I just wanted to register here to help mediate or rectify any harmful information about pain medications, specifically opioids, that are frequently passed back and forth here. I promote a state of wellness and understanding and welcome all questions and criticisms with open arms. I look forward to getting to know you all.
I'm a pharmtech with a bs in business admin marketing comp sci. Was going to go into pharmaceutical sales but they were sleazy (and frankly the majority of doctors I saw took the reps word for word about the drug and it's efficacy and side effects and costs (gabapentin was a great example of that wasn't it?), what's you're DEA number and NPI #? Feel free to PM it to me, I'll check it and the mods can confirm you as an anesthesiologist (which is exactly what am working towards right now). And if you are who you say you are then you may as well give me your first and last initial's as well since... well for obvious reasons. But then once the mods confirm you're status as an anesthesiologist I think you'd be an invaluable asset to this forum. One thing to remember though. In medical school you play by the therapeutic windows and ED 50's. Here most of the people far exceed such doses... but tolerance is a wonderful thing until you have to pay the piper.
Either way shoot me a PM with your DEA and NPI #. If you'd feel more comfortable emailing me instead of private messaging me shoot me an email at
[email protected]
Regards, J
(Oh and feel free to look through my post history so you know I'm intelligible if you want.)
Oh and before we bring you on board officially as the anesthesiologist of BL I just have to ask.... are you a true anesthesiologist who works in the OR and prescribes medication... or are you an anesthesiologist who is doing nerve blocks/ablations, cortisone treatments and other steroid injections? That's something I would personally like to know as a good majority of doctors involved in steroid injections who used to be anesthesiologists (forgive me you never stop being one but afaik an anesthesiologist spends his days in surgery not doing injections... which I've noticed to be an increasing trend.. and they rarely seem to know anything about opiates/pain management/etc because they didn't study pain management they studied anesthesiology.
either way if you're a genuine anesthesiologist who works in the OR still, or even if you used to do that and transitioned to the office injections there's no doubt some people will have a plethora of questions for you. Also do keep in mind exceeding recommended doses doesn't always result in harm (drug depending of course) but rather a high... which is what most people here pursue.
Anyways welcome on board!
Though there is some misinformation that gets passed back and forth, this is generally by people with much less experience. It is always great as a harm reduction tool to be able to correct that information and save someone some pain and heartache. But again, I think you will be surprised at how very much very technical information many of the members here have.
Besides wanting to help mediate info, do you also have any personal experience as a drug user/abuser?
Again, welcome.
No kidding there's misinformation spread by the reps to the doctors and finally through to the patients.. Remember when doctors denied the existence of SS/SN/SNDRI withdrawal? Or are they calling it 'non-addictive dependence' now-a-days?
If he has any knowledge as a drug abuser then I would imagine he's in the suboxone business.
Thanks for joining.
I have a question, you being an expert hopefully you can help. Is opiate induced hyperalgesia a real phenomenon, i.e. do patients on long term pain meds develop a lower pain threshold and reduced ability to cope with pain?
I can answer that for you and the answer is yes. Patients often escalate dosages in order to try to overcome the hyperalgesia but it makes the pain worse. Though (as far as I can remember) it's not so much the opiates that are causing excess pain, but what's called "windup" which comes from the NMDA/glutamatergic receptors. I've heard wind up can be blocked by nmda antagonists such as Neurontin and lyrica though the best course of action would be to reduce the opiate dosage until your pain is no longer worse than it was before the hyperalgesia set in. You can almost imagine it in the same way that panic attacks work. If someone has had enough exposure to stimuli that causes a panic attack, the knowledge that they are going to have a panic attack (even if they aren't having one at all) is enough to scare them into a panic attack. ie. panicking about having a panic attack and being uncomfortable and all the other crap that comes with it.
