol/codeine/ caffeine tabs which are OTC in the UK, Australia and a few other places but not in the USA I don't think. It helps me alot.
I have terrible shoulder pain at nite and wake up hurting every morning so I know it aint fun

Oh just thought remifentanyl is ULTRA short acting and quick when given IV but impossible to get hold off outside hospital setting.....Im not being much help here am I...lol!

dude like everything you mentioned is virtually impossible unless you live in one of the few remaining and unlisted countries that produce them in a clandestine form and sell them for a bunch of money or something, you can't get most of the meds you mentioned, except the morphine, oxycodone, and methadone options you mentioned, but i mean remifentanyl, you're not likely to have connections for that let alone legitimate ones and this threads not for discussing illegal sourcing of narcotics.

 

[ishmael]

Yea, I was thinking about those sublingual pills from everything I've read, just the concept of going back on fent is a weird one. I really feel too young to be on the last line of defense pain treatment.

i do not know of your background with previous treatment, but have you tried buprenorphine?

 

[BigG]

dude like everything you mentioned is virtually impossible unless you live in one of the few remaining and unlisted countries that produce them in a clandestine form and sell them for a bunch of money or something, you can't get most of the meds you mentioned, except the morphine, oxycodone, and methadone options you mentioned, but i mean remifentanyl, you're not likely to have connections for that let alone legitimate ones and this threads not for discussing illegal sourcing of narcotics.

Yes im aware that they are virtually imposible to get which is why is why I said that its virtually impossible to get!!!. I was speaking of short acting opiates in General for the purpose of discussion. I also didnt mention anything about helping anyone source illegal narcotics. Im simply saying which are the shortest opiates ive ever been prescrihed (dipipernone and dextramoramide) and the shortest of all (remifentanyl) which as I clearly state is impossible to get outside of a hospital setting....... Nowhere am i suggesting he actually try to source the stuff.
Since I took the care to include the proviso that I doubt whether either Palfium or Diconal or produced anymore and include Remifentanyl as a purely theoretical afterthought and also mention the things that ARE actually available to him (IR morphine, oxy and hydromorphone) along with my own method of using caffine to prevent drowsiness........I dont get your actual point. The point you appear to be making (that it would be virtually impossible to get some of the meds but that I used to get them scripted years ago) ive already clearly acknowledged in the original post.

 

[bennyZA]

i do not know of your background with previous treatment, but have you tried buprenorphine?

Yes I have. Great for like 3 weeks, then literally nothing. I tried taking as massive amounts after the first 3 weeks and nothing happened, at all.

Is there a patient advocacy lobby? We need to get all political and shit and fight these mofukkas keep fucking us over. F'real, yo.

Yes, and it's huge, and it's very, very corrupt. They agree with pretty much everything the pharmaceutical companies want, so they are in bed with each other financially.

 

[gerry978]

Here's my story. Hope someone out there can give me some direction. Live in the US. Went to rehab nearly two years ago for benzos and alcohol. Got out and a few months later was diagnosed with arthritis, spinal stenosis (lumbar) and small nerve fiber neuropathy (both legs and feet). When I got out of rehab, I had to find a new PCP, as mine of 20+ years retired. Saw the new guy (before any of the diagnoses) and was upfront about out of rehab and the reasons. Anyway, MANY doctors (rheumatologists, neurologists, rehab doc, podiatrist, pain management MDs), 2 MRI and EMG and multiple xrays later...........I continue to feel like shit, minimal if any relief. Tried on numerous NSAIDS, Lyrica, Tramadol and a narcotic topical. Currently maxed out on Gabapentin and Diclufenac. Also on Effexor and Nortriptyline. I do not expect to be cured or to have the pain gone. However, I would like to be able to walk more than 1/2 block or stand longer than 5-10 minutes (on a good day) and sleep more than 90 min. at a time. In folks' experience is 18 months an expectable amount of time with the trial and error method? Am I being unrealistic? I sort of regret being upfront with the doctors about the addiction.....what do you all think?..........I feel like I have a big "A" tattooed on my forehead. Thanks

 

[Morphling]

Yeah, that's a while. I mean, it took me much longer to get properly treated(in the meantime, I was drinking myself to death due to pain), so I've been there. It sounds to me like although you're an addict(many of us are, ok?), you could benefit from other pharmacotherapies. If you're in that much pain suffer that much debilitation it sounds like you need more options and medication than what you're being provided.

You can always have a consult with another pain specialist. Bring the films from your x-rays, the cd's from your MRI's, etc, and start with a fresh evaluation.