Harm Reduction The Pain Management Mega Thread Version 4

[BigG]

I have some experience with buprenorphine but not much I was once prescribed it on its own when I first entered CPP treatment and once again along with 30 milligrams of MXL which is 24 hour morphine sulphate with the MXL being my main med and the buprenorphine being for breakthrough pain if the main full agonist med is low enough then as u know bupe can be used for bt pain. If the dose of full agonist is low enough buprenorphine well not completely displaced the main med from the mu receptortske a . Also if I remember correctly from my short 2 yrs of med school 15 years ago lol! Bupe hits the mu and kapa receptors and so can.complement full agonist without fully displacing it.and throwing you into precipitated wds. However using high dose bupe as a main med (and 4mg is still a high dose) and then a full agonist for bt pain seems wierd to say the least. Surely it would make more.sense for your doc to just ditch the bupe altogether but unfortunately some doctors are.so psychologically invested in a treatment or med that they cant see the woods for the trees (as my pain doc was with fent patches....even tho I told him they wernt working for me). I myself have moved onto methadone on its own and am trying to get off opiates altogether. As for the sweats I suffered those terribly with methadone but found losing weight helped. I lost around 50lbs and brought my bodyfat down from around 17% to around 9% and the sweats stopped completely. No idea if this would work for you as i dont know what kind of shape you in now..
Also to address one of your other comments, you are right about methadone being hard tp get off. With this like morphine, fent and oxy the withdrawl are more acute but subside after a week or so but with methadone they go on for months. Having withdrawn from most ive found that morphine and oxy give more vomiting and nausea but with methadone the symptoms are more extreme fatigue and crippling rebound anxiety(due to the sudden noradrenalin surge) and since they last for so long you cant just Stay in bed for a week and manage the acute withdrawal is with a benzo or something like that and try to sleep it off. There is no way you can stay in bed for 2 months straight! so even though the withdrawal symptoms are not as acute they are far more chronic and so much harder to deal with

 

[tukabirdy]

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.

I will always maintain that bupe is a horrible PM tool. I have had many people tell of being PM failures because their DRS insisted it should work well for them. These people tell of many bad side effects, insomnia and sweating being biggies. Make a log of your weekly sleep patterns and pain. List tasks and goals that you have MISSED because of the side effects and list the side effects with them and how they effected your day. Give this to your doctor and make it a part of your record....

Drs in PM are supposed to question you about the goals of PM....Sometimes they don't take the time to hear you or the goals get lost over time. If it's on paper, you stand a better chance of being heard and taken seriously.

I'm waiting for back surgery after i get some obamacare....I'm lucky my GP is doing my PM but...it's not enough....I cannot lie down at night...I wake up crying. I have just started some Neurontin...I do not take benzos and hate sleeping pills.

CHRONIC PAIN SUCKS!!!!

 

[milagro]

You are lucky that your GP is assisting with PM. That was acceptable where I live until about two years ago when the media driven hype about opiate/oid addiction became all the rage. I used to watch news reports or talk shows that spoke about pain killer dependency but they never addressed the chronic pain that people live with and sadly die with due to this society's need to keep everyone in check.

I spent time overseas and many people in western culture outside the US think Americans are either ignorant, stupid, or just plain out of touch. While watching television in Australia, I saw exactly why they might think that. No GP's in my area will prescribe for patients in chronic pain. They simply refer people to pain management. They have to cover their own asses and do not have time to administer UA's and keep up with the new guidelines imposed by the agencies that think they know every damn thing there is to know about addiction vs. dependency.

I have started a "diary" of sorts regarding what Subutex is doing for me. I am not stupid enough to make it into a medication that has no positive attributes for pain management so I have listed some of the 'good' qualities but the negative impact it has had on my life over the past months is undeniable. I just hope I can get the doctor to see the wood for the trees and get this situation under control.

I think part of the problem was that I felt pretty good during the first 2 weeks after the transition from full agonists, which was horrible(transition). I told him I felt pretty good and it wasn't until the 4th week after starting the bupe that problems became severe. Then I had a couple of bad injuries and the bupe wouldn't do a damn thing for the pain. "Take another 8mgs" was the answer and that did nothing.

Thanks for the advice to all that answered. I have a far better conception of what needs to be done.

 

[BigG]

Makes me wonder how long the stigma around GPs prescribing opiates will take to travel to this side of the pond? I don't think it has quite yet or maybe I'm just lucky to have an understanding doctor. Some of the fuck ups ive made, admitted to and been forgiven for would be unthinkable in the US. How much of that is down to the healthcare system is debatable as others I know havent been so lucky.

 

[Whosajiggawaaa]

Hey guys thought I'd post here for a change. I have feeling a lot of the time that I'm a junkie and addict cos I sometimes get high off my meds (with a bit of difficulty), also it's easier to act like that than someone whose got as much wrong with them as me. Feels slightly cooler in a messed up way and makes me feel less vulnerable tbh.

Let's start with today and a bit of backround, today I've stuck to my prescribed dose of 600 mgs of oxy today for the day(somedays I can encroach on a 1000 mgs of oxycodone due to tolerance. Med's are OC 80's or 40's and OxyNorm IR 20's (I know my dose ridiculous to most dr's in my city except for my pain management doc and my gp), been on opiates for almost 8 years, Oxycodone for almost 2), now as I write this it's bed time and I'm still in pain. My mother (only family I have left) was diagnosed with terminal cancer a few months ago this causes me a great deal of emotional pain as I care for her whilst trying to complete my degree - she is only prescribed 160 mgs for this - making me feel even more like a hypochondriac addict.

Tonight I know I'll sleep through the night and wake up pain free if I take one more OC 80 and a IR 20 (just giving you an example of how I usually exceed my prescribed dose). I just feel like such a junkie scumbag. I'm known as the mechanical man to some due to the amount of metal plates and screws I have in me, some weren't done so well, this coupled with my fybromyalgia and arthritis in my knees (at 23) cause me mild to moderate general pain to bouts of moderately severe pain.

Even at a prescribed dose of 600 I can run out early, and that is living hell.

My therapist insists I'm not an addict and I've been with him a while but I don't fully share some of the getting high parts.

I further entrench my junkie-like persona to my male friends in a joking manner (who envy my meds greatly) - they don't take it seriously, mostly laugh, just feels more manly than whining, and acting weak.

I reckon I"m going to do what'll kill the pain and get me some sleep tonight. and Maybe read more of the post's here instead of DC which further entrench my bad feelings.

Gnight

 

[milagro]

Whosa-

That post just cut me to the core. I remember being on, what I thought was a high dose of oxy, and reading your post shows me how out of control it can get with people. That is "not" to say you do not need what you are taking. I just want to remind you of a term that is thrown around a lot but has significance and may set your mind at ease.

PSEUDO ADDICTION. I have discussed this with my PM many times when I felt like you do. I also have a mother who suffers chronic pain and takes minimal doses of her painkillers because she gets too loopy and ill when taking 5mg of oxy. My doc put it this way. It has been found that people with pseudo addiction may act like addicts because they need higher and higher doses but once they are at a certain level the addictive behavior goes away.

I cannot imagine being at your dose but it sounds like you need it with the amount of damage to your connective and skeletal tissues. All I can say is thank your docs for their understanding and sleep well. If your mother's problem is making you feel guilty, like I did, it is not your fault. She is her own advocate and if you feel she is under medicated then suggest it to her.

I have found this thread to be full of well informed patients that are not as judgmental as people in other forums and threads. This is especially true of people that live with chronic pain. It can be psychologically as well as physically draining.

 

[tentram]

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.

our healthcare systems covers cortisone injections. ive had a few in my knee over the years, for free

 

[BigG]

our healthcare systems covers cortisone injections. ive had a few in my knee over the years, for free

Me too........they fucking hurt though!!!



Also......600mg of oxy? Wow! Thats a lot! When I was last on oxy in 2002 I was on 4x80mg OCs and 4x 20mg OxyNorm for total of 400mg and my gp acted like this was the highest dose in the history of mankind lol!......he would have died of a heartattack if he knew about your dose!!!

Come to think about it I think he did die of a heart attack...last year (shouldnt laugh but he was a total cunt......so I will ha!)

 

[Whosajiggawaaa]

Me too........they fucking hurt though!!!



Also......600mg of oxy? Wow! Thats a lot! When I was last on oxy in 2002 I was on 4x80mg OCs and 4x 20mg OxyNorm for total of 400mg and my gp acted like this was the highest dose in the history of mankind lol!......he would have died of a heartattack if he knew about your dose!!!

Come to think about it I think he did die of a heart attack...last year (shouldnt laugh but he was a total cunt......so I will ha!)

LOL that literally made me lol. I know gp's who'd (and did in the past) freak out like that "THIS IS PROPOSTROUS?! YOUR ON MORE THAN SOMEONE WITH CANCER?!" - one as even gone as far as to phone my doc once and say he needs less etc maybe even cut him off this was my ex rheumotologist merely cos he heard it from some pharmacist - shoulda brought a defimation of character case on his ass buit know his MP insurers will probably hire better lawyers than me.

Also I think size is a factor seldom accounted for in PM - I'm 6.3 and 115 kg's and I've been given 2 mg morphine shots with some of my ops . Hence I avoid another surgery like the plague. Last 2 were bad - last one I had the aforementioned shots and fkin tramadol, was a hospital stay from hell.

Today gonna try and take the minummum/less today. At least it's not cold where I am anymore

our healthcare systems covers cortisone injections. ive had a few in my knee over the years, for free

Our healthcare system is basically like the US - private and expensive - no insurance and you screwed. My mom's C has been usurping all the cover this year. Next year they'll pay for more.

 

[oldirtybizza]

Ha yeah heard the cancer line too , but in regards to bupe patches and DHC ffs. really some doctors have no fuckin clue, In that case it was a female GP , female docs I've seen seem to have an affinity for depriving male patients of analgesics.
I don't know if anyone else had the same experience but the docs that have been most sympathetic regarding my chronic pain have been of the same gender and race. could make for an interesting study.

 

[Whosajiggawaaa]

Ha yeah heard the cancer line too , but in regards to bupe patches and DHC ffs. really some doctors have no fuckin clue, In that case it was a female GP , female docs I've seen seem to have an affinity for depriving male patients of analgesics.
I don't know if anyone else had the same experience but the docs that have been most sympathetic regarding my chronic pain have been of the same gender and race. could make for an interesting study.

Those bupe patches would surely block any effects of the DHC ? I haven't found bupe in any form to be a very good analgesic for my particular pain.

 

[BigG]

Back then I had built up a huge tollerance to oxy and while i was rx'd 400mg a day would regularly blow a 2 month script in 2 weeks which equated to a daily dose of 1600mg per day which is a lot but not unheard of. I would then spend 1 week in acute wds. 3-4 weeks of PAWS then try to bullshit him into giving me my next script early as by this point the pain had become unbearable. I eventually go tired of this never ending circle of misery and came clean to ask for some way of better managing my meds and he flat out refused to believe that a human being could take 1600mg of oxycodone and survive!!! No as most of us CP sufferers know, the amount someone in pain, with a tollerance and/or.addiction can use is very different from what someone who is essentially opiate nieve can take. Some gp's however just cant get their head around it and generally just acuse you of lieing and selling your script! I had never sold even one single pill and it used to piss me off so much that this doc was so fucking stupid and misinformed ahout what opiate doses a person can and cannot take........end of rant!

 

[Whosajiggawaaa]

Back then I had built up a huge tollerance to oxy and while i was rx'd 400mg a day would regularly blow a 2 month script in 2 weeks which equated to a daily dose of 1600mg per day which is a lot but not unheard of. I would then spend 1 week in acute wds. 3-4 weeks of PAWS then try to bullshit him into giving me my next script early as by this point the pain had become unbearable. I eventually go tired of this never ending circle of misery and came clean to ask for some way of better managing my meds and he flat out refused to believe that a human being could take 1600mg of oxycodone and survive!!! No as most of us CP sufferers know, the amount someone in pain, with a tollerance and/or.addiction can use is very different from what someone who is essentially opiate nieve can take. Some gp's however just cant get their head around it and generally just acuse you of lieing and selling your script! I had never sold even one single pill and it used to piss me off so much that this doc was so fucking stupid and misinformed ahout what opiate doses a person can and cannot take........end of rant!

Back when my tolerance wasn't so high (2 * 40s a day and a few ir 10s), i saw an episode of intervention with a chick taking 1600 mgs of oxy a day (she was a rec user with no pain too) and though what utter bs, impossible. 2 years later i know it's very possible.

How the heck did u afford 1600 mgs a day ? U in the uk and make the nhs ur bitch ? Lol

My health insurance has run out and my current prescription is costing what would equate to 370 USD's a week. Its killing me! Wanted to add 2 new guns to my collection but that's gonna have to wait till next year, don't think i'll even be able to afford the glock i had my eye on let alone the rifle, at the moment being pain free > my passion for shooting. no generic insight here either . Typed on my phone in bed soz for errors.

 

[2010SterlingGT]

Hello everyone. I don't post here much but I am. Pain patient. Fortunately I have an amazing doctor and can live my life relatively normal. I was recently changed from oxycodone ir 20mg x 6 to opana er 40mg x 2 plus 2x 5mg oxymorphone it for breakthrough. The endo opanas work after a while but really upset my stomach because of their timerx system. Fortunately after much effort walgreens ordered me generic from Global. So I will get the g74 40mg er shortly here. So if you take opana ask to be switched to generic. Both Global and Actavis are shipping.

I wanted to follow up on this and say that I changed to Opana. Which works well. The ERs take a very long time to work so I have a small amount of IR for breakthrough. The Endo brand also trashes my stomach but fortunately I was able to get Walgreens to order generic so should be getting those soon. I have heard the generics both work better and quicker and won't jack my stomach.

Quick follow up to last post. It was like pulling teeth to get Walgreens to order generic. Doctor has zero problem with it. But after several calls they have it in stock and will make sure it's there for me each month.

 

[Artificial Emotion]

Do you guys find that when you're in pain you just want to start fights with people whenever you can because you're so pissed off? Like when an old lady starts taking her time getting off the bus and you're trying to get to an appointment that you're late to because the bus didn't turn up on time and your back is killing you, even though you know it's wrong you find it difficult to barge in front past instead of waiting ages? I can't control myself when I start feeling pain and deliberately start to cause shit with people for no reason. How do you deal with this? Is there some sort of drug you can take to quell the rage? Benzos? Antipsychotics?

 

[xtcgrrrl]

Hi, I thought I'd introduce myself because I'd like to hang out with you guys if you'll let me. Here's my story (briefly): I have a herniated disc in my spine, lumbar region, L3 to be exact. I've had this issue since November 2011. For much of this time I have had excruciating sciatica going down my left leg but I got it taken care of with physical therapy. However there is still severe pain from the lower back and I am now looking into having surgery to resolve the situation because I am unable to pick up my son and this is intolerable. I take 600 mgs Neurontin 3x a day and 100 mgs Tramadol 3x a day for pain. Also some Flexeril.

I also have migraines, for which I am prescribed 200 mgs Topamax and Imitrex as needed, but the Imitrex doesn't do shit. I liked Relpax, that worked, but my insurance won't cover it anymore. Ugh!!!!

 

[dopemaster]

I figured I would say hello in this thread. I have been on CPM for quite some time. I am currently taking 60 mgs of oxycodone which is 3x day 20mg ir tablets. I find these the most helpful. My breakthrough pain is really nasty.

I also get 60 mg of Opana aka Oxymorphone and that's 2x 30mg tablets. I was one 195 mgs of MS-Contin ER aka Morphine a day before that (3x 60 mgs, 1x 15 mg). The morphine was effective for a while, but it began to work less and cause some side effects mainly constipation and feeling kind of sluggish.

The change has worked out pretty good for me so far. I am hoping to get my dose increased to 3 times a day soon. I haven't approached the subject yet, but will most likely do so on my next visit. The medication definitely holds my pain, but it never lasts anywhere close to 12 hours, its more like 7 hours of relief.

Other than that I cannot really complain. Its taken years to get my pain levels this low. I am hoping that I can get a third Opana tablet for the middle of the day, because the medication always seems to wear off between doses. I just get nervous bringing up the subject. Pain doctors scare the shit out of me, because they have so much control of your quality of life.

You never know when they might ask you to try out some new "miracle" drug that really sucks.

Fortunately after much effort walgreens ordered me generic from Global. So I will get the g74 40mg er shortly here. So if you take opana ask to be switched to generic. Both Global and Actavis are shipping.

My pain clinic has a no generic policy regarding Opana. I really wanted the generics. I had them once in the past and found them much easier on the stomach and they seemed to be more effective on the pain. I did inquire as to why the policy was the way it was and the doctor said "We are protecting patients from themselves." I thought it was a load of BS, because any medication can be abused and I really don't think that the Endo formula really will stop someone who is determined to abuse a drug.

I do know that if I had different insurance I would be able to receive the generics now. I wonder if that policy will remain in place forever. It seems that sooner or later that my insurance company would insist upon a medication that was much cheaper. On the RX it says allow generic, but it also says crush proof required. I wonder if maybe I am just going to the wrong pharmacy?

 

[oldirtybizza]

Those bupe patches would surely block any effects of the DHC ? I haven't found bupe in any form to be a very good analgesic for my particular pain.

Yeah I was quite surprised with the patches, they last for about 6 days and were actually very effective for pain, it was pretty much being wasted 24/7 on bupe which isn't ideal.
I wanted to switch back from bupe to dhc and the doc said I shouldn't be on either because they are so strong and for cancer blah blah I
I find other opiates have some effect on low dose bupe but not once it gets past round 4mg.

Bupe is shite tho, unpleasant psychological sides, same goes for pregabalin.

 

[BigG]

Back when my tolerance wasn't so high (2 * 40s a day and a few ir 10s), i saw an episode of intervention with a chick taking 1600 mgs of oxy a day (she was a rec user with no pain too) and though what utter bs, impossible. 2o years later i know it's very possible.

How the heck did u afford 1600 mgs a day ? U in the uk and make the nhs ur bitch ? Lol

My health insurance has run out and my current prescription is costing what would equate to 370 USD's a week. Its killing me! Wanted to add 2 new guns to my collection but that's gonna have to wait till next year, don't think i'll even be able to afford the glock i had my eye on let alone the rifle, at the moment being pain free > my passion for shooting. no generic insight here either . Typed on my phone in bed soz for errors.

LMAO!!! I am in the UK and the NHS ISmy bitch!!!. Oger here prescriptions are either a small nominal charge of a few £s for anything up to 2months worth of any drugBranded or generic makes no difference and completely free if youre either unemployed, on sickness benefit, pregnant, under 16, over 60 or have a condition that requires you to take medication for life I.e. diabetes, thyroid, heart condition etc and a few other exemptions. I dont know how my American freinds manage. Infact just earlier this year I was posting my lyrica to my mate in the US as he was scripted it over there but it was either too expensive or his doc didnt give him enough (or both). Whereas I was getting 56x300mg a month free and I rarely take them as they make me dizzy. Some people may think that Im full of shit claiming to have been taking that much OC but I dont care...I have nothing to gain my making shit up and as you and I know its very possible for our dose to escalate out of hand very quickly (not that Im suggesting that you would ever be as irresponsible as I was with your own script). Please dont feel like a junkie as you said in your earlier post mate......you're not regardless of whether you sometimes use more than your supposed to. Chronic pain is a complex issue once you mix in factors like mental well being, tollerance, addictive factors etc. and one thing I admired so much about your post was your honesty......a quality sadly lacking in some who post here. I think you're wiser to stay on this forum for a while as the folk here are really nice people who will try to help you rather than post negative/abusive shit as is sadly sometimes the case elsewhere.

Also welcome to the new posters...please stick around and im sure you'll enjoy it here. Its a great place to get advice on your CP issues or just to get stuff of your chest and talk to people who are going through similar things.
UPDATE....... For regulars on here who know her, i spoke to doomed2pain yesterday on the phone and is still in hospital but seems to be doing a little better....... Get well soon J.

 

[Whosajiggawaaa]

Whosa-

That post just cut me to the core. I remember being on, what I thought was a high dose of oxy, and reading your post shows me how out of control it can get with people. That is "not" to say you do not need what you are taking. I just want to remind you of a term that is thrown around a lot but has significance and may set your mind at ease.

PSEUDO ADDICTION. I have discussed this with my PM many times when I felt like you do. I also have a mother who suffers chronic pain and takes minimal doses of her painkillers because she gets too loopy and ill when taking 5mg of oxy. My doc put it this way. It has been found that people with pseudo addiction may act like addicts because they need higher and higher doses but once they are at a certain level the addictive behavior goes away.

I cannot imagine being at your dose but it sounds like you need it with the amount of damage to your connective and skeletal tissues. All I can say is thank your docs for their understanding and sleep well. If your mother's problem is making you feel guilty, like I did, it is not your fault. She is her own advocate and if you feel she is under medicated then suggest it to her.

I have found this thread to be full of well informed patients that are not as judgmental as people in other forums and threads. This is especially true of people that live with chronic pain. It can be psychologically as well as physically draining.

Thanks for the post . I've heard of this once before I will read up on it.

LMAO!!! I am in the UK and the NHS ISmy bitch!!!. Oger here prescriptions are either a small nominal charge of a few £s for anything up to 2months worth of any drugBranded or generic makes no difference and completely free if youre either unemployed, on sickness benefit, pregnant, under 16, over 60 or have a condition that requires you to take medication for life I.e. diabetes, thyroid, heart condition etc and a few other exemptions. I dont know how my American freinds manage. Infact just earlier this year I was posting my lyrica to my mate in the US as he was scripted it over there but it was either too expensive or his doc didnt give him enough (or both). Whereas I was getting 56x300mg a month free and I rarely take them as they make me dizzy. Some people may think that Im full of shit claiming to have been taking that much OC but I dont care...I have nothing to gain my making shit up and as you and I know its very possible for our dose to escalate out of hand very quickly (not that Im suggesting that you would ever be as irresponsible as I was with your own script). Please dont feel like a junkie as you said in your earlier post mate......you're not regardless of whether you sometimes use more than your supposed to. Chronic pain is a complex issue once you mix in factors like mental well being, tollerance, addictive factors etc. and one thing I admired so much about your post was your honesty......a quality sadly lacking in some who post here. I think you're wiser to stay on this forum for a while as the folk here are really nice people who will try to help you rather than post negative/abusive shit as is sadly sometimes the case elsewhere.

I'm in one of your countries colonies , that's fkin incredible omfg! My mom has a british passport, hmmm. Does that make me entitled to any of your countries spoils ?

Edit: Also if I didn't have the cost factor to contend with, 1600 mgs a day is very believable actually. Don't wanna even imagine the w/ds from that though.
Also tried lyrica and I felt like I was drunk, pretty much tried everything. Don't think there' s a painkiller I haven't tried besides oxymorphone. OxyContin let's me keep my faculties which is what I like about it the most. Don't want to be incapicitated by my meds and I'm not with oxy.