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Opioids Desperate about back pain issue

well 90mg of codeine is a tiny dose, i don't have a huge tolerance and i'd need at least 200mg to feel anything. I don't find it particular great for pain either. 70mg of Tramadol is also a tiny dose, i'd try 200mg and see how that works. He probably just has a natural tolerance or is in a great deal of pain. There should be a dose that gives him effective pain relief while still leaving his cognitive abilities in tact.
 
Some people do not respond well to opioid drugs - he's likely one of them.
Try all the alternate treatments you can get your hands on.
 
200mg of codeine will likely aggravate things. Work with the docs on this, if they want him on 200mg codeine then feel free to try it but if your father has enzyme problems and deficiencies then I wouldn't try to force analgesia out of codeine.
 
What is the cause of the pain? If it's chronic/neuropathic than for a lot of people, opioids alone are insufficient and many need adjuvants such as anticonvulsants, TCA's, muscle relaxants/benzos, etc. to get sufficient relief.

There are also a lot of other options such as steroid injections, nerve blocks, PT, Transcutaneous Electrical Nerve Stimulation (TENS), etc. that he could investigate. He should work with a pain management specialist so that the precise cause can be discovered (if it isn't already), the root cause of the pain can be addressed and the pain treated as effectively as possible in the meantime.
 
Do they know the cause of the pain? Depending on what it is, benzos could do miracles, as well as physiotherapy for instance.
(Also I agree that 90mg codeine is a tiny dose - not that I'm suggesting taking more would be the best way to deal with his pain)
 
Yeah, in addition to opioid therapy I use carisoprodol for effective muscle relaxation, tried elavil (TCA) with minimal improvement, and use high potency cannabis extracts, and also use TENS unit and hydrotherapy.
 
If he is CYP2D6 deficient, codeine and tramadol will be useless, as not enough morphine and O-desmethyltramadol are respectively converted by the liver, then regular opiates will be more effective, and and will last longer, with him than with others with normal enzyme levels. Hydrocodone, for instance, needs the CYP2D6 to be eliminated from the body, so the same deficiency that leads to insufficient conversion of codeine/tramadol will also lead to slow elimination of regular opiates.

Some say that CYP2D6 polymorphics (multiple copies of 2D6), such as myself, benefit more from hydrocodone than others since 10% of the dose needs proper CYP2D6 levels to be converted in to hydromorphone, but I believe that hydro/oxycodone are not prodrugs of their *-morphine counterparts, but simply are effective on their own. This is why some people benefit from taking cimetidine or GFJ with their regular opiates, inhibiting the CYP2D6 enzymes and slowing the rate of opiate elimination.

Codeine and tramadol are powerful prodrugs for me, but hydrocodone gives me less than 2.5 hours of lackluster analgesia, when it usually works for 3.5-4 hours or more for other people.
 
I am curious as to the source of your fathers pain? I have had 3 lumbar fusion surgeries and have gone through almost all the different opioids except oxymorphone and all the various muscle relaxers along with lyrica for my nerve damage. Feel free to PM me to discuss more specific treatment methods I've used (medical marijuana, injections, rhizotomy etc) in terms of giving you some suggestions for your fathers treatment.

Good luck OP
 
Your father might want to consider an ssri like cymbalta or a tympanic antidepressant for pain relief. He might be one of those fabled opiate resistant people that i've heard of and who I thank the god I dont believe in every day that I'm nt one of. 3 shots of dilaudid just to cop a feel. No me gusta the sound of that.
 
BiggDirty01 said:
I am curious as to the source of your fathers pain? I have had 3 lumbar fusion surgeries and have gone through almost all the different opioids except oxymorphone and all the various muscle relaxers along with lyrica for my nerve damage. Feel free to PM me to discuss more specific treatment methods I've used (medical marijuana, injections, rhizotomy etc) in terms of giving you some suggestions for your fathers treatment.

Good luck OP
Click to expand...

Right there with ya pimpin. I have 2 herniated discs pushing right up into my scyatica. Injections and epidurals, pt, medical ganja, opiate pain killers, muscle relaxers, chiropractors. Its been shitty.
 
What current medications is he taking, what other non-medication pain management is he doing? Get him set up with a pain management clinic ASAP, I suggest you call tomorrow... They often have long waiting lists, and sometimes need a referral from your GP, so he should see a GP at least to begin with so they can begin working on exploring treatment options.
 
^This. The ER should only be used for emergency pain relief as a very last resort, he shouldn't suffer 99% of the time and have to get IV Dilaudid at the ER 1% of it.

A carefully dosed opioid plan with adjuvants and NSAIDs can help keep his pain manageable. Having said that, if his sports injury was less than 6 weeks ago, he will get a bit better with time, but if it's been 6-9 months to a year, it's chronic, and probably here to stay. If the injury was recent, have him come off opioids once in a while to assess pain levels, after waiting out rebound pain from the opioid w/d's of course.
 
I would like to also add that Yoga helped me immensely after my first fusion surgery. Flexibility and functional muscle strength in the core can make serious back issues much more tolerable with the added-on medications. I recommend looking for a restoratives/beginners class for your father. The teachers are usually very sensitive to students with injuries and can give 1-on-1 assistance during the class if they know beforehand that your father is dealing with an injury.
 
I dont know much about his deficiencies and what medications he can't take, but....

-don't rely on opioid medication as the sole therapy

-make sure he gets any x-ray/CT/MRI imaging he needs

-hydrotherapy, diet and exercise, guided imagery and meditation, these are all things that have helped me soooo much, without these I would require 2-3x my current opioid intake

-physical therapy, TENS unit, biofeedback, group therapy (this reallllly helped me to learn that I wasn't alone, being able to be in a room with no judgement, surrounded by others who share your pain, some have it much worse than you do which makes you thankful for what you have, and also, the most important thing: Not having to explain to anyone how you feel! Because they are all chronic pain patients and it's not like talking to people who don't understand chronic pain, these people know just by looking in your eyes. Better than any psycho therapy I've ever had.
 
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