Harm Reduction The Pain Management Mega Thread Version 4

[BigG]

Hi everyone.I have chronic joint problems due to.a reactive arthritis secondary to salmonella poisoning in my early 20s along with the years of cumulative joint problems from heavy training from bodybuilding and powerlifting. Anyway after being prescribed every opiate under the sun it gery large doses along with NSAIDs and Lyrica. Am currently on the following:- fentanyl patch 150mcg/hr, Ibuprofen 800mg td. Lyrica 300mg bd. Just getting used to the patch and fining that regardless of how strong fentanyl is in theory it doesnt seem to be working as well as oxycontin or morphine did. However since ive strugt for years with overusing my meds the fent patch is much less "abusable" than other meds. Also in the uk due to our national health service yu only pay a small nominal charge for your meds regardless of what they are or how much they cost. I pay about £30 or $45 for 3 months unlimited prescriptions. It always saddend me when I hear about guys in the sates who have to suffer simply cos the meds they need are too expensive. But having said that we pay higher taxes in the uk and a nationalized health care system has its problems to. Anyway I digress, hope you guys suffering with pain find some releaf and god bless u all

 

[thixotropic]

HELP!
I used the fentanyl conversion calculator recommended by several here (http://www.globalrph.com/fent.cgi) and for daily dose of oxymorphone of 20mg, it came up with 41 mcg/hour fentanyl. Even if I just enter the 10 mg per dose, I get 20.5 mcg./hour.

Problem? My doctor has just given me a prescription for 12 mcg/hour.

Can anyone tell me what's right? Recommend another calculator to try? Give me any feedback?

Is this converter really right WRT dose? http://www.globalrph.com/fent.cgi

Thanks so much!

 

[thixotropic]

It's hard because they're all almost owned by the same mega conglomerates but I vote with my dollar, I believe that the dollar vote counts more than pretty much any other form of vote. If more people had boycotted the reformulated versions of the OxyContin and Opana ER and who knows what will be next, I bet Purdue and Endo would have switched back to OC and Opana ER OG Octagons within the fiscal quarter. But I know that would be asking a TON out of many chronic pain patients.... however often I feel like if we don't team up and stand up for ourselves together, we'll just keep getting walked all over on and keep financing these bullshit ineffective abuse-deterrant mechanisms that fuck up the medications ability to release steady and consistent time-released opioids.

What's left, Morphine ER and Methadone? Not everyone can tolerate these medications despite them both being DIRT cheap.

Perhaps they may even be trying to drive us onto to the cheap medications? I've been paying cash for my oxymorphone generic because it's "not AB-equivalent" to Opana ER. Based on the reading I've done, the only reason it's not AFAICT is that it's not that plastic garbage, which is great at abuse deterrence and lousy at releasing the drug into one's system. It is great at causing severe stomach pain, and given what it's made out of, is probably toxic, especially over time. Polyvinyl alcohol is nasty stuff.

We have to stand up for ourselves or things will keep going downhill. This is just wrong. My insurer is trying to push me onto fentanyl, even though I am underweight for it (and underweight period). I don't feel it's safe.

We can fight this politely, firmly, persistently. Keep appealing insurance company determinations. Push the FDA to declare exactly why a given drug is declared "not AB equivalent" (...as though it were inferior?) since AB equivalence is supposed to be a function of quality. Push the drug store chains to carry more of the generic alternatives that exist -- right now only one is available through my store, and it's an off-brand, but it still performs far better than the reformulated Opana.

We need to make our voices heard further up the chain... doctors can only do so much, and with their hard-earned license to practice medicine at stake, even those sympathetic are often limited in what they can effectively do, or have decided to go along to get along. Having the DEA standing over them with a real-life banhammer must be pretty rough.

And that's where so much of this is coming in: there are FDA-approved generics that are not available in-country, but are sold overseas. Why is this?
It reminds me of how multivalent vaccines (like the MMR) are available as individual vaccines (univalent) overseas, but not in the US, despite the far greater risks of severe vaccine reactions with multivalents. Even children with prior severe reactions must simply take their chances with the multivalent shots in the US, even though the same manufacturers make the univalent shots available in Europe. This makes no sense, but it does make dollars -- more profits for drugmakers. That is what it always comes down to, in the end.

That's why our dollar votes do matter. If we spend our money in certain ways and tell them why, join our voices and our dollars with those of others -- there's a chance we might be able to change things for the better. We win, they win.

Hey, I can dream, can't I? But it has to start somewhere. And it starts with us. All of us.

 

[BigG]

Plus when they convert you to fent patches they always start low and work up due to the potency of fentanyl. Im currently titrating upwards to the 200mcg where I need to be (currently on 150) hut they started me on 75. As im surebu know fentanyl is 100times stronger than morphine and the patch dose has to be titrated slowly upwards. Its not unknown for abperson to slap on a too high strength patch at night and go to bed and never wake up again. When I did the conversion from the amount of oxy and methadone I was on to fent and I realised I needed at least 200 mcg/hr my heart sank when my pain doc scripted me 75 with no. bt meds but I just had to tough it out until the dosincreased.

 

[thixotropic]

As it was explained to me, they convert the dose, then reduce it by 25% because cross-tolerance is not complete when switching to a new drug. But a reduction to 75 mcg/hr when the direct conversion would be 200 mcg/hr? That's a heck of a lot more than a 25% reduction! That they feel the need to titrate it *that* slowly is a testament to how unsafe this drug really is outside of the hospital, imo. And no additional bt medication? I feel for you. :/

I'd be totally screwed if my dose was decreased that much, esp. w/o additional breakthrough meds -- I can't prepare my own food or do much of anything w/o adequate pain relief (I have trouble making enough even with it, since my back doesn't work any better), which would mean my weight dropping still further. I really can't afford that. Given that I'm below the weight minimum for fent. and underweight to boot, I'm hoping I can convince the insurer that this is not a safe enough risk for me to assume.

How long has it taken them to titrate you up from 75 to 150, and in what increments have they done so?

How much trouble (pain, withdrawal) do you experience when you have to change patches and wait for the new one to establish a depot in the skin?

 

[BigG]

Hi thioxotropic thanks for replying to my post. Initially when he converted me to the 75 he said he would see me again in 2M ONTHS!!!!. After aweek I went to my gp (I live in the uk) and said this is no goood so she. Phoned him and raised in to 100. I kept about 3000-4000 mg of methadone in the house so I used some of that as well but then my well meaning but interfering girlfreins returned it to the chemist. I then saif fuck 2 months and got them to see me after 2weeks. Ive then gone up 25 every 2 weeks. Luckily os ive been allowed to experiment with various brands I had a stock of patches at home plus there was some overlap in getting scripts from the pain guy and from my gp. I do find tho that after 2 days the pain comes back with a vengence and I.start to feel wds. The pain guy says if this happensbi can change after 48 hrs. In theory there is still plenty fent left in the patch but since they work by passive diffusion the release slows down after 48 hrs and so there appears to be a time lag before the new patch builds up a sufficient depot to keep u constant. Changind after two days helps but make sure you doc oks this first or you will run out early and I dont need to tell u how little dun that is lol!!! The big issue for me is adhesion xos even if the full patch looks to be stuck on if there is any part that is no longer in contact with ur skin then the total surface area delivering the fent is reduced and the dose you're getting is lower. Ive tried durogesic dtrand, matrifen and sandoz mezola matrix which are all plastic matrix and also fentalis gel patxhes and imo sandoz matrix and dtrans are the best. Luckily in the uk we get free prescriptions so the price isnt an issueissue.bif it were then no way couldbi afforld these plus the 600mg of lyrica I take a day.once a patch comes off if no new one isbapplied then it supposedly takes 17hrs for your.serum fent levels to fall by half but if that happens then I start to feel shit after about 5-6 hrs. Regarding bt meds my pain guy doesnt believe in them and thinks if he gets thefent dose higher then that will be.enough. The thing is some of these pain docs (mines not even a doctor hes a seniiur.pharmacist who is licenced to prescribe controlled drugs) have necer experienced what we go through and have their nose burried in ppharmacokinetics data tables which mean fuck all to real life peopleblike us who suffer r every day. I sometimes use apatch buccaly for bt pain but this is a waste as I use a 50mcg patch in an hour. What I have been doing (I dont recoment thirty as its very dangerous is dump all used patches in a bottle of vodka andbthe then there for about half a day. After which about.80-90% of all the remaining fentanyl is dissolved into the vodka. Since there is absolutely no way of calcukating the amount of fent presjt. This coule be fatal but I then evaporate about halfbof the voka and add some citric acid.bi then have q highly concentated fentanyl citratebsolhtion. I then take TINY sips of this for bt pain but as their xould be literally any amount off fentanylcitrate in thebsolution... Please dont anyone try this. The only reason I do it is tht I have anbinsane tollerance and little.sense of self preservation!!!!! My. Doc says that breakthrough pain meds are an old fashioned way of treating chronic pain and that once my fent dose is high enough I wont make anything else. Total bullshit of course. If you are in lots of pain and need to apply a new patch it can take up to 12 hours to kick in which is just stupid if u have no legitimate bt meds. BTW whats your favouite opiate for pain control (I dont mean for the high but strictly the analgesia? Have u tried methadone? As well as a potent mu. Receptoragonist its also a NMDA agonist so gives good releaf from neuropathic pain also. It is however not a very "clean " drug and has ablot of side effects especially at high doses. Oh to have apain free life!!!! Sometimes it getsbmebso down that I wonder if life is eben worth living :-(. Ps apologies for all the typos. Im on ky iPhone.

 

[tentram]

so i also got my meds changed up today, nothing major. just a change in BT meds. my doctor finally allowed me the switch to IR oxy, oxynorm, which are tiny little capsules with a reasonably small amount of filler. they're only 5mg at T.I.D but it shouldn't be long until i can increase the actual pill dosage or up the amount of times where i can take the 5mg caps throughout the day.

so that leaves me like this now :
100mg MSContin B.D
5mg OxyNorm T.I.D
5mg Valium T.I.D

 

[BigG]

Years ago I used to get 5 of the green oxy 80s as my main med and 2x20mg oxynorn twice a day for bt pain. Problems was the worked alittle too well and would blow.thru an entire 2 wmonths worth in a week lol. My whole life seems to be a battle with needing genuine pain releif and yet enjoying the opiates so much that I abuse them then dealing with running out and the pain and wds that that entails. How do ufind the morphine and oxyjorm combo?

 

[tentram]

i find it to be great. SR Morphine is second best to fentanyl patches for me and IR oxy is great as a break through med in this sorta range for me, though will have it upped before too long as it's not quite adequate in 5mg doses unfortunately; that is tolerance's fault, though.

for entertainment purposes i will IV a Morphine dose in conjunction with rectal Oxycodone and a pinch of Valium!

 

[BigG]

Iv morphine..... Ahh those were the days!!! I used to get the 24hr MXL capsules which u could break open. Crush ad a suitable solvent and cook. 6x120mg at once was my person preference. Dont do that now tho...... Lucky to be alive

 

[tricomb]

oxycodone IR works very well via the rectal route, if I want to get another hour of analgesia out of my oxy, I can plug half or all of my dose and get onset in less than 5 minutes, and duration a whole hour longer than the like, 3h MAYBE that I get out of oxyIR taken orally.

@englandz, I'm also a CPP who was abusing opioids prior to becoming a chronic pain patient, and I feel your pain, it's so tempting but the pain is the only thing that keeps my tolerance in check. If I take too many, I'll run out early, and I have plenty of other full agonists to use at my disposal at the end of the month, but they all have EXTREME side effects, especially shit like methadone. Fuck methadone. I fucking hate that shit.

 

[tentram]

yep, those are the main reasons i like to use rectal oxycodone as well, tri :D oral and plugging really are on par for me for the most part minus rectal hitting that bit quicker and initially feeling stronger as a result. it lasts essentially the same time for me.

 

[Dr Pepper]

I need some input and advice, after getting the boot (or at least being told the doc won't script me anymore) from my first PM Clinic.

So some history. 22 yrs old, chronic back pain since 16.
Turns out pelvis was injured during growth phase, causing one side to be bigger, kind of like a leg discrepancy but in the pelvis, so standing/sitting I was always uneven, uncomfortable, in pain.

Got surgery may of last year, fixed the problem by lengthening the left pelvis with a bone graft after they saw through the bone.
8 weeks later, off crutches, bone graft collapses

Then december comes, another surgery, this time didn't achieve correct symmetry or height and problem persists.

I knew things were going to be shitty once the graft collapsed, and since then i've been self medicating. Using opioids, weed, etc. Eventually, recently, it was heroin again... (went to treatment a couple years back).


Anyways, parents and therapist and myself decide pain management. Remember, im using still.

So I go to office 2 weeks ago. Give piss(fuck) since im dirty with benzo,ambien,morphine(no more 6-MAM since it was the day before), thc. I tell the doctor that i've been in treatment, and have been getting drugs illicitly because im in chronic pain, and that i need something till my final (fingers crossed) surgery.

I mention subutex, since it doesnt effect hormones much and isnt really abusable if you have a high tolerance.
He decided methadone, 5mg x2 per day would be good. I was against it, but went ahead, and was scheduled back in 2 weeks. Also to quit weed by 1 month.

Anyways, get my script, and 10mg didnt feel like anything. Ended up taking 40mg the first day. 20mg the next 2 days. Stupid fucking me.. this is where I
screwed up. Didn't even get very high, and it didn't even kill my pain.

Also gave a couple to my dog whose dying (2.5mg doses only, she was fine and pain free for a bit.) By the time 1 week expired I was out, except for 5mg for my drug screen so i had methadone in my system so they knew i wasn't diverting.

Anyways, I arrive today, after withdrawing since monday (finally felt decent today). Had an appointment with a PA. Took a long time, and this young 20 some girl know it all comes in. She is beautiful however. I tell her I only took one tablet today, and she asked why. I told her I ran out early because on of the days I took 3 pills instead of two, since i was in lots of pain. I proceed to tell her that the 10mg methadone dose is very weak considering my history, and I did my best to stick to the regimen. I also had stopped all other illicit drug use (heroin, vikes, benzos) since monday, and that was truly a feat for me.

I really wanted this PM thing to work.
Long story short, she tells the doctor that I took 3 one day instead of 2. SHe comes back telling me he will no longer prescribe me, because i didn't follow orders. WTF!?!?!?

After billing my insurance 1500$ for the first visit, plus urine testing for a couple hundo, and me being up front with these guys, and they say i can stay for counseling and for spine injections. I ask to speak to the doctor not the PA and he is "seeing patients". I stick around looking for him, and talking to some other staff i had met. Can't get ahold of him.

I decide to tell them to cancel my piss test, as i dont want to waste more $ here, and leave.
So I fucked up during my first pain management.

So now I'm going to do some actually research and find a good clinic that doesn't nickel and dime you to death. Also going to make sure my piss is clean when I go in.

How upfront should i be about my previous addiction issues? Im legitimately looking for pain relief and will follow orders to a T next time, even if it isn't helping.

Also, i have a non-related surgery on monday. Ive been scripted from this doc before, and he gave me #30 5/500 hydros.
Today I go pick up the script and low and behold, #60 10/325 norco. Although they are generic, say IP 110.

My tolerance is whack, or hydrocodone fucking blows... I CWE'd 12 pills, and plugged the solution. I think I lost some to my filter. So maybe got 80mg.. I also popped 50mg orally, no filtering, so like 1.5g apap. . So at least 120mg hydro, possible 170mg, and under 2g tylenol.

My pupils aren't even pinned very bad. Just took 25mg hydroxizine and 1mg ativan to potentiate.

Did taking a total of like 200mg methadone over a week fuck my tolerance up that bad, to where 100mg hydrocodone doesn't even put me on the map? I tried with 70mg on monday of hydro, and it was weak as fuck... Now i'll probably have to sell these pills and buy dope for any pain relief, since the doctor tossed me.

Any advice on my next pain management doc? And why is hydro so fucking weak? Thanks!

 

[BiggDirty01]

Hey Guys and Gals, long time no speak-- my laptop broke and I am not one to type more than a few sentences on a touch screen-- So I wanted to briefly check in and update my continuing back problems and Pain Management experiences.

I have been tapering off of my narcotic pain killers per my Doctor wanting to evaluate any possibilty of hyperalgesia and assess my true pain levels off of any opioids. My last surgery was May 1, 2012. I was discharged on 240mg of Oxycodone and 60mg of methadone daily. By May 1, 2013 I will be taking 100mg of Oxycodone and 20mg of methadone. Being more than halfway detoxed, I can say I am truly grateful despite any lingering pain.

I am still in a lot of pain and just started Physical Therapy this week. When I started PT after my first fusion in 2011, I was taking 48mg of Dilaudid, 600mg of MSContin, 200mcg of fentanyl patch and 60mg of methadone. DAILY. This journey is so far ahead of the curve on pain medicines for me. Locked in a safe, I don't dream of schemes to get access to them. Peace of mind is hard to put a dollar figure on.

I am still going to need pain meds for a while longer and as long as I have this safe administration of my medications and am financially strapped to my medical bills (no money for street drugs or a car to drive and get them).

My PM doc (#6 since 2007 for me) is a saint and is the best Doc I have overall in terms of personal, sincere sympathy and empathy.


Hope all is well with all my fellow BLers. My laptop is fixed and I am back. Have a great weekend!

 

[BigG]

Fuck me thats a lot of opiates!!!! I thought I took a lot. I mean ive TAKEN more than that but only because I was taking like 10-20 times what I was presxribed. But to be actually scripted that much is phenomenal. Even as tollerance grows there has to be a point when they just say enough is enough. You have my deepest sympathy and admiration for trying to get opiate free from that kind of starting point. Your vvery brave mate.

 

[tricomb]

welcome back iron man

 

[tomatalli]

hey guys I haven't been on for awhile but I am looking to vent and get some advice

I am 18 and I have been suffering from back pain for over a year now, I have been going to PT for about the same time span, stretching, icing doing anything I can for pain relief. I have been to orthopedic doctors and they don't have anything to say it is really frustrating me. I have never gotten an MRI because they won't clear me for one because I have state insurance. I had awful posture throughout my entire life until this extreme pain started. I do not know what to do anymore I can't sleep unless I am over-tired for staying up days at a time, I can't sit still for more than a few minutes without wincing in pain, I have been taking nsaids for so long that I probably have ulcers all over my stomach. I just cannot take it anymore and I screwed myself over because I used to be a heroin addict which I first started using because of the extreme back pain I was in. I am clean now but on my medical records it will show 3 overdoses, rehab, and a suboxone script. How can I ever be treated for pain with all this on my record? I'm 18 years old and I feel like a 70 year old and I really can't take it anymore I NEED RELIEF and I am honestly thinking about going back to heroin.

 

[Lifeinpain]

hey guys I haven't been on for awhile but I am looking to vent and get some advice

I am 18 and I have been suffering from back pain for over a year now, I have been going to PT for about the same time span, stretching, icing doing anything I can for pain relief. I have been to orthopedic doctors and they don't have anything to say it is really frustrating me. I have never gotten an MRI because they won't clear me for one because I have state insurance. I had awful posture throughout my entire life until this extreme pain started. I do not know what to do anymore I can't sleep unless I am over-tired for staying up days at a time, I can't sit still for more than a few minutes without wincing in pain, I have been taking nsaids for so long that I probably have ulcers all over my stomach. I just cannot take it anymore and I screwed myself over because I used to be a heroin addict which I first started using because of the extreme back pain I was in. I am clean now but on my medical records it will show 3 overdoses, rehab, and a suboxone script. How can I ever be treated for pain with all this on my record? I'm 18 years old and I feel like a 70 year old and I really can't take it anymore I NEED RELIEF and I am honestly thinking about going back to heroin.

I am so sorry for your severe pain at such a young age. Your entire key to treatment is being diagnosed, Seeing a Neurosurgeon or an orthopaedic surgeon is best they will order the CAT Scans or MRI’s. A family doctor or GP usually sends the referral to the specialist. When all else fails the Hospital route is also available and usually nets results, going in through Emergency suffering a sever back problem. Again I’m sorry for your pain.

 

[tomatalli]

I am so sorry for your severe pain at such a young age. Your entire key to treatment is being diagnosed, Seeing a Neurosurgeon or an orthopaedic surgeon is best they will order the CAT Scans or MRI’s. A family doctor or GP usually sends the referral to the specialist. When all else fails the Hospital route is also available and usually nets results, going in through Emergency suffering a sever back problem. Again I’m sorry for your pain.

I really appreciate the support. I went to an ortho twice and they didn't do anything for me just gave me a prescription for meloxicam which just hurt my stomach really bad then the next time I went there they said oh well take aleve then and will not take me seriously

 

[Lifeinpain]

I really appreciate the support. I went to an ortho twice and they didn't do anything for me just gave me a prescription for meloxicam which just hurt my stomach really bad then the next time I went there they said oh well take aleve then and will not take me seriously

Ortho is OK as are other related physical-therapy’s as it sometimes relieves the symptoms or gives temporary relief from spasm or pain but if you in fact do have an underlying muscle skeletal, spine or facet related disease it just delays the diagnosis of the original cause. But you do have to go through the steps as the hope is that Ortho will get you back to work quickly with the least cost involved, so play nice and be a good patient as sometimes its those very people who can get you further investigation of your situation.