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Misc non-opiate pain medication

thelung

thelung

Bluelighter
Joined
Mar 24, 2004
Messages
2,254
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West Coast
I was wondering if there is anybody out there that has experience with non-opiate pain medications. Is there any non-opiate pain medication available out there thats pretty strong, and that a doctor would be able to Rx to a former heroin addict who is on methadone? And, more importantly, do these medications actually work? Please post if you have experience with these kinds of meds - thanks in advance - thelung - :):D:)%):D:)
 
thelung said:
I was wondering if there is anybody out there that has experience with non-opiate pain medications. Is there any non-opiate pain medication available out there thats pretty strong, and that a doctor would be able to Rx to a former heroin addict who is on methadone? And, more importantly, do these medications actually work? Please post if you have experience with these kinds of meds - thanks in advance - thelung - :):D:)%):D:)
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try out torodol (sp?) (NOT TRAMADOL)its a NSAID but it helped my aches and pains during w/ds a couple times.. but it was an IM shot in my ass lol. but i believe its available as a pill.
 
I used 220mg of naproxen last night (and I'm on 150mg of daily MMT) for a pounding headache probably from stress + inflammed sinuses. It helped get rid of the headache and surprisingly gave me a nice 'buzz' from the relief of the headache. It was good.
 
Gabapentin works well for nerve pain.

For general pain, Tramadol is a good non-narcotic pain med from what I've heard.
 
tom80 said:
Gabapentin works well for nerve pain.

For general pain, Tramadol is a good non-narcotic pain med from what I've heard.
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Tramadol + methadone = contraindicated.

Gabapentin and other medications that work on GABA or norepinephrine work well as neuropathic pain analgesics. For non-neuropathic pain, over the counter NSAIDs such as naproxen work pretty well. I'd avoid tylenol like the plague because it simply is way too toxic to the liver and the NSAIDs work better for analgesia anyway.
 
I have a lot of experience with all different forms of opiate and non-opiate pain medication so I'd be happy to help however I can.

If the pain is neuropathic, tricyclic antidepressants are very commonly used because of how they work on serotonin and norepinephrine (these will also mildly potentiate your methadone because they are anticholinergics like diphenhydramine, hydroxyzine, doxylamine, etc.).

Next, also used primarily for neuropathic pain, are the anticonvulsants. Many different anticonvulsants are used however the most common are neurontin (gabapentin) and lyrica (pregabalin). In my experience of 4 years with chronic pain from nerve damage, lyrica was the difference between going to the ER once a week and resuming relatively normal functioning.

Other options include muscle relaxers which there are a diversity of. None of the typical MR's are scheduled but carisoprodol and mebrobamate (soma and miltown) both have abuse liability. Others include flexiril (cyclobenzaprine), zanaflex (tizanidine), skelaxin (metaxalone), robaxin (methocarbamol) and none of these carry any substantial abuse potential but they may potentiate opioids (especially flexiril, another anticholinergic that is very similar to the tricyclics).

If the pain is inflammatory there are many different NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) like aleve (naproxen) and motrin (ibuprofen) that are OTC and stronger versions like toradol (ketoralac) and celebrex (celecoxib) that re Rx only. Also if the pain is inflammatory steroids may be necessary or beneficial.

Lidocaine patches are another novel approach that I found very useful. They are 3'' x 5'' adhesive patches with lidocaine that thoroughly numb the area where it is applied. These have varying degrees of usefulness depending on the etiology of the pain.

Lastly, benzodiazepines are very helpful as muscle relaxers (I tried all the common MR's and then found ativan and used that for a long time) however its unlikely a doc will Rx those for you and it could be dangerous.

If you are more specific about the type of pain and what you are looking for, I can expand on the relevant topics.

Take care
 
^TECHNICALLY its just considered a centrally-acting analgesic (opposed to narcotic-analgesic). It DOES have properties the affect the mu receptor but many medical professionals still differentiate it from other opioids. Around here its generally considered an opioid still.
 
HdoubleODeezy said:
but its also an snri.. and methadone is a NMDA antagonist? or agonist? i forget..
but either way.. they cant be taken together.
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Methadone is an NMDA antagonist (with a low affinity, not as much as ketamine/DXM/etc.) while tramadol is a minor weird opioid receptor agonist with SNRI effects.

Avoid tramadol if you're taking methadone.

From wikipedia:

Tramadol acts as a μ-opioid receptor agonist,[43][44] serotonin releasing agent,[45][46][47][48] norepinephrine reuptake inhibitor,[44] NMDA receptor antagonist,[49] 5-HT2C receptor antagonist,[50] (α7)5 nicotinic acetylcholine receptor antagonist,[51] and M1 and M3 muscarinic acetylcholine receptor antagonist.[52][53]
 
HdoubleODeezy said:
but they can't be mixed right?
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Potentially may cause withdrawal in persons already
taking opioids (Ultram PI 1998); anecdotal cases have
been reported..

Tramadol may cause withdrawal in person's taking opioids including methadone.
 
splenda said:
Potentially may cause withdrawal in persons already
taking opioids (Ultram PI 1998); anecdotal cases have
been reported..

Tramadol may cause withdrawal in person's taking opioids including methadone.
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oh.. i had it confused i thought it had to do with the NMDA and SNRI effects interfering with eachother.
 
HdoubleODeezy said:
oh.. i had it confused i thought it had to do with the NMDA and SNRI effects interfering with eachother.
Click to expand...

I don't think the NMDA/SNRI effects of tramadol interfere with methadone.. I think that tramadol just has a weird binding affinity to opioid receptors which displaces other opioids (methadone) and can cause withdrawal. Not 100% sure about this though, but it's not the SNRI/NMDA effect of tramadol causing it.
 
^Concomitant use of tramadol increases the seizure risk in patients taking other opioids. These agents are often individually epileptogenic and may have additive effects on seizure threshold during coadministration. CNS- and respiratory-depressant effects may also be additive. In patients who have been previously dependent on or chronically using opioids, tramadol can also reinitiate physical dependence or precipitate withdrawal symptoms. ~ drugs.com

i think your right.



Edit: Anywayz... yeah cane2theleft has the best answer in this thread so far.
 
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stay away from tramadol....i am prescribed on it right now, and yes it will knock your socks off, it has absolutely horrible withdraw symptoms. cold sweats with heat flashes, runny nose, cough, respiratory issues, pain all over the body, and you WILL NOT find a comfortable position for 3 days, it doesnt matter sleeping or awake (not to mention you wont sleep). oh i was taking 20 50mg tabs a day tooo.
 
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