The Pain Management Mega Thread v2.0

[Doug2113]

BiggDirty-Just read through your story and Jesus Fucking Christ that sucks...I'm sorry you had to go through all that...My parents have been trying to push back surgery on me, but I've been deathly afraid of it because of the stories of people getting worse from it, but goddamn, your story not only takes the cake, but the entire fucking bakery along with it...I'll let them rip open my gut/make tiny slits and slide a camera in there, cut out some organs, reattach my blood vessels/digestive tract, and sew me back up, but I'm fucking terrified of letting them anywhere near my back with sharp pointy objects...fuck, I was afraid of getting a nerve block/epidural/steroid injection for that matter...I'm really sorry about your experience and I hope you can get your pain under control...

 

[BiggDirty01]

Thanks bro. The thing about surgery is that if you are at your wits end (epidurals,rhizotomy, PT, yoga) and you are not getting any relief except for narcotics it sometimes makes it a decent roll of the dice.

But honestly after the 1st one at the beginning of 2011 I was able to kick the HM,Fent, MSContin and Methadone and spent 6 months clean doing yoga and stuff and have never felt better in 5 years.

But then 2 vertebrae around the cage broke around thanksgiving and then you are shit hitting the fan.

Note to self: Never pick up your head in the Operating room before anesthesia ...bone saws look straight from home depot)

 

[muvolution]

Most hospitals, even Cedars Sinai, don't stock IV oxymorphone, especially because trade name Numorphan is also a name for paramorphan, and can cause confusion.

As to hyperalgesia: I have found that when my meds are no longer working, backing off a few days really helps. It sounds like they either were to aggressive to begin with, or used a medication not suited to you.

 

[Doug2113]

You really aren't helping to easy my fear of spine surgery with that last line lmfao...next time keep your notes to yourself TO yourself .

I have no clue what in the hell rhizotomy is (but it will get wiki'ed after posting this lol), but I've been through the epidurals, PT, dry-needling, chiropractic adjustments, decompression therapy, aqua therapy, UV therapy, TENS units, etc., etc. so I know how frustrating it all can be...Thankfully (in a sick and twisted way), I've had doctors that thought I was a drug seeker, or too young to be Rx'ed narcotics, or something to that effect and I've been kept on tramadol (albeit it hasn't really worked since the first 2-3 months I was on it) for the longest time, so I have a long line of narcotic medications to go through before truly having to consider surgery...hell, I JUST got Rx'ed lyrica, which is only a C-V medication, but I got referred to a PM clinic, so hopefully I'll see SOME relief finally...but, it probably sounds like I'm bitching, and your issues are far more worse than mine, so I'm just gonna shut up .

 

[BiggDirty01]

Lyrica is an excellent medication for neuropathy IMO and I've used neurontin and cymbalta prior.

A rhizotomy is using a lighted scope to burn off troublesome nerves and network points. PM doc pushed procedures he did at his "secret surgery center". Never had much of a spasm problem until this unnecessary procedure.

PM me if you have Q's or whatnot, I'm not sure I understood your diagnosis.

My story is the abnorm, hearing and speaking with others helps normalize my insanity.

Youth has been used against me in treating pain. It is absolutely despicable. But continuing to do all that is asked of you by the MD should be enough of a statement of your intent to try and get better. If you come across a doc that still spits on you after you try all he suggests (see: pain doc #4 for me) then you tell him to basically fuck off and write a bad review on yelp or something...

 

[BiggDirty01]

Most hospitals, even Cedars Sinai, don't stock IV oxymorphone, especially because trade name Numorphan is also a name for paramorphan, and can cause confusion.

As to hyperalgesia: I have found that when my meds are no longer working, backing off a few days really helps. It sounds like they either were to aggressive to begin with, or used a medication not suited to you.

I agree and this being my 3rd surgery in 15 months, the staff was notified there a week in advance and coordination between my outside doc and hospital staff occurred. Yet still had to deal with "we were unprepared for your pain issues" as a responses when I flipped out at staff.

Interesting wouldn't stock OM for confusion but have no issue blasting ketamine with HM into my HV while ketamine is an animal tranquilizer. Cedars is a great hospital, but they got lost in their own bureaucracy and lack of back up plans (hence the freestyling with med combos and doses).

 

[muvolution]

Ketamine was actually a human tranq first as it is one of the only anaesthetics that doesn't require extensive life-support measures (like propofol) and was used extensively in vietnam, and continues to be stocked by most hospitals and emt's as there is just nothing that can replace it.

Most hospital pharmacies can and can't get some things, even if you try and coordinate beforehand. If you are at Cedars, why not see about Levomorphanol?

 

[macd610]

Ketamine was actually a human tranq first as it is one of the only anaesthetics that doesn't require extensive life-support measures (like propofol) and was used extensively in vietnam, and continues to be stocked by most hospitals and emt's as there is just nothing that can replace it.

Most hospital pharmacies can and can't get some things, even if you try and coordinate beforehand. If you are at Cedars, why not see about Levomorphanol?

Muvolution,
Hi there! Would you mind telling me of any experiences you've had with Levonorphanol? My dr has brought it up before....is it also known as Levodremorphin or something like that?
Thanks.

 

[muvolution]

I have no experience with it, but it is stronger than heroin, extremely long lasting, and effective.

It has a 70% BA (oral) with only 40% protein binding, and a half-life of 12-16 hours. Sounds wonderful to me.

From wiki:

Its NMDA actions, similar to those of the phenylheptylamine open-chain narcotics such as methadone and ketobemidone, make levorphanol useful for types of pain that other analgesics may not be as effective against; levorphanol's sigma receptor, SNRI properties make it even more useful particularly for neuropathic pain.

http://en.m.wikipedia.org/wiki/Levorphanol#_

 

[macd610]

sorry if this is a pain...but if oxycodone ir doesn't last long enough and oxymorphone ir was ineffective in every way, would this be a reasonable choice? My MD brought it up but am having a hard time finding people who have tried it? ?

 

[BiggDirty01]

Ketamine was actually a human tranq first as it is one of the only anaesthetics that doesn't require extensive life-support measures (like propofol) and was used extensively in vietnam, and continues to be stocked by most hospitals and emt's as there is just nothing that can replace it.

Most hospital pharmacies can and can't get some things, even if you try and coordinate beforehand. If you are at Cedars, why not see about Levomorphanol?

Luckily went home yesterday...thankfully.

On another note, the IV fent caused me a new problem: Fentanyl Neurotoxicity. Between the 36 hours of IV and then patches (I put new one on when I got home) the fent had apparently caused the hyperalgesia as I mentioned.

Last night I suffered through the most intense hallucinations, they would not stop and I found myself talking to them. Because I had only slept 3-4 hours TOTAL until I got home.

I spent hours trying to call my PM Doc via answering exchange between like 2-5 am. His partner was on call; did not call me back. Cold sweats, hallucinations, exhaustion and the subsequent vivid dreaming and nightmares when I did fall asleep led me to tons of information detailing the symptoms of fentanyl neurotoxicity.

I have never been more distraught or uncomfortable as a side effect of opiates (illicit or otherwise). I haven't done hallucinagenics in years so the experience of interacting with these vivid looking characters in my hallucination was terribly out of the blue.

I still have my fent patch on only because I haven't spoken to my PM Doc so he can either continue or DC the med in favor of another ER medication. I still have like 120 10mg methadone but I am too afraid to take any or discontinue the fent to restart the methadone.

Oh, and btw, the Mali Fent patches suck dick.

 

[tricomb]

Are the mylans better? You know when they first came out, people hated on them for being non-gel, but I liked the matrix.

I'm sorry you had such a bad experience, heart goes out to you.

 

[oxy4toolong]

I would ABSOLUTELY LOVE to know how this worked for you. I have Chronic constant pain from MS and a car accident in 2008 that left me with enough titanium to build a spaceship...lol Ive been on 60mg ms contin twice daily and 30mg oxycodone 4 times a day for way too long. I recently took myself off the oxy....NOT AN EASY TASK!!! please let me know if the suboxone works for pain. Thanks...

 

[muvolution]

Well the strong opiate action plus the nmda agonism plus the snri interaction would, in my experience, cause it to absolutely destroy your pain.

I woud love to give it a shot. I would recommend it to you.

 

[GABAking]

I would ABSOLUTELY LOVE to know how this worked for you. I have Chronic constant pain from MS and a car accident in 2008 that left me with enough titanium to build a spaceship...lol Ive been on 60mg ms contin twice daily and 30mg oxycodone 4 times a day for way too long. I recently took myself off the oxy....NOT AN EASY TASK!!! please let me know if the suboxone works for pain. Thanks...

I apologize for the length of this post....
____
Congrats on getting off the oxy--no easy feat.

For chronic pain, buprenorphine (suboxone/subutex--sublingual tablet; butrans--transdermal patch) is a fantastic medicine. My pain management doctor gives it out when people either don't tolerate high dose full agonist extended release medicines well (oxycontin, MS contin, etc) or when a patient wants adequate relief from chronic pain, but doesn't want to be "high" and mentally impaired/clouded (like for a student who has to study often or a job that requires you to be attentive and alert).
After using buprenorphine for a week, most patients stop feeling the distinct euphoria that the drug gives (it's a lot different than full agonist opiates), but will continue to have great pain relief (as a plus, it also works as a very effective antidepressant--it made me noticeably happier and motivated the day I started to take it and every day I dosed). Me and my friends' experiences show that users don't become tolerant to the drug's analgesic, anixolytic, or antidepressant qualities until very prolonged use. Tolerance builds very, very slow, especially compared to other opioids. You only seem to build a tolerance to the high it gives you

Keep in mind you'd have to stop taking the morphine, because the buprenorphine would block its effects.. If you dedicate yourself to suboxone as a medicine, you're not gonna be able to add any breakthrough medicines, except maybe tramadol, NSAIDs, and the like. No opioids. (This is if you're getting the tablet. The patch delivers a lower amount of bupe, so you can have BT opiates while taking it)

If you're in the states, your doctor will most likely put you on Butrans (a transdermal patch) rather than Subutex/Suboxone, because that's normally used for opiate maintenance (it's not unheard of though for a pain patient to receive the tablets). I was on the patch for 1.5 months, and it worked really well for me. It takes a couple days to kick it, but after 2-3 days, your plasma levels maintain a stable, constant amount of buprenorphine. Patches are worn for 7 days so it's convenient. With your tolerance, I'd ask or the 20 mcg/hr patches (the highest they make) with some BT meds. If you get the SL tablets (they come in 2 and 8 mg) you'll be set

Lastly...this drug is one of those 'less is more' scenarios. Bupe is an agonist-antagonist, but at lower doses, it acts more like a full agonist. once you start elevating the dose the antagonististc properties kick it. In europe they make these pills specifically for pain instead of opiate maintenance, and the dosages are .2 and .4 mg. We get 2.0 and 8.0 tablets. Biggest downside is that Suboxone (bupe+naloxone) and Butrans are very expensive drugs; Subutex (bupe only) has gone generic and is affordable though

all right I'm done. gah. I took some adderall so sorry if this seems long, but I really advocate this drug over other pain medications. It lets you live a more normal life in the sense that you don't feel doped up all the time (Granted, that is really fun, but I digress...).
If you're looking for really good pain relief and not just trying to get high off your medicines, then you should definitely give it a shot.

 

[Psychonauticunt]

Sometimes getting adequate pain relief where I live is fuckin' hard. The narcotic painkiller scale goes codeine-tramadol-oxycodone-morphine.

Codeine and tramadol are pretty interchangeable in my opinion, although tramadol is slightly stronger (and longer-lasting). Oxycodone and morphine are very strong, but not easily prescribed for just anything, and rightly so. Hydrocodone would be a nice in-betweener; I have found myself having to take tramadol in excess of 400mg for adequate pain relief.

 

[BiggDirty01]

Sometimes getting adequate pain relief where I live is fuckin' hard. The narcotic painkiller scale goes codeine-tramadol-oxycodone-morphine.

Codeine and tramadol are pretty interchangeable in my opinion, although tramadol is slightly stronger (and longer-lasting). Oxycodone and morphine are very strong, but not easily prescribed for just anything, and rightly so. Hydrocodone would be a nice in-betweener; I have found myself having to take tramadol in excess of 400mg for adequate pain relief.

Man, that sucks bro. I feel for ya. I was wondering what your condition was and if that relates to how they are treating you?

Is marijuana an option. In Cali now they have lab testing on the medical marijuana so depending on your condition you can find buds higher in THC (anti-nausea, muscle relaxant) vs CBD which is generally being accepted as the valued actual "pain killing" property found in bud.

Best of luck to you

 

[tricomb]

Man, that sucks bro. I feel for ya. I was wondering what your condition was and if that relates to how they are treating you?

Is marijuana an option. In Cali now they have lab testing on the medical marijuana so depending on your condition you can find buds higher in THC (anti-nausea, muscle relaxant) vs CBD which is generally being accepted as the valued actual "pain killing" property found in bud.

Best of luck to you

I use california medicinal cannabis concentrates, THC rich for pain and CBD rich for the antipsychotic.

 

[Psychonauticunt]

Man, that sucks bro. I feel for ya. I was wondering what your condition was and if that relates to how they are treating you?

Is marijuana an option. In Cali now they have lab testing on the medical marijuana so depending on your condition you can find buds higher in THC (anti-nausea, muscle relaxant) vs CBD which is generally being accepted as the valued actual "pain killing" property found in bud.

Best of luck to you

Living in the Netherlands, marijuana is very much an option but I find it is only suitable for certain kinds of pain. Serious injuries to joints and limbs need something stronger than marijuana - at least for me.

 

[Doomed2pain]

I find cannabis helps bring my pain down a point if i smoke enough but unfortunately it isn't available medicinally here and i cannot afford to smoke enough as and when i need it.

I just keep taking my meds, doing my physio and meditating in the hopes it distracts me for a while.