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

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^I agree 100%, on top of worrying what the doctor would do/think I don't know that ThePharmacist would benefit most from being prescribed medications he used to abuse.

I think in some situations, doctors have to bite the bullet and give opiates to addicts, but you need to try everything else first to gain their trust at VERY least... non-narcotic meds, PT if you are eligable, biofeedback/neurofeedback, meditation, yoga, accupuncture, etc. etc. etc.
 
Cane2theLeft said:
^I agree 100%, on top of worrying what the doctor would do/think I don't know that ThePharmacist would benefit most from being prescribed medications he used to abuse.

I think in some situations, doctors have to bite the bullet and give opiates to addicts, but you need to try everything else first to gain their trust at VERY least... non-narcotic meds, PT if you are eligable, biofeedback/neurofeedback, meditation, yoga, accupuncture, etc. etc. etc.
Click to expand...

I'm going to get diagnosed first, and see what the actual problem is. If he determines it's something that opiates may be needed for, I'll ask then. The thing is, my pain is still a 6 or 7 with Bupe. Bupe does not help for the pain like a regular opiate would. It's got very little analgesic power in my opinion.
 
^Well of course not if you're on a maintenance dose! If you're body is used to a dose, its not going to produce analgesia... this is true if you were on a maintenance dose of heroin, methadone, bupe, anything.

That's why I suggested raising your dose and/or using medication that increase the analgesia the bupe provides.
 
What comes after dilaudid?

So i got a doc appointment on tuesday and ive been thinking about asking the doc to try something other than dilaudid for my chronic back pain.

Ive been using the dillies for about a year and a half now, taking an average of 32mg a day, mostly plugging.

Of course my opiate tolerance is sky high and it takes way too much to make me feel good anymore. I was wondering if it's worth trying something new.

Are all opiates created equal? If i'm tolerant to one, will another be any different?

Anyway, just interested in hearing everyone's thoughts. My doc is generally pretty loose with his prescription pad, so he'll probably give me anything i ask for, as long as i have a decent reason for wanting to try it out.

Thanks!
 
Your tolerance will have a cross effect with any opiate, the only way of beating it would be if you're put on a stronger dose than the dilaudid of another drug.
 
I don't think a stronger dose will cut it, as it stands upping my dose of dilaudid does not increase the effects for me to any large degree. I was hoping a different opiate might affect me differently.
 
A different opiate may effect you differently more in terms of how it helps your pain I think. Me and my doctor went through every opiate before finding the one I felt worked the best for my pain, but aside from being a different opioid I believe it also could have been because it was the strongest daily dosage of any opioid I had been on yet. But then again I was also put on the 100mcg fentanyl patch, which is considered very strong, and they were not that effective against my most severe pain.

Its worth a try to change, but its risky because the doctor could put you on a med and dosage that doesnt compare to the current one you're on now. He could look at an equivalence chart but even then you never know how it will work out.
 
I'm a pain sufferer , too. I've tried going without medically prescribed
pain medications for over 27 years. I finally gave in, I take the exact
prescribed doses and no more. It's been a long, painful journey.
But, I can't stop The Pain I endure due to osteoarthritis, two foot surgeries,
bulging discs in my spine and neck, plus I'm an ex- gymnast....and a panic
attack suffere.... so I had no choice but to give in to meds. My family is happy because I am more active now than they have seen for years and years.

My fear was wanting more and harder drugs like my sons did, but I now
know that they went on to harder drugs by choice. They started on pain
meds to get high- not for medical reasons (which makes it difficult for
true pain sufferers to get relief for valid reasons).

All I can say is thinking about it more seems to
make the pain worse....

Well, they say laughter is the best medicine.
Want to laugh you ass off? If you haven't seen it already:
[Please refrain from spamming youtube links in multiple forums, thanks - n3o]
 
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I started taking pain meds for the pain and still do - but let's face it - the buzz is nice too and I'm man enough to admit that i don't want to give it up! Sometimes after a crap day at work and my back is killing me all I have to look forward to is going home, taking my meds and just enjoying e way they make me feel.

But after 18 months, the dilaudid barely even registers anymore, and rarely does it get me high.

So, what's next? Any advice on what I can ask my doc for that will put a smile back on my face?

My only idea right now is to ask to try opana. Maybe there is something else, like a muscle relaxant or sleeping pill or anything that, when combined with dilaudid, will give me a good result?
 
I dont think it has anything to do with the dilaudid. Your tolerance is high and it will now be very tough to get any kind of buzz unless your tolerance drops. Many daily users here have the same problem. No matter what drug you use, heroin, dilaudid, opana, if you use it daily at a high amount you will eventually have a near impossible time getting high.
 
I had my appointment today. The doctor spent all of about two minutes looking at me and decided I had Myofascial Pain Syndrome. I got injections in my "trigger points" of lidocaine, and some steroid, and it hurts worse now. I was given a script for Meloxicam and Tizanidine. NSAID and Muscle Relaxer, respectively.

I'm pissed because the doctor didn't listen, I had a written down list of symptoms and a pain diary and he didn't even pay attention. I'm in A LOT of pain, and there's nothing anyone will do.

Should I go see another doctor? Or call him back? The injection sites are killing right now. . .
 
Im sort of surprised he didnt put you on something like lyrica. He could actually be right about your diagnosis and the muscle relaxer may help. Some experienced doctors will look for certain things in patients claiming pain and if they dont see them then they may not fully believe you. You could go see another doctor until you get what you want, maybe a PCP/GP may be able to help you more, I dont know what else you can do.
 
ThePharmicist said:
I had my appointment today. The doctor spent all of about two minutes looking at me and decided I had Myofascial Pain Syndrome. I got injections in my "trigger points" of lidocaine, and some steroid, and it hurts worse now. I was given a script for Meloxicam and Tizanidine. NSAID and Muscle Relaxer, respectively.

I'm pissed because the doctor didn't listen, I had a written down list of symptoms and a pain diary and he didn't even pay attention. I'm in A LOT of pain, and there's nothing anyone will do.

Should I go see another doctor? Or call him back? The injection sites are killing right now. . .
Click to expand...

Sadly, you're in pretty much the same position as the rest of us chronic pain sufferers with the docs....

Injections rarely help at all, and usually cause a lot more pain than they relieve. For some people they do help, but it takes a day or two for the initial pain to subside enough for it to count as relief. Depends a lot on the condition and the doctor as well as what is being injected.

Being mostly ignored in favor of only the most obvious, simple observations (and ignoring the details which are often at least as important) is unfortunately par for the course. I wouldn't put much hope in that improving even if you found a different, "better" doc.

Personally, I suggest trying Turmeric. There are related supplements including ginger, bromelain, cayenne, piperine (black pepper extract), etc which can help...but Turmeric is by far the most effective anti-inflammatory supplement that I've used -- and I've tried almost everything there is over the years. It works better than NSAIDs for me.

You may also want to try Voltaren Gel....it's an NSAID that is applied topically, so there are fewer side effects and it works better because it's directly at the site of worst pain -- for me, the sacro-iliac joint. I have pain everywhere, but my ability to cope with the 1,000 other things is very much variable based on how I'm doing with the single worst source.

Frankly, we're mostly on our own with this shit. It's sad, it's frustrating and it makes me incredibly furious. But 99% of docs -- even those specializing in pain mgmt (pathetic as most pain mgmt practices are!) -- aren't going to do anything close to what they could be for you. They'll rush through your appointment and ignore half the shit you say no matter how important or accurate it is....and they won't consider -- or even think of, in many cases -- any number of valid treatments.

Cannabinoid therapies have been very helpful to me: cannabis itself, Marinol, and Cesamet in particular.

You may want to look into Low Dose Naltrexone; you can acquire the 50mg naltrexone tablets online if necessary (e.g. your doctor won't consider it, or you aren't willing to potentially damage your relationship by even asking about something that most docs consider so outlandish/unproven), and dissolve them in water to accurately measure out the necessary dose, anywhere from 15-25 micrograms to 4.5 milligrams. Most patients find a "sweet spot" between 0.5 and 3 milligrams. Look up LDN/Ultra LDN/ULDN/ULD-NTX on BL or Google for more details on how this works....I'm about to start it, hopefully with my doctor's support, as an adjunct to low dose pain medication. I've been on quite high doses (equiv. to 500-600mg+ Oxycodone per day) in the past, and didn't get adequate relief. I battled to get down to nothing last year and have resumed low doses, but don't see much long-term hope for pain relief other than (U)LDN.

My hope is that the (U)LDN will upregulate my natural endorphins/enkephalins, possibly even directly relieve my auto-immune problems by "balancing" my immune system, and maintain my tolerance at a near-naive level while helping the opiates work better. If it works well enough, I may even discontinue the opiates entirely and go with just the LDN alone.

There are other things I'll try to mention in this or other threads if I get a chance....but except for a few other supplements that may be useful (some, such as Phenylalanine, may work well with (U)LDN), my principal suggestions are Turmeric, Ginger, and LDN.

I'm sorry you're going through this....it's hell, and nobody but a fellow sufferer will ever really understand.
 
Yo, Grandma,
DONT SMOKE DOPE!
You may get thrown off your doctors list, forever.
It has happened to people I know...just trying to get relief, they smoke a joint then get tested and thats it, no more pain medication.
 
^Its certainly something to be conscious of, Dave but its not that black and white. There is often a lot of discretion involved in these situations.

There are certainly doctors who would drop a patient or cease prescribing medications if someone pissed dirty for pot and I've even spoke to some PM patients who this has happened to. I've also spoken with other PM patients who failed for pot and their doctors didn't care at all. When it comes to pot, doctors have differing views (for both therapeutic AND recreational use).

Not to mention 14 states have medical marijuana that should be relatively accessible for pain management patients.

Its always good to be open with your physicians but when it comes to issues like this, just be cautious. Early in treatment with a doctor you could tell them that in the past you've used marijuana and it helped and to get their views on it... if they say they'll drop you for that, then be aware. If they say they don't have a problem with that then you'll know.
 
Im 35 and have had problem with chronic knee pain for almost 2 years and my doctor refereed me to a pain clinic my first appointment is on Jun 9 2010. I have had x-ray's and mri's that both showed nothing but the aching, burning and throbbing pain in my knee is definitely real. I was pescribed lidoderm patches for my knee that did nothing and I recently had a cortisone/lidocaine shot in my knee on May 5 2010 and it didn't work at all the lidocaine numb it for a day at the most. I take 1 7.5mg Vicodin ES at night for pain from a umbilical hernia surgery and they barley ease the pain from my knee a little. Sometimes my wife has to put her leg on to of my knee until my leg goes numb so I can fall a sleep. The pain in my knee keeps me awake most nights (3:10AM as i type this) which adds to my anxiety and depression which I take lexapro for which does not help and i refused to take ambien again for sleep(makes me sleep walk with amnesia). Will having my mri's and x-ray's come back normal cause me more problems when I see the pain management? What should I expect on my first visit? How should I prepare my self for my first visit? (My pain management and primary doctor are in the same clinic)
 
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^PM doctors generally do two things- diagnose and treat pain. If they believe you and trust you, they will generally treat your pain more aggressively than GP's but they will also pursue diagnosis so will probably have you do a lot of tests that don't show anything in the meantime.

Doctors vary quite a bit from region to region and even just doctor to doctor so there is really no way to predict what type of doctor you will have.
 
John_Burrows said:
I started taking pain meds for the pain and still do - but let's face it - the buzz is nice too and I'm man enough to admit that i don't want to give it up! Sometimes after a crap day at work and my back is killing me all I have to look forward to is going home, taking my meds and just enjoying e way they make me feel.

But after 18 months, the dilaudid barely even registers anymore, and rarely does it get me high.

So, what's next? Any advice on what I can ask my doc for that will put a smile back on my face?

My only idea right now is to ask to try opana. Maybe there is something else, like a muscle relaxant or sleeping pill or anything that, when combined with dilaudid, will give me a good result?
Click to expand...

Pretty pathetic to tailor your pain management regime so that you get high instead of treating your pain , its not like your doctor is giving them to you to get high with .
 
i am causal user of H for 7 years. i re-injured my knee 3 months ago. i went to several doctors and was completely honest with my past addiction to H, but almost felt discriminated against at one point... so after that i decided to go to a gp with my diagnostic report of my original mri i had seven years ago, in about 2 and a halft months i've gone from being on 5mg oxycodone ir's as needed to 5mg contins twice daily, then to 10mg and now i'm currently on 20mg 3 times daily.
and my quality of life is so much better at the moment.

i know it's different everywhere, but if you feel like you're not getting the best possible treatment, then you should defiantly be seeking a doctor who is willing to listen to you and effectively manage your pain.
 
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