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

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^Great advice, great example. I always tell people to look for another doctor if they feel they are not being heard. We have free market medicine here so consumers have choices so utilize those choices and find one who will listen and give you respect and treat you appropriately.

Thank you for sharing, Sublimit.
 
Sublimit-
I have FMS and inactive MS. In my experience, the pain management doctor was the one who was so mean to me. I cried in his office as he slammed the door. This was before I went to a kick ass hospital (Mayo Clinic) and was properly diagnosed. Though, he should've had enough information to help me. I wasn't begging for pills or anything. He just took one look at me, 26yr old female.. complaining of pain.. and thought I must be there to score. Idiot. I'm glad you found someone who will help with your pain. It's so hard to get actual help if you have a history of addiction ( I do too) I'm on Lyrica for the FMS and it works quite well. Cymbalta was terrible.. I'm surprised I didn't do something crazy on that medicine. It made me so depressed. Also I found I had a vitamin D deficiency. That's something people can really get checked quite easily. Vitamin D deficiency, esp in women, can cause all kinds of problems. Anyway, that's my two cents. :)
 
I have a GP who takes care of me. When I was injured I was in the hospital for over a week, when I was released instead of being sent to their Pain Clinic I was referred to a GP that worked outside of the hospital but for the same large health System. This GP had great knowledge of people who were wounded and also of severe nerve damage. The GP did send me to the health systems pain clinic to try injections, and the pain doctors I talked to their had a very tough time understanding my pain and symptoms which was annoying.

There are some GP's who have just as much if not more knowledge of certain pain related problems than an anesthesiologist trained in "pain management." And if your doctor isnt helping you enough, you should see a different doctor.
 
Do any of you have herniated disk? What does that feel like for you, and what meds were you scripted?

Also, how long did it take to work your way up to OP nikolai?

Just wondering what everyone experience is on how long it takes to reach their ideal medication or ideal medicine that controls their pain appropriately.
 
^Im not sure what you are asking Shady when you say "work your way to OP"

I was started on a dilaudid IV after being rushed to the hospital and over the next 5 days or so my dose was steadily raised I think every 12 to 24 hours until I felt really comfortable. Even though I had no tolerance I still had a very hard time on the low to medium dosages. Making the transition from IV opiate to oral opiate was a challenge. I probably left the hospital early, I didnt feel great but wanted to get home. I had trouble at home and my med's and doses were probably changed and raised for about the first year before I felt pretty good. It was a hard year with a lot of hospital stays. Ive been on the current dosage Im on now since my last operation late last year. It was my 5th operation in three years.
 
I have an appointment tomorrow with a pain management specialist. I have Chronic pain due to neuropathy and I am in a wheelchair due to it. I had an EMG done and my diagnosis is Polyneuropathy, which is in my right foot and ankle and also a little bit in the left foot. Right now I am in a facility for physical rehab and it has been taking forever to get meds straight and appointments in here. I am choosing to stay in here though because I am getting medicaid and everything for me health-wise is getting paid for me in here. I am on MScontin 30 mg 3 x's per 24 hours, Valium 5 mg 2 x's a day, and Lyrica 200 mg 3 x's a day. The doctors here didn't want to give me Oxycontin because there is no generic version available so when I leave there wont be anyway for me to pay for it realistically. I was originally on 10 mg's of oxycodone IR 4 x's per 24-hours (40 MG a day.) but it wasn't enough and I really need to start walking or it will cause deformities in my leg and I already have atrophy in the right one. I actually am an experienced drug-user along with opiates but came here with no tolorency. It usually would take me at least 100 MG of MScontin withought a tolorency to feel anything. It is different now though because I am not trying to get high just get the proper pain relief. Anyway I was wondering what I should ask the Doc because;

I need something for breakthrough pain for sure.

The MScontin doesn't really help at this current dose, if at all.

They don't want me on Methadone here because they say it is really hard to get off of. but I think it would be beneficial anyway because of the neuropathic pain (being a partial NMDA antangonist) and its long acting properties. This pain might be long-term anyway if I want to walk.

I need to start walking as soon as possible here despite any risk of addiction which is what the physiatrist here said too.

I was wondering if I could maybe try to be put on something stronger like maybe hydromorphone or something I don't know. Let me know some opinions please guys..
 
^you could talk to them about levorphanol (leh-VOR-fuh-nahl), its another potent opioid with powerful NMDA antagonist properties and I think its only available in IR but longer acting (8 hours?).

There isn't much we can tell you, just be open and honest about how the lack of pain relief is affecting your life and what you need/want to address that (not specific drugs, but generalities).

Doctors need to feel in control and you need to not look like a drug seeker so be careful and use discretion!

Also, polyneuropathy is really more of a symptom than a diagnosis, do you know what caused the neuropathy?
 
Well unforutnately what caused the neuropathy is the fact that I overdosed, but not not on opiates. My kidneys had failed but came back so that is why the physiatrist thinks that I have neuropathic pain now, because I had gone through dialysis for a bit and the organ failure.

He also told me the same thing, was to just be honest with them and he had the same philosophy as me which is to way out the risks and the benefits of addiction. He wrote on the piece of paper for his recommendations that I could they should just discuss the risks of narcotic use so I should be fine with the whole overdose thing. They are sending my records over there with me anyway. But yeah I don't really think that I need a longer acting form of an opiate anyway.
 
Is your pain pretty constant? If so, having a long acting drug is rather important to establish stable blood plasma levels. When you use short. acting opiates you get peaks and troughs of pain relief meaning everytime you take the drugs you have more opiates than necessary and then not enough between doses.

This instability exacerbates the pain and often leads people to take more than they would need otherwise. This naturally lends itself to abuse and IR drugs are more habituating than long acting ones.

I would say you if you have to dose short acting drugs more than twice a day you should be on ER ones instead and supplement with BT meds once or twice a day if necessary.
 
Thats sort of a low dose of morphine, oxycontin works much better than morphine IMO, maybe you could be put on oxycodone, since theres a generic, for breakthrough along with your morphine, and your morphine could also be raised which would help. I took methadone for a few months and it worked ok for me, better than ms-contin but maybe not as much as oxycontin. Im not sure what else you could try, Im not sure of levorphanol's cost, thats the one pharm I havent been on. I also have horrible nerve damage in my midsection, legs, and feet, my left leg and foot more so. Im on Opana which by far has helped me more than any other opiate, but its very expensive.
 
My pain is definitely constant. So I see now that I would need an ER form of something, and I agree with the fact that it is a really low dose of morphine. It was supposed to be titrated but on Friday there was a jail nurse practioner in here instead of the normal doctor and apparantly she doesn't even like prescribing Tylenol the nurse told me, so I have been in pain here all weekend. The Oxycodone worked pretty good it was just the fact that it was like a rollercoaster of pain-relief and then pain. So that is what I was thinking too Nikolai. If there is an ER generic form of something other than oxycodone or morphine I would love to know. Otherwise I will probably just stick to the morphine. Hydromorphone, Oxymorphone, or Levorphanol would be nice for breakthrough pain though.
 
If the US there is no more hydromorphone ER, but there is Oxymorphone ER (opana ER) as we'll as the 72 hour fentanyl patch.
 
^thanks a lot for the info and correction!

I just remember purdue's palladone SR being pulled after all the oxycontin hysteria. The media hype painted hydromorphone as *worse* than oxycodone.
 
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We have HydromorphContin - ER hydromorphone in Canada - 3,6,,12,18,24,30mg pills made by Purdue. I'm wondering why Purdue hasn't tried to release this medication in the US?
 
Cane2theLeft said:
^thanks a lot for the info and correction!

I just remember purdue's palladone SR being pulled after all the oxycontin hysteria. The media hype painted hydromorphone as *worse* than oxycodone.
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No problem, man. I just wonder how often it's actually going to be prescribed, though. So far, I've only heard of one person getting it Rxed. And that was just online.

That, and I'm wondering how well it works, honestly.
 
Snugg said:
No problem, man. I just wonder how often it's actually going to be prescribed, though. So far, I've only heard of one person getting it Rxed. And that was just online.

That, and I'm wondering how well it works, honestly.
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I'd say being that it's so closely related to oxymorphone that the efficacy would be similar to Opana ER.

I have a question, has anyone here upon trying to get an appointment at a pain clinic, needed a written referral from their doctor? I've never needed a referral for anything, this is the first time I've ever been required to have one. . .
 
^yeah, I have because I have an HMO. It usually depends on the insurance, for example my HMO requires referral from my PCP to see any specialist.
 
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