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

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Hello all,

I didn't see an answer to my post on the previous page, so I thought I would phrase it a little differently. Has anyone else run into the same problem I have? If so,what helped to get you through? Just really in a lot of pain here, and frustrated because I just want some relief.
 
Hey guys,

Are any of you in this type of situation?

I have been abusing opiates on and off for the past 6 years...part for the euphoria, part to help with the 2 herniated discs I have in my back. I started doing pain management and ended up a full blown addict IVing my dilaudid and buying heroin on the streets.

I ended up getting off all of them through rehab (I was scripted fent patches and dilaudid for BT) and now I am taking suboxone. I don't really have any mental cravings or feelings of wanting to abuse meds, but subs aren't doing ANYTHING for my back pain.

I have thought about doing a hydromorphone implant so I couldn't abuse the meds, but I don't know. Is that a reasonable idea? Does anyone else have any ideas or who has been in a similar situation?

I need help. I really don't want to go back to the streets.
 
I am seeing a new general practitioner doctor this friday. I have brachial plexis paralysis and neuropothy. I am on Lyrica 75mgs three times a day, Xanax 2mg 3 times a day, and Coumadin 5 mgs a day. I have tried both Cymbalta and Neurontin. I have been using either oxy or opana for the neuropothy, but I been getting them from the street. I just want my pain under control. I was thinking of telling him that I am also on Opana for the neuropothy, and that I have tried oxy but it was getting to be too many mgs (like 180mgs of roxi at a time to control the pain.) I get seriously depressed from all this pain and feel like cutting my arm off, and Opana is the only med that controls the pain.

What do you guys think I should do? I have tried upping my Lyrica to a total of 600mgs a day with no help in controlling the pain.

I am afraid he will ask who has been prescribing the Opana and I just dont know what to say.
Also, I am on medicaid, so I cant see a PM doc.

Please help me.
 
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Hey guys

I've geen on 2.5mg fent patches for almost a year now, i switch them every 48 hours.

How much longer can i expect until i would need to get a stronger patch? I'm still on 5mg oxycodone tablets over a year later, i get 120 roxi 5mgs a month, but i've been telling my dr & pa i take 2-3 at a time and the effects don't last anywear near 6 hours
 

your best best bet would be seeing a nerologist and seeing a pain mng dr

pcps don't like rxing pain meds in general.

you'r going to need to bring in reports and what not of you condition. even then you can't tell any dr what you have been on, and they are going to start you on vicidon 5mg at the most first
 
your best best bet would be seeing a nerologist and seeing a pain mng dr

pcps don't like rxing pain meds in general.

you'r going to need to bring in reports and what not of you condition. even then you can't tell any dr what you have been on, and they are going to start you on vicidon 5mg at the most first

With this medicaid plan, I can only see a general practitioner, no specialists, don't you think that would work in my advantage since he will know I can only see him?

Thanks.
 
^I agree. Oxymorphone/Opana has blown up in recent years and is some of the most commonly used medications in pain management. It seems a lot of PM doctors switched patients to or started using this when oxycontin got so much heat with the lawsuit and all.

EVERY opioid that agonizes the Mu receptors in the brain produces analgesia, that is indisputable. Maybe for you, Unknown, it was unsatisfactory but it does produce analgesia.

I see heroin users saying codeine and tramadol have no effect for them but that is due to their tolerance, its not that those drugs don't produce analgesia.

Its just silly to say an OPIOID ANALGESIC doesn't produce analgesia!

For various reasons it seems very possible to me that opiods will vary in their analgesic efficacy from person to person, setting aside tolerance of course. No analgesia at all seems unlikely, but dramatically less than usual, or a naturally extremely high tolerance to a specific drug - sure. And this seems to occur pretty frequently, too.

For example, I have always responded very poorly to tramadol (I don't even consider this really an opioid, but for the sake of completeness), oxycodone, and fentanyl. All of them are much less analgesic for me than they 'should' be, with intolerable side effects. Supposedly oxycodone is at least as potent if not more so relative to hydrocodone, but I find the latter VASTLY superior for analgesia.

I have a severe case of scoliosis which mostly results in a lot of muscular pain/tension (including spasming) that is unresponsive in the long term to non-drug treatments. So things like stretching, massage/bodywork, chiropractic, heat, etc help but only during the actual process and if I'm lucky for a couple hours afterward. I am doing quite a bit of yoga now but every other day or more for a couple months and I am still not seeing any relief - if anything, it makes my pain worse. :\

The best treatment I have found is valium, which reduces my pain more dramatically than any opioid. I also have severe insomnia, partly due to pain partly unexplained and of course it's wonderful for that. Klonopin helps a bit but I find it amnesiac which I dislike. Some of the other benzos are useful for me for sleep (triazalom, xanax, temazepam, oxazepam, nitrazepam) or anxiety (lorazepam, not sedating for me at any reasonable dose) but these don't help my pain at all.

I've tried all the non-benzo muscle relaxants and none of them are useful for me. I had an extremely mild effect from baclofen, likewise from soma. Flexeril doesn't relax my muscles at all; it used to knock me completely out for 14+ hours but now it doesn't even touch my insomnia. Zanaflex is mildly useful (for both relaxation and sleep) but tends to give me nasty headaches. Skelaxin does nothing that I can tell at all. TENS units do nothing at all.

Opioids vary in how much they help my back pain, but none of them reduce my pain as much as valium usually does. I am still in pain, but I feel distracted and separated from it - classic opiate mechanism. Morphine was somewhat effective until I developed hyperalgesia, which unfortunately happened in a matter of months. While it still worked I mostly alternated between morphine, valium and nothing to prevent dependence and tolerance, though I was up to 20-60 mg of valium.

I have been out of valium for nearly 6 months now (the supply I had was loose powder I inherited) and my pain has been crippling since then. Even when I had it because of my rotation schedule I spent much of my time in excessive pain anyway. At this point, as soon as I can afford it I will pursue being on valium constantly because as much as benzo dependence terrifies me, I would rather be dependent than be in pain so much. I didn't realise until I ran out how much of a miracle valium was!

Heroin works the best of all opioids for my pain, but is obviously not available by prescription - I think used occasionally in addition to constant valium use I would probably be able to keep my pain at manageable level. After reading this thread I'm interested in trying methadone for my pain; I've also long been interested in hydromorphone and demerol.

I hate oxycodone and fentanyl so these are NOT options (my prior PM doc wanted me on oxycontin but agreed to morphine when I complained). I am scared of oxymorphone since it's an oxycodone metabolite but I realise it's a rather minor one, so I'd give it a try. I'd also really like to try lidocaine patches and the shots (which must be steroid?), although the expense of these may not make them very feasible for me.

Eeek, that was long. I haven't seen much discussion of muscular tension and its treatment so I figured I'd chime in with my experience. I found this thread both depressing and mesmerising to read through; regardless it is nice not to feel so alone. Both chronic insomnia and pain are, IMO, completely inexplicable to those who haven't experienced them and it can be VERY frustrating being surrounded by a pointed lack of sympathy.
 
lower doses of the fent patch phenegren for barfing matbe lyrica for nero pain is all i can think of
 
I have really bad head pain for about 2.5 years. I took everything until ending up on suboxone and klonopin. Now i'm going to see a new Dr. tommarow, i'm still on klonopin but would like to take norcos, sense suboxone sucks. In other words it doesn't work for my head pain like the norcos. When I first had this accident I was given oxycodone. But i've found norcos to be really effective, plus I love the fact they have alot less apap then vicodin. My tolerance is just low enough to use norcos.

I just dont know how to tell the guy this is the only thing that works. Or one of the only things. I'm finaly getting off this stupid suboxone train and treating my pain right. Unless I were to get a suboxone patch. I noticed when I quit suboxone my head pain really came back in full force. Even though it never went away.
 
chronic pain and addiction

So I'm guessing I'm not the only person in this thread or these forums who has suffered from both chronic pain due to a legitimate condition as well as opiate addiction.

A little about me: I'm a 27 year old male with Crohn's disease (diagnosed at 17) who has had one major surgery (bowel resection) and multiple hospitalizations for flare-ups, drains put in for abdominal abscesses, etc. Bottom line - pain has been a major part of my life for 10 years and opiates not only helped the pain but made me feel awesome. I became an addict.

Fast-forward through many years of abuse and misuse, and I'm still the same patient with Crohn's disease, except now I'm on Suboxone and my family doesn't trust me around opiates. I recently had a "planned relapse" where I abused dilaudid heavily for two weeks, but felt awful and transferred myself back onto Sub.

The bottom line is, I still have abdominal pain sporadically, even when I'm "in remission" from the Crohn's. When I'm having a flare-up (haven't had one since the resection surgery), the pain is near-constant. The problem is, I don't even trust myself anymore to distinguish between pain and an addict's opiate-craving. I have "bent the truth" with my family and doctors so much over the past ten years that I find it difficult even being honest with myself anymore about what my medical needs are.

I feel strongly that Sub doesn't do much for the visceral pain I experience when the Crohn's is bothering me. However, I don't trust myself and my family doesn't trust me to 1) accurately assess my own pain level and 2) not abuse any meds I'm given. My ultimate "nightmare scenario" is an acute flare-up that comes on while I'm on Suboxone, where I have to be hospitalized and try to finagle pain relief while carrying that kind of stigma. It could very well happen at any time.

Can anyone else relate to what I'm going through? It's kind of a lose-lose situation because it's either dive back into the world of coaxing opiates out of doctors and trying to justify their use to everyone around me, or live with discomfort (is it pain? I don't even know anymore... sometimes, yes, definitely), cravings, or whatever the hell this is.

Honestly getting doctors to write me opiates wouldn't be much of an issue,... hell, maybe a few months to get referred to the right people, a few hours on the phone getting records faxed around,... maybe another month or two trying out the "honeymoon meds" like tricyclics and Lyrica... I could do it. Financially, it would be a fuck-ton cheaper than Suboxone maintenance.

I just don't know if I can stand further alienating myself from my family and potentially winding up back in a pit of self-deceit that lasts god-knows how many more years.

At least there's pot. Thank Christ for that.
 
So I'm guessing I'm not the only person in this thread or these forums who has suffered from both chronic pain due to a legitimate condition as well as opiate addiction.

A little about me: I'm a 27 year old male with Crohn's disease (diagnosed at 17) who has had one major surgery (bowel resection) and multiple hospitalizations for flare-ups, drains put in for abdominal abscesses, etc. Bottom line - pain has been a major part of my life for 10 years and opiates not only helped the pain but made me feel awesome. I became an addict.

Fast-forward through many years of abuse and misuse, and I'm still the same patient with Crohn's disease, except now I'm on Suboxone and my family doesn't trust me around opiates. I recently had a "planned relapse" where I abused dilaudid heavily for two weeks, but felt awful and transferred myself back onto Sub.

The bottom line is, I still have abdominal pain sporadically, even when I'm "in remission" from the Crohn's. When I'm having a flare-up (haven't had one since the resection surgery), the pain is near-constant. The problem is, I don't even trust myself anymore to distinguish between pain and an addict's opiate-craving. I have "bent the truth" with my family and doctors so much over the past ten years that I find it difficult even being honest with myself anymore about what my medical needs are.

I feel strongly that Sub doesn't do much for the visceral pain I experience when the Crohn's is bothering me. However, I don't trust myself and my family doesn't trust me to 1) accurately assess my own pain level and 2) not abuse any meds I'm given. My ultimate "nightmare scenario" is an acute flare-up that comes on while I'm on Suboxone, where I have to be hospitalized and try to finagle pain relief while carrying that kind of stigma. It could very well happen at any time.

Can anyone else relate to what I'm going through? It's kind of a lose-lose situation because it's either dive back into the world of coaxing opiates out of doctors and trying to justify their use to everyone around me, or live with discomfort (is it pain? I don't even know anymore... sometimes, yes, definitely), cravings, or whatever the hell this is.

Honestly getting doctors to write me opiates wouldn't be much of an issue,... hell, maybe a few months to get referred to the right people, a few hours on the phone getting records faxed around,... maybe another month or two trying out the "honeymoon meds" like tricyclics and Lyrica... I could do it. Financially, it would be a fuck-ton cheaper than Suboxone maintenance.

I just don't know if I can stand further alienating myself from my family and potentially winding up back in a pit of self-deceit that lasts god-knows how many more years.

At least there's pot. Thank Christ for that.

Why does your family need to know about this?

It comes down to whether you're really in pain or whether you need the euphoria.

You may trying going to a doctor and getting on methadone for pain. I hear it works pretty well, is way cheaper than sub and will block most other opiates if taken in appropriates doses.

The feeling i get from you is that you need opiate maintenance and maybe you have pain maybe you don't. You have to make the final decision.

The last thing i'd like to say is that family is really all there is in this world and no opioid is worth losing those relationships if they are meaningful to you.
 
Any thoughts on what I can expect?

It is a long time-consuming road to relief and can seem crazy long at times, but the key is to be patient and know that after all this is over, you will have your diagnosis, and your plan for relief and you will most certainly feel better after all is over with than you did when you began.

The key is to be patient, it can be as hard as hell sometimes when it seems like their running in circles, but it does take a long time to get a diagnosis sometimes and we have to remember we're not their only patient, many having hundreds of patients.

The other key is to have a good doctor, one that listens to you, lets you be active in your recovery, and is there for you when you need him/her. It can be hard to find one that fits the requirements, but it is invaluable to your recovery.

I'm always here on bluelight and frequent the Pain Management thread so we're always here to help you as their are a few other very knowledgeable pain patients (Cane2theLeft comes to mind) such as us that also frequent the thread and are a great wealth of information, knowledge, and advice.

Keep your head up brotha,

-TheMatador
 
^I don't mean to question you but if there is something to this, I'd like to understand more. I've never heard of SSRI's (or any psychotropic) causing neurological damage upon discontinuation, can you give me any more information about this? I am definitely not saying you're wrong because I can't know that, but I'll admit I'm skeptical.

I can see SSRI discontinuation exacerbating depression which will absolutely make pain worse but that's a little different then neurological damage... either way, I truly hope you can find some help and some true relief!

As my good friend the matador mentioned, him and I have been navigating the pain management world for years and we've both done a lot of research, tried many medicines and procedures and talked to a lot of people who have been through similar things and with that said, (I don't want to speak for him but I'm confident he agrees) we both would like to help in any way possible!

I am always hesitant to give advice to people going through this because when my pain wasn't sufficiently treated and I was straight miserable, a lot of the advice I got just pissed me off so I'll try to avoid those areas. I have seen a lot of people who are convinced that opioids are the only avenue to relief and I definitely held this view when it seemed like nothing else was working, but try to be open-minded because a lot of things can really make a difference in your quality to life. In a lot of ways opioids are the most effective treatment for pain but alone they still only provide 50% relief for about 1 in 3 people with chronic pain. The most effective strategies for treating pain are utilizing a very diverse approach utilizing different types of pharmacological and non-pharmacological treatment.

Neuropathic pain especially tends to respond better to drugs that inhibit reuptake of serotonin and norepinephrine (specifically tricyclics and SNRI's) or anticonvulsants (topiramate/topamax is popular for TN and other popular options are lyrica, neurontin, lamictal, tegretol and others). Often times drugs like NSAIDs and muscle relaxers can further aid in the analgesia. If nothing else, adding adjuvant medications often provide an opioid-sparing effect so you can get more pain relief without skyrocketing your tolerance.

It's important to get things stabilized some pharmacologically and restore some quality of life, but if you share my philosophy you want to take the least amount of drugs possible in the long run. When I got things stabilized I was able to eventually lower or eliminate many drugs I used for pain and supplement lifestyle changes that really made a difference.

Please keep us posted in here and feel free to ask any questions you may have!

Take care!
 
Great post C2tL, I thoroughly agree with every point, really great post,
you would be a wise man if you listened to his advice chicpoena:)

Good luck with everything, and as always we're here to help whenever needed so make sure to keep up updated!!!

-TheMatador
 
^I don't mean to question you but if there is something to this, I'd like to understand more. I've never heard of SSRI's (or any psychotropic) causing neurological damage upon discontinuation, can you give me any more information about this? I am definitely not saying you're wrong because I can't know that, but I'll admit I'm skeptical.

I believe it was the rapid discontinuation of my high dose SSRI that caused neurological damage. I have posted voluminously on this in the past and there are websites that go into more detail about how it might occur. I also experienced a prolonged neurological withdrawal syndrome. I was not (and am not) depressed, I was initially placed on an SSRI for OCD (which I have cured with psychotherapy).

I believe very strongly in exercising to raise endorphin levels, take fish oil and a multivitamin religiously, get massages, and see a therapist to help cope with the pain. They all help me function but at the end of the day it still feels like I have a nerve on fire in my face. When I cut down on stress I find I am not bothered as much by the blinding shocks.

Part of my frustration is because I am not being listened to. Twice now, neurologists have been treating me for a migraine. The pain is constant with shock-like sensations (my face twitches with the pain). From what I've read I should be on something to block nerve firing or help with nerve pain, like a TCA, but they keep throwing migraine meds down a black hole. Doctors feel I am too young to be suffering from nerve irritation, but I was diagnosed by a resident physician with an irritated nerve in the past.
 
Interesting about the SSRI discontinuation... I hope you didn't get the impression that I was dismissing what you're experiencing because I truly don't feel that way. Regardless of etiology, your doctors should listen to you and thoughtfully evaluate and address your distress so please keep fighting to find one who will listen and treat you properly (in both their demeanor and relieving your symptoms).

I know what its like for doctors to dismiss pain or treat it improperly due to bias because of youth. I was 19 when my pain first started and many of my doctors were straight up unwilling to truly help. Eventually I had a great PCP who managed most of my symptoms for a year and then he left and the doctor I got stuck with then was very dismissive.

Neuropathic pain is absolutely miserable and is difficult to treat but your symptoms absolutely can be managed and your quality of life restored. I found one of the most effective ways to get doctors to fucking listen, was to in absolute detail describe all the ways the pain and associated symptoms negatively impacted my life. I put it in real terms clearly outlining the imposed limitations I faced and more emotional terms describing the impact that had on various aspects of my life. If you are genuine and descriptive I think you can really get them to listen, whether they are the most rational or emotional type of person (most doctors of course being the former but it doesn't hurt to appeal to the latter unless you're perceived as malingering/attempting to manipulate).

I really hope you truly find some relief and please keep us posted here! Also, its great that you're taking care of yourself and exploring alternative ways to find relief and restore wellness but of course, those only go so far. You truly deserve relief so please keep advocating for yourself and make sure you find it!
 
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