Harm Reduction The Pain Management Mega Thread Version 4

[phenethylo J]

^ In the US us pain patients have already been dealing with forms that have extremely invasive questions and overly expensive drug tests for years. Like 3 years ago when I was getting my meds from my rhuematologist one day she decided she no longer wanted to handle my opiate scripts and sent me to a pain doc who gave me a $1500 drug test not covered by my insurance since my rhuematologist had given me a test a few months prior, then said that he thought she should still handle my meds and sent me right back to her which she was ok with. Eventually after a year or so I was able to get most of my money back so it cost me $300 which is still allot.

 

[BigG]

The idea of having to pay $1500 (£1000) for a drug test (not even a treatment or procedure) is shocking. People over hear complain about the NHS and it has many faults but something like that would be totally unheard of. You have my deepest sympathies mate. D

 

[Morphling]

Nobody pays that. The physicians will, indeed, actively tell you not to.

Those people can fuck RIGHT off.

Billion dollar industry, of course.

 

[Dr Pepper]

No responses yet. I went back to a new pain management doc to switch from my tramadol to a different med. She was nice and seemed to want to help, thank God. Last guy treated me like complete shit, kept repeating he cant legally rx me opiates with a harsh tone, told me there's nothing he can do for me in different ways in a rude manner, and literally walked out on me, loudly talking over me repeating the same shit while I was trying to say I don't even want opiates/opioids as they do nothing for my pain and am trying to explore other options. Followed by a nurse coming back with a refill for the 100mg ER Tramadol script that was doing nothing for me before... even when I'd take 400mg out of desperation.

Anyways, this better new doc didn't understand how much pain im in. She is trying to help, but she sent me home with a rx for 5mg baclofen twice a day. This obviously wont do crap. I didn't communicate too well with her for that visit as my social anxiety was bothering me and I didn't express everything I needed to. I took 40mg of baclofen at first try out of desperation. Didn't help really. I don't know what to say or do when I go back to her.

I'm really at the end of my line here. I'm sitting here on 60mg baclofen, a Xanax bar (no tolerance), my maintenance opioid dose, a bit of vodka. Still in my normal spine pain with my back muscles still hurting with regular spasms/contractions. I've been in pain for two years now. Its just getting worse and worse. All I can do is lie in bed in pain and do anything to try and cope with it every day. I'm desperate for treatment and relief. Not sure what to tell y doctor. I don't want to resort to other things. They're

How old are you? What condition do you have? Perhaps your spine pain comes from uneven leg lengths ? Myself had uneven pelvic bones one taller than the other, causing me to sit/stand with a curved spine... had major surgery to fix it but it collapsed 2 months later.. now im looking at surgery #3 because without having symetry back i will always be in chronic pain... its been the bane of my life

 

[tentram]

The idea of having to pay $1500 (£1000) for a drug test (not even a treatment or procedure) is shocking. People over hear complain about the NHS and it has many faults but something like that would be totally unheard of. You have my deepest sympathies mate. D

yeah, coming from australia, reading that is just shocking. if a doctor wants to piss test you for opioids, they'll do it right there in the surgery for free, taking a whole 3mins; it is just the quick UA strip test, though. you'll find most pre-employment piss tests are even covered by the hiring company. allllll free!

 

[BigG]

Yeah I used to work for Searle the big drug company and thy would piss test me but certainly wouldnt CHARGE me for the privilege. Luckily other than prescription opiates and benzos ive never really taken anything so I was ok

How does everyone xope with having to work especially sit down office jobs) and dealing with the drowsiness caused by opioid pain meds? Methadone in particular causes extreme drowsiness in high doses and I often find my eyesclosing while at my screen. I dont actually nod or fall asleep just feel very tired and cant keep many eyes open. I uses caffeine pills but I hate caffeine....makes me anxious.

 

[KeithRichards]

I've been "graduated down" by a new doc. From 3 x 80mg oxycontin daily plus sublingual hydro for breakthrough pain. That regimen has been perfect for my cervical nerve damage. Now my NEW Dr. (Mr "saw a bad report on the telly") has pulled my off to 2 x 60mg w 10/325 Norco 3 's as needed. I feel AWFUL! It's been 8 months. And he's the only chronic pain Dr. around.
I feel if I complain, I'll seem like a (ahem) "problem patient"


Any ideas??

How does everyone xope with having to work especially sit down office jobs) and dealing with the drowsiness caused by opioid pain meds? Methadone in particular causes extreme drowsiness in high doses and I often find my eyesclosing while at my screen. I dont actually nod or fall asleep just feel very tired and cant keep many eyes open. I uses caffeine pills but I hate caffeine....makes me anxious.

If you "hate caffeine" it's (of course) all the more difficult. I'm on a similar pharmacological regimen and do sip a small cup coffee - a small amount, during my work shift. But probably as beneficial is a short, 5-10 minute brisk walk once an hour...for me, it's just around the outer hallway, short flight of stairs, and a ring around the fake plants at center-court. But the blood flow helps!
Also, you may be mildly hypoglycemic. Try a mid-morning and/or after-lunch protein bar.
Might help!

 

[milagro]

I have visited the OD forum many times so I would not ask a question unless I really needed some help. I visited the sub/bupe mega thread and everyone is talking about how to get around its lack of euphoria or sedation. Essentially, abusing it. I began taking Subutex, not Suboxone, three months ago. I am a CPP and have been in pain management for 8 years.

Suckutex is beginning to piss me off and I want to know if any other CPPs are having success with it. Specifically, how long have you been on it, did you decide to begin taking it voluntarily,dosage, side effects, are you pleased with it, etc. I would also like to hear about people that have been prescribed Subutex (Bupe hcl sublingual) and found any of the following side effects:

Insomnia-sometimes 48hrs+ without any sleep but usually 3 hrs of broken sleep in a 24 hour period.
Flop Sweating-Sweating so profuse that people around me think I am having a heart attack. My clothes are becoming ruined.
Crushing depression- I have had some psych. issues but I used to take an interest in music, movies, writing, and now I just think about not wanting to be here anymore.
Heartburn-Every freaking day after I take 4mg I feel like throwing up and eat tums like candy
Stigma-I had fractured bones (avoiding specificity) and horrible pain. ER doc asked why I was taking bupe rather than addressing the problem. I heard him speaking to another doc and "drug seeking" came up. I couldn't f-ing believe it. I wanted x-rays to show to a surgeon and specifically said I didn't want any pain medication because it wouldn't have any effect. Stupid f-ing ER docs and PA's.He said "Buprenorphine isn't prescribed for pain". My Pain doc, prescriber, told me that was typical of ER docs and said to take more bupe which produced
Lack of Analgesia- When on the previous regimen I would have severe breakthrough pain for my condition and the meds worked while this foul tasting crap (bupe) works well for baseline pain but cannot do a damn thing for breakthrough pain and blocks any breakthrough meds.
Sudden onset cramping of my legs and feet-I will be lying down and my leg, usually calf, or my foot will go into a cramp that is debilitating until I stretch or massage it out.

I do not know how much more of this I can take and I am afraid of asking my pain doc if I can return to full agonists again. I was on a medium regimen of percs and methadone but after all these years my tolerance was getting out of hand and I moved in with someone that began getting into my supply. Bad news. I wanted something that I didn't have to take every 6 hours and something that wouldn't shoot my tolerance up too quickly. What have I gotten myself into? This is becoming nightmarish. I have to spend 9 hours a day between school and work and I look like a phantom because I am not sleeping and I am so damn depressed and angry that I am impossible to be around. Is this normal?

 

[Morphling]

^^ As a CPP you shouldn't have to put up with that. There is so many better medications for pain with far better side-effect profiles.

Keith--Bitch. Call and bitch. You're paying them. You need treatment. So bitch. You are giving the doctor money, which gives you certain rights, tbh. So complain. You're in pain, while your symptoms should be better managed than that.

 

[Fire&Water]

I agree ^^^ even Buprenex ampules are only good for pain if used once every month or two - straight Buprenorphine (patches or pills) are a horrible choice for chronic pain.

You sound like a candidate for the fentanyl patch...

 

[BigG]

I was on fent patches for a few months earlie on the year and didnt like them. My pain doc wouldnt prescribe bt meds so ended up on the ceiling dose of 300mcg hour and was STILL in pain. Switched back to methadone tabs. Patches just dont work for some people. However somepeople swear by them

 

[milagro]

Thank you for the responses. In reading them and the posts in the Sub/Bupe megathread I still do not see any responses that indicate others on Bupe are experiencing the same adverse side effects that I mentioned in my previous post. I have used fent patches and they did help the pain but I was riddled with red, itchy marks when they came off. I still have scar tissue from them. That cannot be normal?

I am concerned about asking to go back to agonists like percs or norco. I need baseline medication that works like bupe but will allow me to get relief from BT pain and help the insomnia. I continue to believe that the insomnia will lessen but after 3 months at 8mg/day of Subutex and the fact I am typing this at 0330 after getting 3 hours of sleep last night seems to indicate that I may never regain a normal sleep cycle while I am taking bupe. The other side effects I mentioned are bothersome. When someone has had 15 hours of sleep over the past week and breaks into a flop sweat at work, shouldn't that indicate that an adjustment needs to be made? I am concerned that once a cpp goes on bupe that he/she can never return to full agonist opioids.

Feeling exhausted and unable to sleep is making me psychotic. Ambien and Lunesta have NO effect on me at all. Sonata is a joke as is trazadone. Seroquel might allow me to fall asleep but I am wide awake withing two hours and it is not covered by my insurance. I hate seeing the "Allleve" commercials for middle aged people that have chronic lower back pain and can take 2 tablets that brings brilliant smiles and a working ethic like I had 20 years ago. Alleve gave me a peptic ulcer. At the moment I want to fall asleep and could care less if I wake up.

 

[Morphling]

I can understand your caution, but I don't believe there's a legal basis for your concerns. IIRC, subs are schedule III medications in the US, as are the aforementioned norcos, percocets, etc.

It's not like your physician caught you slamming your morphine with coke, I'd think you'll be ok...

 

[Survival0200]

milagro: Are you sure you aren't taking too much buprenorphine? Where I live we have Temgesic (a buprenorphine product) for pain. It comes in sublingual tablets of 0,2 mg and 0,4 mg. The recommended dose is 0,2 mg - 0,4 mg every 6 or 8 hours. It also might be, that it just isn't for you.

 

[BigG]

Usually when bupe is presceibed to an opiate nieve person it is given as the 200mcg (0.2mg) temgesic tabs and the subutex/suboxone thats prescribed for opiate withdrawl is in milligrams as a higher amount is needed to supress wd symptoms. You are in a strange sifuation in that you are being prescribed the higher strength subutex but for pan not addiction. This is obviously because of your tollerance. Usually when someone has developed a tolerance they are moved away from a partial agonist like bupe to a full agonist. To then put you back on bupe seems strangeas it doesnt seem to work well for pain in the higher strength subutex tabs.

 

[wny]

Are perhaps the 50mg ones controlled release and the 10mg ones immediate? If thery are the same manufacturer and the same tablet release mechanism then they will be identcal. I worked in the pharmaceutical industry for several years and the quality control standards are incredibly tight so if there is no difference other than the strength then any perceived differences between 7x10mg caps and 1x50mg + 2x10mg must be psychosomatic. T this effect can be incredibly powerful so please dont think i sm being dismissive.

Thanks for this thoughtful reply. I am going to borrow from your wisdom here because I have been able to resume the 50mg capsules as I hit 80mg this week, and the side effects have abated. So this can be all dismissed as titrating-related side effects and insufficient evidence-based correlation.

Overall, the biggest thing I have learned about nortryptyline is that it can be a very uncomfortable drug to start at a higher dose. Starting with 10mg and increasing by 10mg every 3-5 days has made this a lot easier. People taking this should also not expect any significant pain reduction until the third week. There is definitely a lag time here, and that isn't usually reported in the drug insert, except when using as an anti-depressant. It doesn't take all the pain away, but it has been the only drug I've taken so far that has made a noticeable difference. The same isn't true with the narcotics, which really did very little.

 

[Morphling]

Makes me wonder if Metirosine would help your pain levels as well....

 

[wny]

No responses yet. I went back to a new pain management doc to switch from my tramadol to a different med. She was nice and seemed to want to help, thank God. Last guy treated me like complete shit, kept repeating he cant legally rx me opiates with a harsh tone, told me there's nothing he can do for me in different ways in a rude manner, and literally walked out on me, loudly talking over me repeating the same shit while I was trying to say I don't even want opiates/opioids as they do nothing for my pain and am trying to explore other options. Followed by a nurse coming back with a refill for the 100mg ER Tramadol script that was doing nothing for me before... even when I'd take 400mg out of desperation.

Tramadol is utterly useless for back pain, especially if you've had experience with opioid meds recently. It did nothing for me at all, even at 200mg. I got better results with 600mg ibuprofen. My naproxen did not work as well for back nerve related pain. Withdrawal after two weeks on tramadol was very unpleasant -- severe depression for first 48 hours.

The spam about Obamacare is hilarious because the right wing loons that oppose this are often quite happy on their Medicare, a gov't run program. The health exchanges that just opened this week sell PRIVATE insurance plans. There are no government runs plans there. These are from the same private insurers that raped and pillaged our wallets in the US for decades.

So if you are nicotine tested, that is because the for profit provider selling you that plan demands it to reduce risk exposure. That isn't Obama's fault.

What is his fault is both he and the Congress didn't simply extend Medicare coverage for all, which would have been a lot easier. As it stands now, my two person plan from a Blue Cross affiliate in western NY costs around $830 a month with a $30 co pay for primary doctor and $50 for a specialist. Generic drugs are covered with a $7 co pay, but virtually all branded meds have no coverage at all. Had health care not been tackled at all, the projections were that same two person plan with even higher co-pays would be over $1000 a month within five years.

Those on the NHS or other national health care system who hate the waits to see a doctor or to get surgery should consider what Americans have to pay for so-called deluxe health care. The back specialist I see now had a five month waiting list for an initial consult. If I elected for back surgery, there is a two year wait before the insurance company and doctor will approve it. So we have long waits here, restrictions on care, and we pay obscenely for it.

yeah, coming from australia, reading that is just shocking. if a doctor wants to piss test you for opioids, they'll do it right there in the surgery for free, taking a whole 3mins; it is just the quick UA strip test, though. you'll find most pre-employment piss tests are even covered by the hiring company. allllll free!

My spinal injections of cortisone cost nearly $5000 each. My insurance co pay was $250 each. I got a collective four days of relief for $500 out of pocket.

 

[benzoman12345]

Sudden onset cramping of my legs and feet

I have suffered with that for years extremely painfull shit, since being put on Gabapentin, (I take Diazepam as well)

It's more or less dissapeard

 

[milagro]

Usually when bupe is presceibed to an opiate nieve person it is given as the 200mcg (0.2mg) temgesic tabs and the subutex/suboxone thats prescribed for opiate withdrawl is in milligrams as a higher amount is needed to supress wd symptoms. You are in a strange sifuation in that you are being prescribed the higher strength subutex but for pan not addiction. This is obviously because of your tollerance. Usually when someone has developed a tolerance they are moved away from a partial agonist like bupe to a full agonist. To then put you back on bupe seems strangeas it doesnt seem to work well for pain in the higher strength subutex tabs.

You hit the nail on the head. The post previous to yours suggests that I am taking too much bupe. I have cut down from 12mg to 8mg to 4mg and at 4mg the pain became ridiculous. I waited it out but I have to work and go to school and cannot function in that pain. I am indeed caught in a strange situation.

Has anyone heard of someone taking low dose of bupe and full agonists for bt pain? It seems counter intuitive but my pain mgt. doc swears that doses of bupe below 4mg/day allows some analgesic relief from fulll agonist, bt meds. I doubt it but when I see my doc again I want to ask if this regimen of bupe can be altered somehow.

I have taken methadone which would seem to be the answer for my baseline pain but when I heard of how hard it is to quit and how long it takes to get out of the body, I became alarmed and remembered a time years ago when I used it. I was on 20-30mg/day for 4 months and quit over a 2 month period. I was switched to MS-contin so one would think I wouldn't experience WD from the methadone but even with the ms-contin 80mg/day my legs ached for 3 months after my last dose of methadone. I cannot imagine coming off of it without anything to help. I have read and listened to people (cpp's) that said it was a monster of a dependency.

My original question may never be answered with the exception of benzoman. It sounds like bupe is NOT typically given to cpp's even though my doc and his PA believe it is a miracle pain med. I am just trying to find out if anyone taking bupe has experienced the side effects I mentioned in my first post. The insomnia and flop sweats are the worst of all the side effects.