Opiate/Opioid with reduced histamine release?

[Jager336]

As stated in another thread I am almost done with this script of hydromorphone, but these itches are starting to cause some skin damage, they're getting awful. Diphenhydramine and Hydroxyzine have not been very helpful for me. I would like to talk to my doctor about it and try another analgesic that hopefully would cause less itchiness. Opiate therapy is the only kind that helps with my pain so taking something else isn't really an option for me.

Hydrocodone causes bad nose itch but is dealable and localized, though it doesn't offer adequate pain relief.
Hydromorphone causes some severe itching but offers excellent pain relief at higher doses.
Oxycodone offers minimal pain relief and itch as well as makes me incredibly nauseous.
Fentanyl makes me develop flu-like symptoms and [Duragesic] bad itching under the patch though not anywhere else.
Methadone is not effective for my type of pain (migrainous headaches often, as a result of degenerative disc disease in my neck, also painful)

I'm considering morphine sulfate as an alternative to Hydromorphone, but I really don't know what direction I should go with this. The skin damage (I misuse stimulants as well so I have 'sores' in various areas, itching and scratching, thus, are not desirable) is beginning to get significant and I'm strongly desiring an alternative with even slightly reduced histamine effect, though it must also be effective for treating my pain.

Any insight/advice/information is far beyond appreciated. I am in no way a vain person and can pretty easily let my looks go (not really a good thing mind you) but the sores are bad enough and making them worse from the constant scratching is really fucking my self-esteem...

 

[amapola]

Hey Jager336,

Unfortunately the only way to figure out which opioid may work for you is by trying them as they are all histamine releasers, and the fact that you react poorly to so many means that most others will likely result in the same. I would usually recommend trying fentanyl but as you already have with negative results I'm really not sure.

I think you have a better chance speaking to your doctor about treatment for the histamine release. An opioid with a slightly different mechanism of action that you haven't mentioned is buprenorphine which might be worth a shot as well.

Finally you can try a mix of other pain relief medication with a reduced narcotic content which could perhaps have a more tolerable side effects profile. For example mix in some NSAIDs, muscle relaxants, Gabapentin, etc.

 

[Jager336]

Thank you. I will definitely speak to him. Unfortunately he's out of town so next week I am supposed to just go pick up a new hydromorphone prescription, I don't have an appointment until the 13th. This sucks.

I for sure am going to mention this to him, we were planning steroid injections but there was concern about the sores, injections aren't ususally a good idea when something like that is happening because of infection, and scratching so badly is keeping me from healing (thankfully though they're not getting any worse as I've been much better about poking and prodding).

 

[NeighborhoodThreat]

I'd say you'd have to find the opiate that works better for you, I'm going to second with amapola on this one, I'm certainly not you, but of all the opiates I've used, buprenorphine is the one with the least amount of histamine activity.

 

[Jager336]

Got it today, no doctor around, since the opioitch is still fresh in my mind I don't think I'll be taking as much as I was. :D