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

[Cane2theLeft]

^ are you young, DP? It seems many of us have felt our practitioners don't care because they are apprehensive about prescribing a life-sentence of opiate use to a twenty-something. I really see both sides of this, when my pain was REALLY uncontrolled I didn't give a fuck about the future, I needed relief then. Now that things are more stabilized I'm always searching for ways to reduce or eliminate medications I have to take.

I'm really sorry that you've had to struggle to find relief though, nobody deserves that and a lot of doctors (especially in the US) need to get some CBT for their opiophobia (real term by the way).

 

[2muchpain]

i have fibromyalgia too and any input on it is always welcome here as far as i'm concerned. Thing is i really don't like smoking weed cause it makes me feel sick and adds to the massive amounts of fatigue i already have. Although some people may think me strange, i would take a thc pill if it didn't get me stoned but i have heard the synthetic stuff isn't very good for pain anyway.

 

[SupDUDES]

Oh my god, I'm in so much pain, ughh! Doctor doctor, I need something, anything, to take away this awful pain of mine, uhh! Thanks doctor! Thanks pharmacist! Thanks paramedics!......

FUCKING DISGUSTING THE NERVE OF YOU FIENDS ON THIS WEBSITE! WHY THE FUCK AM I EVEN ON THIS FUCKING WEBSITE? YOU PEOPLE IN THIS FUCKING THREAD OR WHATEVER DON'T KNOW WHAT TRUE, PHYSICAL PAIN FEELS LIKE! SUREEEE, YOU ARE QUITE FAMILIAR WITH YOUR EMOTIONAL AND PSYCHOLOGICAL 'PAIN' ISSUES, BUT YOU'VE NEVER EXPERIENCED THE LIFE OF SOMEONE WHO HAS TO GET UP EACH MORNING, IMMEDIATELY INTENSE PAIN SPREADS THROUGH MIND LEAVING YOU YOU CRAWLING ON THE FLOOR TO YOUR MEDICINE CABINET AND POPPING OFF THE TABLET BOTTLE LID TO DOWN TO OC80'S! FUCK ME! I'M ACTUALLY GLAS THAT SO MANY DUMBASS YANKS DIE EACH YEAR FROM DRUG OVERDOSES, IT'S NO WONDER WHY GIVEN THE VAST MAJORITY OF BLUELIGHT MEMBERS THAT ACT LIKE YOU DRUG-SEEKING, LIFE-TIME ADDICTED COCK SUCKERS!

 

[alicat72]

Does anyone have any information or experience with Fibromyalgia they would like to share? Maybe a PM or a mail because I don't want to hi-jack this thread or start a new one.

I found this bit of interesting information about a study involving THC and Fibromyalgia:



Source: http://en.wikipedia.org/wiki/Fibromyalgia

I smoke Cannabis as well and found it to be quite helpful in relieving my symptoms, I wish there was an adequate treatment for Fibromyalgia but I guess it's self-medicating until then.

I hope someone found this useful, smoking weed would be way better than Opiate treatment IMHO and is definetly something that needs further research, any thoughts?



Peace o/

i smoked for years to self-medicate. it worked pretty well. then i started having panic attacks on it so i tried just cooking with it. that was ok, but gave me horrid migraines sometimes and stomach trouble.

currently i am taking an arsenal of prescriptions instead and wish i could go back to the days of moderate pain while only smoking....there are many considerations though. mainly the fact that smoking anything is bad for your lungs and cardiovascular system. even if filtered marijuana is potentially as harmful as tobacco. ingesting is a much better option. make sure that the product is cooked with some form of fat to release the thc. thc is stored in the fat molecules of the body, so it must be taken witha fat soluble compound (butter, olive oil, i think even dairy products are good but don't take my word for that!)

 

[alicat72]

^ are you young, DP? It seems many of us have felt our practitioners don't care because they are apprehensive about prescribing a life-sentence of opiate use to a twenty-something. I really see both sides of this, when my pain was REALLY uncontrolled I didn't give a fuck about the future, I needed relief then. Now that things are more stabilized I'm always searching for ways to reduce or eliminate medications I have to take.

I'm really sorry that you've had to struggle to find relief though, nobody deserves that and a lot of doctors (especially in the US) need to get some CBT for their opiophobia (real term by the way).

my doc said the same thing cane and i'm almost 37. i understand why, but they don't understand that those of us in chronic pain conditions would rather have the pain controlled than to worry about a so called"life sentence" i kinda feel like it is a life saver if i can find some relief. i also would like to reduce my meds.....i am waiting for the pool therapy to become available again....i think it may just help me have a better sense of well being which may lessen my need for medicine....

i went thru many years trying all kinds of vitamins and supplements never thinking i'd be to the point i am now with the meds. i just want to feel capable. able to do at least half of what i did before i got sick and too mostly to be able to do that on my own (without the help of medication)

 

[2muchpain]

http://www.myalgia.com/treatment/addiction def.htm

This is a link to something i found through the uk fibromyalgia association recommending the site, it's useful for ANY pain management patient who wants to discuss opiate medication with their doctor, not just FM patients. But for anyone who has fibromyalgia i recommend looking around the whole site.

 

[philly_philly]

Hi. I don't have fibromyalgia (although I realize it's a terrible disease), but I do smoke cannabis for interstitial cystitis, ulcerative colitis, endometriosis, uterine cysts, and kidney stones. It works especially well for the first three conditions (the other two are generally acute attacks that require narcotics.)

I can't overstate how valuable cannabis has been to me. I was on 2000mg/day of Neurontin; on top of that, I was on daily Percocet which switched to daily Vicodin which eventually switched to daily Dilaudid. I was also on Klonopin and then Xanax to deal with anxiety (which seems to go hand-in-hand with pain) and Restoril to sleep. I was on this cocktail for a few years and although it dulled the pain, it also killed my social life and zombie-d me out. I did nothing and had no memory. I couldn't handle what the meds were doing to my social relations-- my family and friends said I was like a different person with no personality and no emotions.

I finally kicked cold turkey (which ended up making me very ill) and couldn't have done it without weed. Now I take small doses of Tramadol and smoke and do lots of yoga to control my pain and I'm functional, back in school and able to socialize every once in a while. Unfortunately, cannabis isn't legal where I live; which sucks because it offers me relief without the apathy and depression that came with the pain meds.

I realize that some people definitely need to be on pain meds and that they don't effect everyone the way they affected me. But for me, cannabis has been instrumental in getting my life back; even though I feel more physical pain than I did when I was on meds, it's worth it for the mental clarity and mood stability.

 

[Cane2theLeft]

I created this chart some time ago to personally assess different pharmacological treatments for neuropathic pain and since there are so many dealing with chronic nerve pain and fibromyalgia, I thought this could be useful here.

A few definitions:

NNT= Number Needed to Treat. This means very basically how many patiens need to be given that medication for 1 patient to receive 50% pain relief. So if something had an NNT of 4 then for every 4 patients receiving the medicine, 1 will receive at least 50% pain relief.

NNH= Number Needed to Harm. This means how many patients need to be given that medication for 1 patient to experience an adverse reaction.

In summation- The lower the NNT, the more effective the medicine is and the higher the NNH, the safer it is.

This chart compiles all the major nerve pain treatments (many apply to fibro) as well as average American monthly costs that I compiled from various pharmacies... this would be the least accurate portion but should give you a basic idea. Some of the prices may have changed, they are all based on price before insurance and of course location and other factors have a large impact.

_________________

The typical progression of prescribing for neuropathic pain follows this path

-Tricyclics
-Anticonvulsants
-Opioids

These medications may be used ad adjuvants to the aforementioned at any time
-Capsaicin
-Lidocaine patches
-SNRI's like Cymbalta or Effexor
_________________

 

[kovus]

I've never had them, but are the Lidocaine patches really that expensive? I though Lidocaine was something that was cheap. Then again just looking at it I would have though the Marinol/Marijuana would have been a lot cheaper too.

Then again there is no mention of how the cost is derived.

The other interesting thing is that I though that Pregabalin was supposed to have fewer side affects than Gabapentin.

Not saying any of it is wrong, just a few things that I wouldn't have expected.

 

[Cane2theLeft]

Most of the NNT/NNH material came from one big study, I could track down the source later.

I use lidocaine patches and without insurance, for 60 a month (2 boxes) it is around $550.

Marinol is notoriously expensive, I checked 10 minutes ago and saw sources of $200-$1000 a month.

I chose some major pharmacies ~6 months ago when I made this chart and averaged their prices so there will be some inaccuracies, this was more to give people an idea.

 

[TheMatador]

niiiiiiiiice work bro, thats an excellent chart w/ great information
hats off to you

 

[Rexeh]

Great chart indeed.

I see that Amitriptyline is listed on there, I currently have a prescription for 1x10 mg daily but sometimes I get a few 25 mg pills from my mom. I use them primarely as a sleep aid or as a Benzodiazepine potentiator, but after looking at the chart a TCA (tricyclic anti-depressant) seems to be an interesting option to try out for both my Fibromyalgia and my Scheuermann's Kyphosis. I thought Amitriptyline inhibits the conversion from Codeine into Morphine? I think someone mentioned it in a thread here on BL. Gabapentin seems to be worth exploring as well.

My daily pain medication regime is currently OxyContin 3x5 mg / Codeine 4x20 mg / Tramadol 200 mg (which I am slowly tapering off, going to miss Tramadol though ). I might ask my psychiatrist about both Amitriptyline and Gabapentin, I also need some form of anti-depressant and a sleep-aid. The problem is: sitting at home doing nothing combined with the realization that you have a life-long disease made me depressed. I also can't fall asleep anymore and when I do fall asleep I wake up multiple times per night. I have already tried Valerian + Melatonine, Alcohol, Cannabis, Benzodiazepines and Zopiclone, would Zolpidem be worth trying? I might even ask for Temazepam since it generally gets positive reviews on here.

***warning: little bit off-topic***
My mother also suffers from Fibromyalgia, as well as rheumatoid arthritis, and a whole lot of other diseases. Luckily she has an iron will and is a great supportive person as well, I am glad that she supports me in difficult times and I am in a way 'lucky' to have someone close to me who also understands how I feel. She is worth mentioning in my post because of this.

Sorry for the rant but I needed to write down my feelings ATM, lots of good stuff is happening in my life but somehow it took a while to finally realize that my body is no longer capable of the things I did when I was young. Sometimes I feel like I am 50+ years old while I am only 23 yet... already dependant on OxyContin, Codeine, Tramadol, Methylphenidate and Diazepam, if only the pain would be gone completely for JUST ONE day... *sigh*

Good luck everyone with your (chronic) pain, and thanks 2muchpain for the link, information for the win!

Peace o/

 

[kovus]

... Sometimes I feel like I am 50+ years old while I am only 23 yet... already dependant on OxyContin, Codeine, Tramadol, Methylphenidate and Diazepam, if only the pain would be gone completely for JUST ONE day... *sigh*

That about sums up how I've often felt. At least twice (if not more) my age (26 now.... been in pain management for my current condition about 3.5 years now I think and was in a while when I was 19).

I did get about a good week of being pain free once... I was upping my Lyrica (Pregabalin) dose and finally hit 3x75mg twice a day. After about 5 days at that dose I felt basically completely pain free including none of the very annoying and nagging sensations going down my leg. Then I developed a horrible bought of swelling all over my body. I ended up in as much if not more pain than I had been in before. My hands ached horribly, my shoulders, upper and lower back, feet and ankles... everything hurt.

At first we didn't know what was causing it. None of the doctors thought it was the Lyrica - none had ever heard of swelling like that from it. Which led to a bunch of tests and a rhumetologist. Finally I decided to drop the Lyrica just in case that was it... sure enough 3-4 days after dropping the dose down the swelling started to subside and the pain went with it. Granted as that happened my original nerve pain in my back/leg came back.

*sigh* It was a good week though - I remember being quite happy at the time thinking it was finally all over. I still take the Lyrica, but only 1-2x75mg a day. It helps at that dose some - actually it helps a surprising amount as the pain is considerably sharper if I stop entirely. That and the weird form of headaches I get is stopped by the Lyrica as well though that's another story.

Sorry for all that. Your post about having just that "one day" of being pain free made me think of that and I felt the need to throw that story out there. I'd still recommend anyone with chronic pain - especially nerve pain - to try the Lyrica though. If it hadn't been for that seemingly rare side affect I had (and I tend to be the "medical mystery" child of my family who gets these rare issues...and just medical issues in general) I'd not be dependent on opiates.

 

[paranoid android]

^ are you young, DP? It seems many of us have felt our practitioners don't care because they are apprehensive about prescribing a life-sentence of opiate use to a twenty-something. I really see both sides of this, when my pain was REALLY uncontrolled I didn't give a fuck about the future, I needed relief then. Now that things are more stabilized I'm always searching for ways to reduce or eliminate medications I have to take.

I'm really sorry that you've had to struggle to find relief though, nobody deserves that and a lot of doctors (especially in the US) need to get some CBT for their opiophobia (real term by the way).

Oh fucking hell i can't count how many times i was told your too young to be on opiates. So basically i should go home and suffer in pain because im young? What a bunch of useless cunts . I have trigeminal neuralgia not a fucking sore toe and some naproxen or toradol ain't gonna help.

I got that alot before i finally got my pain treated correctly. I still get it abit now if i happen to end up in the ER or something but i just say what makes my pain any less significant then someone who is 50? They usually just stand their with a blank look on their face trying to think of something to say and that makes me feel better .

I would be interested in knowing how well marinol works for neuropathic pain. I could use it for nausea and vomiting alone mind you since when i get really bad breakthrough pain i often get sick before i get a chance to take a ms IR or something. Then it's either hope to hold down some gravol or methotrimeprazine or take a much dreaded gravol suppository. Those really burn like hell

I see that Amitriptyline is listed on there, I currently have a prescription for 1x10 mg daily but sometimes I get a few 25 mg pills from my mom. I use them primarely as a sleep aid or as a Benzodiazepine potentiator, but after looking at the chart a TCA (tricyclic anti-depressant) seems to be an interesting option to try out for both my Fibromyalgia and my Scheuermann's Kyphosis. I thought Amitriptyline inhibits the conversion from Codeine into Morphine? I think someone mentioned it in a thread here on BL. Gabapentin seems to be worth exploring as well.

I used amitriptyline for about a year and a half to treat neuropathic pain and it worked great until it crapped out on me. So it's definetely worth trying if you have neuropathic pain or fibromyalgia. It's also the best damn sleep aid ive ever had and it's also a pretty good anti-depressant. I ended up on 150mg's a night and i could tolerate it well. I found it to be much easier to take then effexor and i would take a tricyclic anyday over a ssri since amitriptyline didnt cause any sexual dysfunction with me at all. Unfortunatly the anti-depressant effects crapped out at about the same time as the pain killing effects and it also started to make me rapid cycle since i have bipolar.

I took it along with codeine and the codeine still worked as good as ever. So i don't think it inhibits cyp2d6 at all or very much anyway. Either that or i have a weird liver.

 

[2muchpain]

i was wondering if anyone could help me? Cane? Anyone else? I'm on among other things 3x 30mg dihydrocodeine four times a day. Would it make more sense to be on something stronger at a lower dose? My doctor's only doing it this way so i don't have to go on something that causes the powers that be to breathe down her neck (i live in england) and the max dose for dhc is supposed to be 8 a day. Thanks in advance. 2mp

 

[Cane2theLeft]

Kovus and rexeh- I used to chase having 1 pain-free day and it just got me into trouble and feeling psychologically defeated.

Its much more productive to pharmacologically do your best to manage the pain, try alternative methods and after all that, you need to learn how to live with that remaining pain... Its a bitch to constantly be reminded of your limitations and know how affected your life is but its so quintessentially important to move on so to speak.

I'm glad we got nice plugs for amitriptyline and lyrica in here because these are the most effective treatments for nerve pain and FMS.

2mp- if you need round the clock the clock pain relief then you would probably do a lot better on a low-ish dose of an ER med with something like DHC for breakthrough pain... If you want to discuss this more specifically, PM me... I'd love to get to know you better anyway

Thanks to everyone for revitalizing the PM thread and if anyone has any questions, I want to help so if I don't have the answers, I'll spend the time researching because I want to know anyway.

Take care, fellow sufferers.

Peace

 

[stringtheory]

I can understand why they do that thing of trying every other conceivable medication before going to opiates for treating fibromyalgia and similar ailments. In my mind however, if they are going to do that, they need a better grasp of what these non-narcotic medications will actually do for each individual rather than just throwing everything at the wall and seeing what sticks.

I went through over 12 months of total misery while they tried one medication after another to try to find something that would provide some measure of relief for my fibromyalgia. At the end of that time, I had boxes and boxes of prescriptions that either did nothing or had horrible side effects. All this because they were hesitant to prescribe narcotics.

Once they finally did, I had my life back and was able to function like a normal human being, at least most of the time. Yes, chronic opiate use is a bitch, but so was my life without opiates. And as far as the research that says that opiates are not effective in treating fibromyalgia....well, I have a roll of toilet paper that I hold in greater esteem and find to be more useful.

 

[Artificial Emotion]

I'm really scared, as I have a documented history of substance misuse and am on methadone maintenance therapy for opiate dependency and addiction.

I live in the UK and would like to know, what would happen if I had an accident or developed a medical condition that caused chronic or acute pain? Would my GP and other specialists refuse to prescribe me opioids because of my history? Am I condemned?

 

[iSamurai]

Hi. I don't have fibromyalgia (although I realize it's a terrible disease), but I do smoke cannabis for interstitial cystitis, ulcerative colitis, endometriosis, uterine cysts, and kidney stones. It works especially well for the first three conditions (the other two are generally acute attacks that require narcotics.)

I can't overstate how valuable cannabis has been to me. I was on 2000mg/day of Neurontin; on top of that, I was on daily Percocet which switched to daily Vicodin which eventually switched to daily Dilaudid. I was also on Klonopin and then Xanax to deal with anxiety (which seems to go hand-in-hand with pain) and Restoril to sleep. I was on this cocktail for a few years and although it dulled the pain, it also killed my social life and zombie-d me out. I did nothing and had no memory. I couldn't handle what the meds were doing to my social relations-- my family and friends said I was like a different person with no personality and no emotions.

I finally kicked cold turkey (which ended up making me very ill) and couldn't have done it without weed. Now I take small doses of Tramadol and smoke and do lots of yoga to control my pain and I'm functional, back in school and able to socialize every once in a while. Unfortunately, cannabis isn't legal where I live; which sucks because it offers me relief without the apathy and depression that came with the pain meds.

I realize that some people definitely need to be on pain meds and that they don't effect everyone the way they affected me. But for me, cannabis has been instrumental in getting my life back; even though I feel more physical pain than I did when I was on meds, it's worth it for the mental clarity and mood stability.

I was recently diagnosed with polycystic kidney disease, similar. What kind of pain do you have? Is it daily pain? So far I've been lucky with pain and I'm only on a blood pressure med to keep my kidney safer. Apparently I'm also at an increased risk for aneurysms as well

 

[2muchpain]

I'm really scared, as I have a documented history of substance misuse and am on methadone maintenance therapy for opiate dependency and addiction.

I live in the UK and would like to know, what would happen if I had an accident or developed a medical condition that caused chronic or acute pain? Would my GP and other specialists refuse to prescribe me opioids because of my history? Am I condemned?

I'm bumping this and specifically this question as it hasn't been answered and is now on the page before last.