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Harm Reduction The Pain Management Mega Thread - for all your questions on dealing with chronic pain

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Why do pain management specialists aim to reduce pain from 8 or 9 out of 10 to about 4 out of ten when they can successfully reduce the pain even further with a higher dose?

In general how many times higher is a recreational dose of an opioid than a therapeutic one in most individuals?
 
ATF said:
Im not experienced with fentanyl, or a doctor, so I dont know if that advice is safe, but if you've been seeing a pain management specialist for over 5 years..jeez..whats their next course of action?
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Fentanyl is the end of the road narcotic. Theoritacllythey can increase yout dilaudid, but you can die. I was takink dilaudid in the pump and also had 2,000mcg, once every 2 hour. Now I am on the pump with fent and dilaudid ,and I have a PTM deviece that allows me to give myself bolus doses as needed. I no longer worry about counting pills or watch the clock This computer is call a PTM machine from mrdtronics if your PD is ok. I am sure anyone ekse who has experienced fentanyl WD, it is hell. Give it a try
 
You might ask your physician about switching your morphine to oxymorphone. It's about 10X the potency, if taken parenterally. I'm not sure about the oral per-milligram potency, other than it's high compared to morphine. Another strategy might be to use a sedating tricyclic antidepressant in place of, or with the temazepam. Short-term, the TCAs will anable you to sleep better, which USUALLY helps elevate your pain threshold. LONG term, whether it helps you to rest better, it should elevate your pain threshold from its centrally medicated actions. I'VE gotten good results with doxepin, but amitriptyline might work just as well. Imipramine or Nortriptyline are less sedating and (usually) slightly less anticholinergic, if that's an issue. Protriptyline and desipramine are (usually) the least sedating, which won't help your sleep problems, but their central actions are generally no less pronounced. They DO lack the advantage of somewhat instant help with pain through better sleep, but any of the TCAs will work well. They also have the advantage of being dirt-cheap. They MIGHT do funny things to your cardiac rhythms, but these tend to be well tolerated.
Another possibility is Effexor (venlafaxine), which is typically non-sedating, works well on chronic pain through central effects (in MY case, better than the TCAs), but is horrendously expensive, even in generic. It also tends to elevate blood pressure in some folks.
Although the cause for your pain seems quite evident, you MIGHT find that some of the meds used for neuropathic pain (gabapentin, pregabalin, carbamazepine, valproate, others) will help control the pain. These might also be combined with the TCAs or the Effexor for an even better effect. They might not provide relief sufficient to reduce your opioid demands, but they MIGHT make the doses you're currently on somewhat more effective.
In any case, best of luck.
 
tg.mu said:
Hexxx, yeah I meant "chronic pain" by "CP." When I tell my doctors about the patch not lasting the full 72 hours, they increase the dosage. I have said to them, "I would prefer it if you would let me change the patch every two days rather than increase the patch dosage," but they say that they would prefer to increase the dosage. So maybe the next step is to increase to the 100 mcg/h patches?
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i told my dr the same and he changed me to every 48 hours and started giving me 15 patches a month

he said 50% of patients need to change it every 48


If you put it on your inner arm or over your heart, there will be a big differance

i trim my chest hair on two spots as i alternate every two days
 
I've been stabilised on 25 mcg/h Duragesic patches, replacing every 3 days for quite awhile now. Definitely the best thing I've tried. Cheap, and extremely effective

I'm also on Percocet for breakthrough pain, and lately it's been giving me wicked headaches. So, I think I'm going to talk to my doctor about the possibility of switching me to a breakthrough med that is Fentanyl based, as it seems I react best to that

Here's where I have a question though. The only two products I know of that are instant release fentanyl are Fentora and Actiq.

Are either of these available in generic form? This is extremely important, as I really don't want to switch to anything that costs me an arm and a leg. If the concensus is that neither are, I probably won't even bring up the issue with my doc
 
One of my biggest problems with this country's health care (U.S.) is that doctors usually err on the side of undertreating pain. Legal reasons, misinformation about opiates. My deal is that this is the only life I'm going to get for all I know. I don't want to spend it in pain. Why should someone get to say that you're only allowed to have pain treatment to get you from an 8 or 9 to a 4? I didn't ask for existence in the first place, and now that I have it I can't even make it tolerable, much less happy. It's horrible the kind of pain people have to live through because of whatever reason that the doctor's don't want to prescribe for.

My doctor's reason for holding out is that he doesn't want me to develop a high tolerance and become dependent, and then not be able to get relief if I get mangled in a car accident years down the road. But what about now? I mean, for people in serious pain, we are willing to take the risk of not being as sensitive to medication for a freak accident down the road. Not to mention that there are many strategies for trying to control tolerance. There are many studies that show that taking a small dose of naltraxone with your opiate will slow or even reverse tolerance.

I think the shittiest thing about pain management in it's current state is that certain types of pain are viewed as legitimate to treat with narcotics and others aren't. I have horrible pain in my esophagus and throat that was caused by a long period of acid reflux. I eventually had a surgery and it stopped the reflux and my esophagus healed but I still have the exact same pain, because my nerves have become oversensitized due to such frequent stimulation. My doctor's keep saying that we don't want to treat the pain, we want to fix the underlying condition. Well I do too! But my life is passing me by in the mean time while I wait months to see specialists who time and time again fail to treat the underlying condition. Yet there's been polls to show that doctors agree that all cancer patients deserve pain treatment, and even most doctors agree that cancer patients with a history of drug abuse deserve treatment. However, most doctors don't believe it is appropriate to treat chronic non-malignant pain with opiates, and some think it's a crime to treat non-malignant pain patients with a history of abuse with opiates. Pain should be treated by how bad it hurts and how much it affects the individual, not purely based on what the source of the pain is. The source doesn't matter, if it hurts, it hurts. Some say that addiction is worse than pain, but I say that let that decision be up to the patient. He should be the one with the right to decide if he wants to take that risk. Meh, there wasn't really much substance to this post, I'm just a little angry right now... hehe.
 
It's alright, I understand where you're coming from

I went through two years of pain, and doctors who wouldn't treat it because they couldn't diagnose it

Eventually, I found a pain management doctor who was willing to treat me, even without a diagnosis. He works with me, and let's me make choices with regards to my treatment

I think that really is the key, finding a pain management doctor who is willing to treat your pain. I would think you would be able to find one with your history and documented problems, records of surgery, etc. tell him/her what you've been prescribed before and how effective it was, and they'll put you on something. It might be non-narcotic at first, but give it a chance. Establishing trust is extremely important in situations like this (especially with my case, since all my doc has to go on is my word)

I wish you the best, and I hope things work out for you
 
About a month ago I started using pod tea for pain. I was using it about 2 times a week and then about a week and a half ago my pain got worse for a few days so I had some tea 4 days in a row. About 3 days after this I started feeling flu-like and the symptoms I noticed most was I would get these sweats where it would feel really cold and then I'd put a blanket on and all of a sudden I'd be burning up. From this I'm sure it sounds like an obvious case of withdrawal but there was something else going on at the time.

For about the past month I've had a lingering case of thrush on my tongue (yeast overgrowth). My tongue has been all white and yellow and sometimes green. Yea,,, gross stuff. When I first got the infection, I noted a similar sweaty feeling and flu-like symptoms. The infection has kind of "come and gone" over the past month. At first it responded to nystatin oral, then it got worse and I was put on Diflucan, then it started getting better. Then it started getting worse again about the exact same time as I started noticing the flu-like sweaty symptoms that I mentioned in the first paragraph.

Now, after a surgery about 5 months ago, I took around 60 mg hydrocodone/day for 2 months. The pharmacy made a mistake on the amount of refills I was allowed to have and cut me off cold turkey when I tried to get a refill (thinking I had 2 more 40 pill refills to taper down with). I had no withdrawal after this, which surprised me.

So at first, I assumed that it was the infection that was causing my symptoms. But the symptoms kept getting worse (seemed to get the worst about 5 days after my last cup of pod tea) and for a while, it seemed like my tongue was getting worse simultaneously. However, I drank a cup of pod tea last night to help what I thought was the symptoms of my yeast infection. I woke up this morning and noticed my tongue was getting better. Then later in the day as the tea was wearing off from the prior evening, I began to get the sweats again and started feeling a little flu-like. So now I am going to go on the assumption that it is pod tea withdrawal that is causing the flu-like symptoms and sweats, and that the tongue infection is unrelated, or at least not causing the majority of the symptoms. So I'm going taper down with pod tea until I'm at baseline and see where I stand. It could be that both the infection and the WDs are causing 2 different sets of symptoms that are hard to distinguish from one another.

One thing that worries me about this is that I would really like to use pod tea as daily pain management, however, I don't want to have to worry about having these horrible symptoms if I am empty on pods for a day or decide I want to quit and try other means. Does anyone have any insight here?

Okay,, you'll probably want to know my dose. When I dosed four days in a row, I was taking 20-25 grams powdered pod material.
 
Any prolonged, regular use will cause dependence and some degree of withdrawl. The best way to minimize this is to not increase your dose when the high goes away. Even if the high is no longer felt, the analgesia can still be present. Only increase when absolutely necessary. And never dose more than required

Following simple things like this, pain patients can stay on a steady dose for even a year without having to increase
 
Desdenova said:
Any prolonged, regular use will cause dependence and some degree of withdrawl. The best way to minimize this is to not increase your dose when the high goes away. Even if the high is no longer felt, the analgesia can still be present. Only increase when absolutely necessary. And never dose more than required

Following simple things like this, pain patients can stay on a steady dose for even a year without having to increase
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Thank you for the advice, like I said, I'm going to try to taper down to baseline because I want to know if my symptoms are related to my infection or if they are related to my pod use. Then I'll start with the pods again and work up til I get decent pain relief and just leave it at that to see how that works for me.

Another thing I plan on trying once I return to baseline is a suggestion my natural doctor gave me. She actually works in conjunction with an MD so she can talk with him and he will evaluate me and write me scripts if they both feel they are necessary. But what do you think of this idea. She wants me to try taking a low dose of naltrexone (3 mg/ day) after being off opiates for a week or so. Apparently studies show that when taken like this, it can cause your body to increase it's endorphin production while lowering your sensitivity to opiates. I have never really heard of doing this before, but it makes sense and is backed up by a few studies, not to mention, if it doesn't work, it should at least knock my tolerance down a bit.
 
background... Quadriplegic for a couple months due to my spine swelling until it ripped from c-4 to c-6. Three months before this paralysis I had a traumatic brain injury with an occipital fracture and all the cognitive side effects that go along with it. That injury is what got me started with Oxycontin. 90mg a day for about three months then I was paralyzed and they didn't have the heart to take my no longer required pain meds away from the 22 year old marine that just lost the ability to move everything from the neck down. At any rate now I've relearned to walk and struggle with neuropathic pain that brings me to the floor. I've tried Gabapentin lyrika and several others to at least soften the blow but with no results. While on the high does of Oxycontin I never get these pains. Granted I do abuse my medication from time to time by snorting or shooting it. The people around me nor myself seem to have a problem with this. I don't get out of control. I bought Heroin before when my oxy wasn't being prescribed and it had the same effect, no nerve pain. Sounds like bullshit even to me but it works. I've been off opiates for about two months now trying to find a non narcotic pain med regiment that works with no luck. My neurologist knows nothing of my abusing pain meds but what kind of an idiot would it take to believe that a 22 year old male wouldn't? He plans to put me back on Oxycontin before the end of the month. Yes I will indulge from time to time but it seems like I'll be getting the best of both worlds. I'm just wondering a few things... 1 Has anyone ever heard of an overdose causing paralysis? 2 Why is this opiate helping my nerve pain. 3 What are the extreme long term side effects of Oxycontin like taking it as prescribed 30mg 3x a day.
 
The long term side effects of taking it only as prescribed are pretty minimal. Eventually tolerence and dependence will set in, and some day your doc would need to increase your dose. You could also deal with some constipation, but this is pretty manageable.

Of course, abusing your meds will lead to an increased tolerance and possible addiction. As a pain management patient, you really should stick with taking as prescribed. It will really make things easier on you.

The opiate is probably helping with the nerve pain simply because it's a pain killer, and that's what it does.

As for the overdose causing paralysis, I've never heard of it personally, but I'm no expert
 
I am no expert on opiates, but sometimes I wonder if it's really true that you can always achieve pain relief without getting a buzz. I have always been told that there are two actions of narcotics, one that acts by blocking pain signals traveling to the brain, and the other is by acting on your mood so that what pain signals do reach your brain do not bother you. It seems like I am always able to get a buzz at a lower dose than what would be required to make me not feel my pain. I kind of see a similar situation with cannabis. Cannabis can actually remove my pain to a point where I don't feel it anymore, but in order to get that kind of relief I have to be so high that I can't think straight. Opiates are similar for me (but to a much less extent) in that, like I said, I can get a buzz without having much pain relief. Going off what you said in your above reply Desdenova, if I were to take a dose of opiates that actually made me feel like my pain didn't exist (not just causing me to not care about it) and continued to take that dose even after the mental high went away, would I still have the same pain relief as I did when there was a high present?

I am not objecting to this notion at all, I am just saying that in my experience, I always reach a point where I have a buzz and my pain doesn't bother me prior to reaching a point where I actually don't feel my pain.
 
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I suppose it could be not the same for everyone, but I never get high from my duragesic patches, but the pain relief is always there

Maybe it could be different for you because your pain is neuropathic, and mine isn't?

I dunno though, this is just going from my experience and what I've read on this board. I'm definitely not an expert
 
Someone talk to me about TENS units. My doctor recommended one to me a few visits ago, and I promptly filled my script and tossed the paper for the TENS unit aside. A few months later, looking for anything non-narcotic, I'm starting to think this is something worth trying. It's much cheaper than I expected it to be as well; the way he described it made it seem expensive.

I'd describe my exact condition if I could, but I don't really know. In a nutshell, I have two protruding discs in my neck/back, which are bad, but even worse is my right shoulder/scapula. When I move it, I feel it grinding and anyone in the room can hear it. My right scapula and accompanying area (like the C7-T1 region of my spine and my shoulders) is very tense and I have the occasional spasms. The majority of the pain isn't on the spine, its underneath and behind my arm. I'm sick my arm twitching every 5 seconds, and I can tell my friends are too. ;) Alright, enough about that.

Drug-wise, I take this and that and the other thing for it, but I'm trying to taper off the opiates/muscle relaxers/etc, and a heating pad only goes so far, so here I am looking for answers. The disc problems are relatively minor, at least compared to the pain coming from the shoulder/scapula. Unfortunately I don't know what I actually "have" - my insurance sucks, so up-to-date MRIs and whatnot escape me. A rough explanation: something grinds (viciously) when I move my arm, and I have constant muscle tension and spasms, which I hope a TENS can fix.

Anyway, there's my fucking life story. All I want to know is youz guyzez experiences with TENS units (or anything comparable - don't care to discuss meds, that is taken care of).
 
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johanneschimpo said:
Someone talk to me about TENS units. My doctor recommended one to me a few visits ago, and I promptly filled my script and tossed the paper for the TENS unit aside. A few months later, looking for anything non-narcotic, I'm starting to think this is something worth trying. It's much cheaper than I expected it to be as well; the way he described it made it seem expensive.

I'd describe my exact condition if I could, but I don't really know. In a nutshell, I have two protruding discs in my neck/back, which are bad, but even worse is my right shoulder. When I move it, I feel it grinding and anyone in the room can hear it. My right scapula and accompanying area (like the C7-T1 region of my spine and my shoulders) is very tense and I have the occasional spasms. The majority of the pain isn't on the spine, its underneath and behind my arm. Anyway, I don't want to explain it any more than that.

I take this and that and the other thing for it, but I'm trying to taper off the opiates/muscle relaxers/etc, and a heating pad only goes so far. The spinal problems pain is relatively minor, the shoulder/scapula is 90% of the problem. Unfortunately I don't know what I actually "have" - like I said, something is grinding, I'm also having muscle problems, and who knows about the rest of the joints/ligaments/etc. I have shitty insurance, so up-to-date MRIs and whatnot escape me.

Anyway, there's my fucking life story. All I want to know is youz guyzez experiences with TENS units (or anything comparable - don't care to discuss meds, that is taken care of).
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Im glad to hear ur getting off that shit :)

I have heard great things about TENS. Basically it stimulates nerves in a way that it hinders pain (for those who dont know). I think it would be worth a shot, and a step before a pain pump.
 
My mom has a TENS unit for her back problems, and she thinks is just great

I've tried it on my neck when it was stiff, and it worked well

You should definitely try it. Plus, if you turn it up enough and put it on the right spot it'll make you look retarded. I gotta big kick out of that when I used it. But my sense of humor isn't always the most mature
 
I know 'TheMatador' regularly uses a TENS unit and he's always willing to help so you could shoot him a PM and get better information. I only know what I've read which is all the same things you have access to and have probably already looked at to some extent.
 
^ Nah, you know how it is. I didn't even use google. I just came straight to BL. I guess I fucked up by not starting a new thread for it though. ;)


Thanks Cane (& all)
 
Yes, I regularly use my TENS unit for any intense stiffness that hinders me that my Soma can't deal with (which is too often, but what can ya do?) and I have started using it as a replacement for breakthrough pain medicine as I have stopped using it to try to avoid having another crutch.
My basic extended release analgesic (OpanaER) works pretty well most of the time, but when I do have breakthrough pain or excessive stiffness or strain on my back and/or neck muscles (which inevitably turns into pain) my TENS unit is a god send, it really, really helps me a lot. It blocks some pain signals, and signals telling the body to tighten up its muscles from the brain by flooding your back (or wherever you put it where your pain is, the shoulder in your case) with electrical signals which blocks the signals from your brain, helping your body relax its muscles. That is just the basic rundown of how it works, it is more complicated than that, but that's pretty much it in a nutshell.

I don't know if I've left anything out you would like to know, it's kind of late right now and I'm pretty tired so I gave the best response I could given my circumstances. But as Ct2L said (he knows me quite well) shoot a PM over to me and I'd be more than happy to talk about it (your the man JC, its always good talking to you), or anything related, anything at all really :)

-TheMatador
 
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