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Harm Reduction The Pain Management Mega Thread Version 4

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^ welcome to the pain management thread!

are you seeing a pain specialist? have you talked to your prescribing doctor that your meds dont work? sometimes nothing works for me too.
 
Brighton

Pain specialist no but Ruhmatologist yes. But he is old as hell and against pain killers. All I get from him is Tramadol, cymbalta, and gabapentin. Which I find helpful but does not kill all pain and most of the time I'm still really hurting. I was diagnosed possibly fibro and definantly osteoarthritis. How about you?
 
Any issues with nerves like fibro do not necessarily respond well to treating with Opioids. Methadone is the best opioid for treating nerve pain.

And issues with osteoarthritis, of which I have (and autonomic peripheral neuropathy...very painful), is a tricky diagnosis when it comes to opioids and respond best only to certain narcotic medications.

Try and do some more reading and consider seeing a PM Specialist.
 
Sorry about all the pain thats awful.

Also, saying methadone is the best for nerve pain is a pretty vague statement (no offense).
Truth is noone knows that and we all respond differently to medications. There are many other ones to try if you do decide on going the narcotic painkiller route. Talk with your doctor, and be honest with all treatment.
 
Can you just go out and see a pain specialist or do you have to be refered by a Doctor?
Before seeing my RA my regular doctor had me on Vicodin for the pain, it didn't really work either.

Not sure if there is a difference state-to-state or with insurance companies but I needed a referral in NY state. Also then had to fill out a long questionnaire from one PM dr to see if I "qualified." I'd call a PM specialist and ask to make an appointment and see what they say about how to start the process. Best of luck, and my primary put me on Cymbalta for a short time too, it didn't do anything and made me feel crazy on top of it. Like others have said everyone responds to different meds differently and nerve issues especially are really tricky
 
I don't feel crazy on the cymbalta. However I get super fatigued, I won't take more than the 50mg dose cause it makes me so sleepy. Thank you for all the info, I really like this thread.

I had completely the opposite reaction from Cymbalta, made me all twitchy and speeded up thought processes but couldn't string any of them together,it was like every thought was a different leaf blowing away in the wind, after 2 weeks told my doctor couldn't take it anymore. Anyway yeah, this thread has a lot of good advice from people who have been there and done that, am grateful it exists.
 
I haven' t yet figured out how to tell who is replying to which post. So I may be replying to posts not directed to me. In any case, I do have a question so this will not be just a waste of screen space.

For the first time ever, I have run out of my oxcodone five days early. We recently (last Wednesday) moved from our four story home to a four room one story house. I did take extra oxy this last month on extra bad flare days.

This is the first time I have ever run short in all the months I've been prescribed them. I started on 5/325 oxy and about 3 months ago doc moved me to 7.5/500 because after 7 months or so, the fives weren't helping much. I am also out of the lorazepam, 2mg prescribed at hs (bedtime.) and there were days this past month I took 1mg during the day. We've lived in the same place for 17 years in the very middle of nowhere. Closest neighbors were a mile away and now I'm on a one acre lot in a neighbohood. The anticipation of the change was stressful to say the least. I also take skelaxin, which oddly enough, I have a ton of left so I am taking them as prescribed x3 daily.

Apologies for the ton of info given but I felt if you knew everthing, I'd have a better chance an informed opinion from you good people.

Anyway, my question (finally. I know!!!)

I took my one last oxy yesterday morning instead of the prescribed 4 per day. I am having no withdrawal symptoms (so far at least and that is a pleasant surprise) and no lorazepam for sleep since two nights ago.

I have about 30 Tylenol Codeine 3s and about a hundred .25 Alprazalom.

Can I safely take these drugs as a sub for my lorazepam and oxy until Monday? BTW, these are my scrips from last year when I had surgery and healed so well, I only took them for a few days instead of the month my surgeon thought I would need them which is why I have such a surplus.

I used marijuana after my surgery which worked well enough by the second week after surgery to stop he two scrips. (I won't have access to that herb, my DOC, until Christmas, a few weeks away.) I know this was simply poor planning, or rather no planning on my part.

I just couldn't afford to lie on my back, crying in pain, covered in heating pads for a day or four in a flare while a huge houseful of things needed sorting, donating and packing up so many years of a wonderful life I loved by a specific date that had to be met.

Any way. Two questions and I am sorry if this info is here somewhere. I typed this long posts in five sessions because I can only semi recline for a short time before having to curl up on my side, the most comfortable position for me. Apologies.

So, can I sub these two drugs for a few days and if so, considering the lorazepam 2 Mg and 7.5 oxy, what doses should I take of the tyl 3 and the .25 alprazalom?

ETA:
I did take a tylenol 3 this morning and it does help @ just one every four or five hours so I'll leave that alone for now but the .25 alprazalom didn't help with sleep night before nor did the .50 I took last night. I think the .50 may have helped me fall asleep but I was wide awake three hours later. Can I take another dose in the middle of the night or would taking a larger dose before sleep work longer?

If you've made it through this post, thank you. Any comments or advice will be very much appreciated.

Mods? Please move this if it belongs elsewhere. TY.
 
Personally, I would just call your doc and be honest about your stressful move. Also most pharmacys let you have ur script up to a week early.
And kuddos to you, your doing great, breath,rest and take one day at a time.
 
I have a question for fellow pain management patients. I'm currently in very severe and constant pain WITHOUT pain meds, so thank God I found a great pain doctor who is helping me a lot. I've been having intermittent pain problems for the past 20 years, but it's gotten worse and worse as the years go by. I now am in CONSTANT SEVERE PAIN, which is a horrible way to live. But the opiates DO help.

My question: What would happen to a pain management patient if their UA drug screen tested positive for an "unauthorized" substance? Here in California, we have legal medical marijauna, but even that it probably not allowed by most pain docs. I know that pain docs have to be careful to follow all of the FEDERAL LAWS, which trump the state laws.

Actually, my pain doc has been practising for about 25 years, and he has always fought AGAINST mandatory drug tests for patients. He told me he'd never take someone on as a patient if he didn't trust them.

However, after the Michael Jackson tragedy Calif. put even MORE pressure on pain doctors to drug test their patients. So by 2009, my pain doc no longer felt that he could avoid drug testing his patients without possibly getting shut down by the DEA. My pain doc is so nice that he even apologized profusely for making me give a urine sample like a convict on parole. It's rather humiliating, but I know I have nothing to fear. I've had two drug tests in the past 3 years or so. All came back clean of any non-authorized drug.

I don't smoke marijauna even though a few friends have suggested it for pain. I handle opiates and benzos great (I have a high tolerance) but marijauna is one drug that I really cannot handle very well. (MJ makes me feel VERY sleepy and VERY stupid). SO I don't take MJ in any form.

I also have never tried any of the "hard" drugs: i.e. herion, cocaine, methamphetamine, etc.

The only "drugs" I've ever done in the past were psychedelics. Before my pain got so bad, I was involved a bit in the rave scene here in Calif. My pet turtle likes Lucy in the Sky With Diamonds and also something "ecstatic". It's been a long time since my turtle took any psychedelic drugs, but she did so in order to experience transcendental levels of consciousness. My turtle was even given her entheogens by a licensed psychologist, so she is a pretty cautious turtle.

I know we're not supposed to ask questions re: drug testing here, but that really is NOT my question.

I just wondered in general what a pain doctor might do if a patient's UA screen came back positive for Ecstacy? Or marijauna? (I'm pretty sure LSD is undetectable, but again, I'm NOT asking if it is or isn't.) Would the patient be "terminated" by the doctor for just one mistake? I'm guessing that the answer is probably yes, knowing all of the rules and regulations that the DEA puts on pain docs.

My turtle is way too smart to ever do anything to jeapordize her great relationship of trust with her PM doc. My turtle has abstained from ALL entheogens ever since she began seeing her pain doc (about 3 years ago). My turtle's pain is so SEVERE that she NEEDS strong pain meds just to be able to funtion at all in life.

So my general question is: What would happen if a pain patient's UA screen revealed any "non-authorized" substances? Is the penalty automatic expulsion or termination? Or is there a warning and then the patient is told to NEVER do it again "or else"?

Has anyone had the experience of testing positive for a non-authorized substance at your pain doctor's? IF so, what were the consequences? Thanks in advance for any info or personal experinces! I'm here to learn, and I know this is one forum where people won't be judged for their past entheogen use. I guess my pet turtle had better put her rave days behind her FOREVER? That's a rather sad thought, but my turtle's pain is unbearable WITHOUT opiates, so I guess that is just a sacrifice that she must make, right?

Thanks again for any info or experiences! I have no idea what happens to a pain patient if they test positive for a "non-authorized" drug, but I'm guessing that the consequences would be pretty ugly. My pet turtle is very intelligent and doesn't like to take risks, especially with something as important as pain relief!

I'm sure someone on here has at least heard a story of what may happen if a pain patient were to test positive for "unauthorized" drugs? I'd love to hear any stories, anecdotes, or experiences as to what happened to the pain patient in this situation. Thanks.

Eva
 
Hey all-

I have been through hell and back for the past three months. I didn't get a chance to know many of you as I was pretty new before I lost my place to live and the domino effect took over. Bad thing to be a chronic pain patient and homeless. Very bad.

I swallowed my pain and worked my ass off at a shelter so I could stay off the streets. I saw a great deal of people that are, in part, homeless because of their pain and the unrelenting issues associated with being disabled and not being able to work. You become a number, pigeonholed, stigmatized, and I just realized this is a pain management thread not a place for a synopsis of ideologies.

I would like to know if any of you have experienced deprivation to the point of being nearly off the map due to pain. Specifically, pain's impact on one's ability to work.

How do you get by? I get help through Social Security but I know it is not nearly enough for someone to live on unless you have little to no monthly monetary debits.

I finally had to work a PT job for less than half of what I used to make before the pain left me jobless 4 years ago. The new job requires a great deal of movements that I am not supposed to do such as lifting, reaching, squatting, and just about any movement requiring use of the back and shoulders. The upside is that I can withstand the pain for a few hours and then take my meds. I cannot take them while working (yes, opiates). I can also afford my own place again though it will take some time to be fully self sufficient.

I could write a book on disability and homelessness and maybe, once settled, I will. It is simply awful out there and any feedback from fellow PM patients regarding this issue would be greatly appreciated. Perhaps it belongs in a thread all its own but I will leave that to the mods.
 
Sorry about all the pain thats awful.

Also, saying methadone is the best for nerve pain is a pretty vague statement (no offense).
Truth is noone knows that and we all respond differently to medications. There are many other ones to try if you do decide on going the narcotic painkiller route. Talk with your doctor, and be honest with all treatment.

Once again your arrogance begets your integrity and your appearance as knowledgeable. I didn't just come up with the notion that methadone is the best opioid for nerve-related pain. It's something I've discussed with two different PM Doctors who are professors at UCLA and they are substantiated by plenty of literature and peer-reviewed studies in this area.

Methadone's unique properties and NMDA-antagonism make it the best option if you require narcotics for nerve pain. Not just my own experience with it, there exists plenty of supportive information.
 
I have a couple questions maybe some of you could help me with, and if this is maybe better suited for basic drugs or or other drugs then please move this mods. Anyway I have long term chronic health issues: both hips need replacement, a shoulder and ligaments are shot and need replacement, bad arthritis everywhere, cervical herniations impinging on nerve roots/spinal cord, some lumbar scoliosis, kidney problems including only having one, stomach problems which needs major surgery which putting off as long as possible, various nerve problems caused by/creating these other issues. For various reasons surgeries to fix these either aren't advisable-- have had 30 or so past surgeries, developed problems with general anesthesia, reactions to previously safe antibiotics, and have still-unclear nerve problems affecting inner organs and limbs-- or won't be happening anytime soon.

Am on a fentanyl 50mcg patch, 10 mg oxycodones, and neurontin. I've been on all of these meds for 4 years and lately am starting to have some problems, namely am feeling more fogged out but with considerably less pain control, it's the worst of both worlds. Some of this is due to knowing certain things have gotten worse, namely the hips, stomach, and shoulder, but some of it just feels like I'm not on the right med mix anymore. And my sleep has been shitty for years but it's getting worse now too, for the last 9 months average about 5 crappy hours a night where wake up repeatedly (or have lots of dreams about pain which is just fucking unfair, at least let me see visions of sugarplum boobs) and while taking benzos or Ambien helps it's more like being on knockout drops instead of real sleep, still don't feel rested at all so rarely take them.

I want to speak to my doctors about switching up meds, think have gotten too assimilated to the percocets, and know OxyContin has a time release version but the only time ever had it was a hospital stay when was on so many other IV painkillers that really don't remember what it did. I don't want anything strong than the percocets, in fact I'd like to try something a bit less strong if it lasted longer, am so tired of waking up constantly, being an absolute mess for hours the next morning, etc. This isn't about upping dosage, it's more like wanting to make a lateral move, know what I mean. So what would be a appropriate dose of OxyContin (or a different, long lasting med) for something like this? Also, I don't want to up the fentanyl strength, have tried it before and it gives me splitting headaches and generally makes me feel like crap.

My other question is, the lack of sleep and constant hurting is starting to get to me, my memory is getting worse and feeling foggier more often. I do what I can to stay mentally active, read 3-4 books a week (in a past life before Pain I was a novelist), went back to playing guitar, started doing small gardening stuff a couple years ago, and do as much possible physically to get endorphins flowing but I feel like I'm slipping lately. Is this just one of the doleful effects of long term narcotic use, does anyone think changing from percocets to something else could help, and can I take vitamins to try to mitigate what feels like the slow onset of tardism? I'm going to pick up B12s and other vitamins tomorrow, I've heard kava kava might help but really don't know much about it, but does anyone know of other helpful supplements, especially things that could assist while on narcotics?

Any help greatly appreciated, typing this long tedious post has finished me for the night, hoping get up tomorrow and someone responds "I'm actually your primary physician, recognized your symptoms and a bigass RX for blow, dilaudid, fresh fruit, and a free cottage overlooking a lake in the canadian rockies will be waiting for you at the desk on monday morning' :\
 
Wow, this place is deserted...

Quick check in....my spine health is continuing to worsen as the temperature continues to drop. It is taking me twice as long just to get in and out of bed and it seems like every step I take requires more and more effort.

My only positive over the last 7-8 weeks is that I've radically altered my diet so I can get back to my pre-surgical weight of 190lbs considering I am 6'4. I've put on about 80 pounds at the max, and now am down over 20lbs with the hope that continued effort in this arena will take more and more pressure on my spine.

Hope all is well with everyone, and I pray for continued reduction for everyone's pain...
 
as some of you may know i have chronic neck and back pain and i was in a car crash this Halloween and since my neck and back have been killing me even on high doses of my pain medications
 
Hey everyone,

I've been reading through this thread and would like to join the pm group, everyone seems lovely and CP is hard to deal with alone.

I had a bad car accident in 2005, I herniated a number of discs in my neck and thoracic and had a fracture as well. I've had a neck fusion and 2 thoracic decompressions. My spine is stable now, although I am developing cervical stenosis slowly. My back aches a lot but the worst part of my pain is severe thoracic nerve pain. It's pretty acute and unfortunately breathing makes it worse lol. Anyway, that's basically me, I've had some other bad luck which has contributed to my pain, a liver resection in 08 and a massive staph infection which meant 7 spinal debrasions in 3 weeks. Wow, I'm just whinging now! I'm sorry. I don't talk a lot about my pain, I find it very hard to discuss with friends and family.

I've taken lots of meds at varying doses, like most here, depending on what's going on. My base med is oxycontin with oxy BT (i think I need to change my base med as my bt isn't working very well, to be addressed at next pm appointment). I also take panadol (acetominophen) and melatonin or valium or xanax to get me through the night. I have taken neurontin or lyrica at different times for long periods but have finally come to the conclusion that the side effects outweigh the benefits. Oh, I have just started using clonidine for my nerve pain which is working better than the antiepileptics.

Long post, thank you to those who have stayed with me. I do have a question - my PM (also one of my neurosurgeons) has been getting worried about hyperalgesia in lomg term opioid patients and I am currently weaning my meds slowly (5mg a month). however, the pain is slowly getting worse and the really bad days more frequent. Technically with hyperalgesia my pain should slowly come back down as i adjust to the lower doses but this isn't happening. Has anyone else been through this? Do believe in hyperalgesia? Any thoughts and experiences welcome. I would like to get off the long acting meds as they are slowly ruining my body but I don't know if it's possible with this level of pain, I already take a lower dose than expected for my problem.

Thank you everyone, I hope today is a good day for you.
 
Hey everyone.
I made a thread a few days ago when my doctor changed my medication. Actually, my doctor added Fentanyl patches on top of my oxycodone I have for breakthrough pain. I'm in my early 20's and have a pretty severe stomach condition that presented itself after an emergency abdominal surgery a couple years ago. My stomach condition triggers alot of other pain (nerve and muscle) which is why I am on these medications, on top of others as well. Opiates, rarely cause me nausea when I take them for my pain. Although, with the switch to fentanyl daily the though of possible nausea can happen. So far its been fine... My question is more out of curiosity, If for what ever reason I needed to remove my patch for a little bit is it ok to re-attach using medical tape a little later? (1-8 hours)

Another question for people who go to a PM specialist. Would you say it is worthwhile for me to make an appointment with a PM doctor. Since the diagnoses of my condition my General practitioner prescribed me my Oxycodone IR and my new GP (moved) prescribed my my Fentanyl patches. I know some people have a hard time getting prescribed pain medication from their regular doctors. Is it worth it for me to make an appointment with a PM specialist? It has never been recommended to me by any of my doctors.

You and I have a lot in common. I'm also on the fentanyl patch along with oxycodone IR.
As for your first question: I've reapplied the patch after taking it off during vacation. Since you just started the patch, you haven't experienced this yet lol.I don't care what the literature that comes with the patches says...they are NOT going to withstand water AND sand! I tried to leave it on at the beach 2 summers ago and I learned quickly that wearing it to the beach is a guaranteed way to lose it.
So I had to take it off and put it back on last summer. While it was better than the alternative ( putting a new patch on everyday), I did notice that over a couple of days of this I wasn't getting quite as much pain control.
Just a note-if you wear the gel patches you must apply tape to the outer edges only.
You may do well to see a pain management specialist, I don't know. For myself, I see my general practitioner for everything. I had to sign a pain management contract with him just like a lot of other CPP's (chronic pain patients). Did you say that you are getting everything you need from your primary care doctor, or did I misunderstand?
Sorry for rambling. I'm on a new ADHD med (Dexedrine) and I'm not doing too well on it :(
Anyway-I hope everyone is doing better!
Cat
EDIT: If you do I remove the patch with the intent to reapply it later, make sure you put it in a plastic baggie and seal it up... If you don't have 1 of those on hand you can use the envelope your pactch came in, Just make sure you put the backing on it first.
 
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Hey everyone,

I've been reading through this thread and would like to join the pm group, everyone seems lovely and CP is hard to deal with alone.

I had a bad car accident in 2005, I herniated a number of discs in my neck and thoracic and had a fracture as well. I've had a neck fusion and 2 thoracic decompressions. My spine is stable now, although I am developing cervical stenosis slowly. My back aches a lot but the worst part of my pain is severe thoracic nerve pain. It's pretty acute and unfortunately breathing makes it worse lol. Anyway, that's basically me, I've had some other bad luck which has contributed to my pain, a liver resection in 08 and a massive staph infection which meant 7 spinal debrasions in 3 weeks. Wow, I'm just whinging now! I'm sorry. I don't talk a lot about my pain, I find it very hard to discuss with friends and family.

I've taken lots of meds at varying doses, like most here, depending on what's going on. My base med is oxycontin with oxy BT (i think I need to change my base med as my bt isn't working very well, to be addressed at next pm appointment). I also take panadol (acetominophen) and melatonin or valium or xanax to get me through the night. I have taken neurontin or lyrica at different times for long periods but have finally come to the conclusion that the side effects outweigh the benefits. Oh, I have just started using clonidine for my nerve pain which is working better than the antiepileptics.

Long post, thank you to those who have stayed with me. I do have a question - my PM (also one of my neurosurgeons) has been getting worried about hyperalgesia in lomg term opioid patients and I am currently weaning my meds slowly (5mg a month). however, the pain is slowly getting worse and the really bad days more frequent. Technically with hyperalgesia my pain should slowly come back down as i adjust to the lower doses but this isn't happening. Has anyone else been through this? Do believe in hyperalgesia? Any thoughts and experiences welcome. I would like to get off the long acting meds as they are slowly ruining my body but I don't know if it's possible with this level of pain, I already take a lower dose than expected for my problem.

Thank you everyone, I hope today is a good day for you.

hi Wrongdose- wow, that is rough about all those debrasions in such a short time, am sorry for all your troubles. I believe in hyperalgesia but think it can be diagnosed a bit too often, there are so many fine lines and gray areas when it comes to chronic pain and long term opiate use. Where does hyperalgesia begin versus is someone's body hurting simply cause between the pain and the narcotics their body has deteriorated and they've begun to ache all over from deconditioning? (Similarly, as a doctor once told me about pain and depression, "Is depression creating a pain syndrome or are patients depressed because of all the pain?") Anyway, true hyperalgesia can have symptoms like tactile pain just from touching the skin; also in the greater scheme of things you haven't been taking tons of opioids, no fentanyl patch, morphine, or anything like that, it doesn't sound like you're in a hyperalgesia situation right now.

Physicians are right to be concerned about hyperalgesia, though personally rate several other long-term effects from opioid pain control as more common and serious, and trying to ween off of pain meds is almost always the right thing to try, but if I had to guess would say you're not in any real hyperalgesia danger right now. I'd tell your neurosurgeon about how you've been lowering doses and the pain is increasing, and in the meantime don't let the pain get on top of you. Take what you need to get as comfortable as possible, for your sake and the sake of your loved ones around you. Don't know if any of this is a help, sorry again to hear of your troubles-- and it's not whinging, it's explaining :) -- and hope you're having a decent day
 
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