Harm Reduction The Pain Management Mega Thread Version 4

[wrongdose]

Thank you, Nine North, your post has made me feel a lot more confident about my conclusion that I don't really have a hyperalgesia issue. I no touch or temperature sensitivity and my pain has only increased as I lower the dosage of oxycontin when if it were truly hyperalgesia one would expect the pain to come down as your body adjusts to the new dose (and my neuro says she has patients with significant pain who have had no pain at all once they finally come off), I don't believe this is me because I have completely weaned in the past and never been able to cope. I do wish I could completely wean off the oxycontin and just use BT though. You mentioned Fent which for many is very effective but I have terrible trouble with the patch and have had some horrible experience with too much being released and then the patch running dry. I just prefer tablets.

I am going to ask to switch from Oxycontin to Kadian/MScontin at our next appointment, I think. Has anyone had experience with using morphine as their baseline med? Or even swapping from OC to morphine as I am considering? I would love to know your experiences.

Someone was asking about spinal stim a few weeks ago, if they are still interested I would be happy to share my experience.

Wishing you all a low pain day

 

[tentram]

I am going to ask to switch from Oxycontin to Kadian/MScontin at our next appointment, I think. Has anyone had experience with using morphine as their baseline med? Or even swapping from OC to morphine as I am considering? I would love to know your experiences.

yeah i do. personally, i find morphine a more efficient round the clock medication as we still have the original OC's here in aus which time release mechanism is only for 8 hours compared to the 12 hours of morphine, using codeine for BT and diazepam as a muscle relaxant. though, i do swap back to oxycontin every now and then to avoid building full resistance to morphine, then after a while switch back to morphine. i find switching to and fro between oxy and morphine a rather efficient method. if i didn't have valium in my regime i'd be a hell of a lot worse off as well because of all the muscle spasms i have, especially in regards to sciatica, easing a great deal of the pain relative from that problem alone.

any other questions then shoot away!

 

[painpatientNY]

i am a pain patient of 15 years. turned 27 yesterday. i am currently on 100mg MS 4x/day. i am now going to NYC in search of help. i honestly would love to be opioid free but it is not an option at this moment. has anyone had any experience with abdominal migraines/cyclic vomiting syndrome. i have gone undiagnosed most of my life and this diagnosis is one of exclusion. im just looking for help finding ways to deal with this pain other than opioids. also i can deal with most pain. ive had my face smashed to mush and that was NOTHING compared to this stomach pain. 6-7 hours of plastic reconstruction to fix my face and asking for pain meds was never on my mind. this stomach pain is just a whole nother beast.

 

[wrongdose]

yeah i do. personally, i find morphine a more efficient round the clock medication as we still have the original OC's here in aus which time release mechanism is only for 8 hours compared to the 12 hours of morphine, using codeine for BT and diazepam as a muscle relaxant. though, i do swap back to oxycontin every now and then to avoid building full resistance to morphine, then after a while switch back to morphine. i find switching to and fro between oxy and morphine a rather efficient method. if i didn't have valium in my regime i'd be a hell of a lot worse off as well because of all the muscle spasms i have, especially in regards to sciatica, easing a great deal of the pain relative from that problem alone.

any other questions then shoot away!

Awesome response, thank you, you just clarified to me exactly what I need to do. The OC time release really is crap and even though I take it 3 times a day, I still have probs from the 6 hour mark and that wastes a lot of BT meds. I need something smoother and more sedating, I really struggle to sleep on OC. I have tried other meds, bupe patch & sublingual when I thought I didn't want opiates and fent after surgery. Never morphine though. How do you find codeine for BT? Is it strong enough - Aus docs really aren't into high dose BT meds, I've found. I think I'll ask to stick with oxynorm for BT as it's not as sedating as morphine for during the day plus slightly different analogues should work better.

Valium is a wonderful drug. I get horrible spasms too and this is as bad as my other pain. I'm assuming yours are lumbar? I hope today isn't too bad for you. Thank you again, I really do think my problem is tolerance rather than hyperalgesia...i am happy to go along with not increasing my OC though, at one point I was taking 360mg a day all up (and I was about 52kgs) and it was great pain wise but the stim effects really stuffed everything else up. I naturally have a fast 2D6 metabolism so we always have to take this into account.

 

[Livinginthealps]

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.

Thanks for the reply. Yes, currently I get all my medicine from my primary care doctor and not a pain specialist. I prefer a long acting medicine that last ~12 hours instead of around the clock dosing by the patch. After the holidays, I will go in and speak to my doctor but as of right now things are going pretty good.I'm going on vacation in a few days and I figured the beach would not work and I surf so of course that's a problem. I will have to put on the after or just take my oxycodone and forget the patch for a few days.

 

[tentram]

bump.

how's everyone coming into the new year?

 

[Swimmingdancer]

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.

Thank you, Nine North, your post has made me feel a lot more confident about my conclusion that I don't really have a hyperalgesia issue. I no touch or temperature sensitivity and my pain has only increased as I lower the dosage of oxycontin when if it were truly hyperalgesia one would expect the pain to come down as your body adjusts to the new dose (and my neuro says she has patients with significant pain who have had no pain at all once they finally come off)

The fact that you have no noticeable touch or temperature sensitivity is a good sign. It's still possible that you could have some opioid-induced hyperalgesia though, there are varying degrees of it. I absolutely disagree that with opioid-induced hyperalgesia one should adjust to one's new dose and the hyperalgesia go away, I think it must depend on the person, situation, what opioid it is and how long they have been taking it. Because when I began lowering my methadone dose I had severe hyperalgesia which did not go away no matter how long I waited (up to a couple months) in between dose drops, and I've been off it for months now and still have hyperalgesia. I can only hope it will get better at some point! I was on opioids for around 16 years though, and methadone withdrawal takes a very long time in comparison to most opioids, but I've never heard of anyone who was on opioids long-term and found they had no pain or withdrawal symptoms by the time they stopped taking the opioid, regardless of how slow the taper.

 

[phenethylo J]

Last Tuesday I boarderline failed the instant drug for thc at my pain clinic. The nurse acted like she thought it was a false positive and didn't think I smoked but I am sure that was just an act to catch me off guard. Her reaction just seemed too calm. It doesn't even make sense I failed since the break I took was 2x longer than other tests I have taken at that clinic that I have passed. It still has to go to the lab for confirmation. I had already been feeling very bad mentally and physically lately and a few days before the appointment I was finially getting a little glimmer of hope. Now my pain, stress axiety, depression, and suicidal thoughts are 10x worse. I just can't stop worrying about what is gonna happen, this wait is killing me. I just want to find out what my doctors reaction will be. I was all set the come home and smoke but decided not to after the failed test in case I get called down again. It is bad enough not having mmj in my state but even worse that my doctor denies me the right to use it and I can get my medication taken away if i do even though I have several conditions it is proven to help. At least I had some ketamine which helped allot with the stress and pain but I ran out on Friday. It has had a lasting anti-depressant effect which is helping.

 

[ChemicalFeelings]

Off to Doctors again.....wish me luck, with the pain.

 

[tricomb]

best of luck to ya

 

[brighton]

doctors are so strange
suddenly they want me to stop my DHC taper and start on methadone. is that overkill or what! i havent even bitched about the pain for 6 months.
too much too late. i havent even had a chance to try morphine or oxycontin. weird shit.

 

[macd610]

bump.

how's everyone coming into the new year?

Hi Tentram and Everyone else!
I haven't been on in forever. Why's this thread been so inactive, I wonder?
Will post more later...just wanted to wish you all a good night (or day, depending on where you are .
I'll be on again in an hour or 2 if possible if anyone needs to vent!
Cat

 

[tentram]

hey, cat girl how are you?

how's the pain situation been this year?

mine's been up and down and all over the place but has been settling since i've once again started routine light exercising i put the weight on i needed so now just need to strengthen and tone it up as it built up as fat resulting in spikes of pain day and night.

i was also having some more major sleep issues but since the exercising it has returned to almost normal. i'm sleeping right through the night instead of constantly waking, even if i get an hour or two less sleep than desired. i still feel better during the day than after nights of tossing and turning, waking up constantly

 

[macd610]

hey, cat girl how are you?

how's the pain situation been this year?

mine's been up and down and all over the place but has been settling since i've once again started routine light exercising i put the weight on i needed so now just need to strengthen and tone it up as it built up as fat resulting in spikes of pain day and night.

i was also having some more major sleep issues but since the exercising it has returned to almost normal. i'm sleeping right through the night instead of constantly waking, even if i get an hour or two less sleep than desired. i still feel better during the day than after nights of tossing and turning, waking up constantly

TENTRAM!
Sorry, passed out early last night and this is going to be short because I'm pretty shaky right now. Things are going pretty well pain wise. I'm afraid though, that after nearly a year of being stabilized with 100mcg fentanyl patches, it's not quite cutting it. my doctor said if I required more he would want me to see a pain specialist. ( That was something he told me a long time ago... he said he realizes some people need more but he would want me to have a talk with the pain specialist first if it came to that). SO, Trying to figure out how long to wait before I bring the subject up.... And is it worth it? I'm very comfortable with my doctor now.
Lots of other things are going well and I will post about them shortly.

 

[tentram]

MAC!!!

hey, no need for apologies!

how come you're shakey? the pain?

i'm sorry to hear it's increasing and there's a chance you're going to be having to raise your dose from an already high dose of what i deem king of the pain management medications and also a shame your doctor is likely unwilling to raise it without consultation of a PM specialist - though it could be the best thing you do for yourself and your pain issues. it'll be a pain in the ass originally but likely to turn out the most beneficial course of action as they are a specialist after all.

you could bring up the possibility of getting something for breakthrough pain if that's your main concern. or perhaps introducing another extended release med such as oxycontin or mscontin for example. i'm sure you'll hash it out with your doctor and reach a reasonable decision!

GP's, understandably, are very wary in particular with pain patients especially when on medications such as fentanyl as there's chance of them being scrutinized and a chance of them being found or deemed over-medicating unnecessarily and ultimately jeopardising their practicing license. they're also not specialists in that area and would be more comfortable moving someone on such high doses to a PM specialist who know exactly what they're doing. they're so much less likely to be scrutinised as close or harshly as a GP in such a situation. they're not "restricted" in their prescribing as such. if you understand what i mean?

i hope there's some sense in all that jabber. i'm a wee over medicated currently

 

[michael]

sigh.

i have some minor surgery scheduled and they want me to be off baclofen and ibuprofen for 5 days previous. not looking forward to life in between now and then.

 

[macd610]

MAC!!!

hey, no need for apologies!

how come you're shakey? the pain?

i'm sorry to hear it's increasing and there's a chance you're going to be having to raise your dose from an already high dose of what i deem king of the pain management medications and also a shame your doctor is likely unwilling to raise it without consultation of a PM specialist - though it could be the best thing you do for yourself and your pain issues. it'll be a pain in the ass originally but likely to turn out the most beneficial course of action as they are a specialist after all.

you could bring up the possibility of getting something for breakthrough pain if that's your main concern. or perhaps introducing another extended release med such as oxycontin or mscontin for example. i'm sure you'll hash it out with your doctor and reach a reasonable decision!

GP's, understandably, are very wary in particular with pain patients especially when on medications such as fentanyl as there's chance of them being scrutinized and a chance of them being found or deemed over-medicating unnecessarily and ultimately jeopardising their practicing license. they're also not specialists in that area and would be more comfortable moving someone on such high doses to a PM specialist who know exactly what they're doing. they're so much less likely to be scrutinised as close or harshly as a GP in such a situation. they're not "restricted" in their prescribing as such. if you understand what i mean?

i hope there's some sense in all that jabber. i'm a wee over medicated currently

Definitely makes some sense. 1 concern that I have regarding pain management specialist involvement may not be a valid one, considering this advice came from one person only- and it was just her experience...
It came from a friend who is in unsuccessful pain management at the moment, and is also a nurse. She told me that if I were to go to a specialist they would tell me I'm on way too much already and take away most of what I have, and that I am lucky to be on the high doses that I am on now.
This obviously is not the point here, but I don't feel I am "lucky" to be in so much pain on a regular basis that I need this much. I do see her point, though... there are many patients out there hurting who can hardly get a rx for a few oxycodone /APAP. I am lucky in the sense that my doctor gives me ample BT meds (240-300mg/day oxycodone IR). So in answer to 1 of your questions, breakthrough pain is not the issue.
I feel that I shouldn't have to take that much breakthrough pain medicine, first of all. Second of all, I question approaching him about this because I wonder if it's just a matter of tolerance? In which case I don't think it would be in my best interest to raise anything considering the doses I am on at 35 years old?
I don't know, I'm pretty confused., I'm going to stop talking now. I hope some of THIS made sense

 

[Tattood1]

TENTRAM!
Sorry, passed out early last night and this is going to be short because I'm pretty shaky right now. Things are going pretty well pain wise. I'm afraid though, that after nearly a year of being stabilized with 100mcg fentanyl patches, it's not quite cutting it. my doctor said if I required more he would want me to see a pain specialist. ( That was something he told me a long time ago... he said he realizes some people need more but he would want me to have a talk with the pain specialist first if it came to that). SO, Trying to figure out how long to wait before I bring the subject up.... And is it worth it? I'm very comfortable with my doctor now.
Lots of other things are going well and I will post about them shortly.

Sorry, I am new here and did not know how to post a clean reply in a thread. I am a pm patient who's struggle is still ongoing. I broke my neck in 2006 and again in 2010. C4-c7 fused and about to have another surgery to change out some hardware anterior and posterior. With the fusions and a nasty staph infection I am looking at lucky surgery #7. I was originally on MS Contin 60mg 3x daily and 10/325 percs 4x daily. I now have gi issues and can't take ex release pain meds. I was just swapped to oxymorphone 10 mg ir q6 because of an increase in pain and restlessness. I was also given 100 mg lyrics 2x daily and zanaflex 4mg 3x daily. I tried the 10mg ir for the first time last night and holy cow!! I don't remember anything. I thought I was asleep but apparently was texting all night. For the first time I'm actually scared of the bump up in meds, and really scared about adding lyrica and zanaflex to the mix.. Any suggestions??

 

[brutus]

^ Talk to your doctor.

 

[Tattood1]

Is this a med I will get use to? Is the fact that its ir and has no apap part of the reason it feels so strong?? I tried to talk to the pharmacist but he wasn't studied up on opana.