Harm Reduction The Pain Management Megathread (Chronic and Acute Pain Discussion) Version 5.0 ~ V

[BigG]

I know how much u suffered with that fentanyl withdrawal D2P...... Especially with all that other horrible personnal shit your dealing with. I have withdrawn from fentanyl too and its awful. Its more acute than methadone withdrawn and causes so much rebound pain. Methadone withdrawn lasts much longer but things like fentanyl and morphine are definately more accute. I still think it was wrong for them to make you suffer like that and as I told you on tge phone the other night if it happens again pick up tge phone and dial 111 or 999 and speak to the ambulance service control. They can get you help straight away and organise a doctor to sort your scripts. Helping people in need is what we are there for in emergency services and although we get a lot of shit it is why we do the job we do and the reason for me to get out of bed every morning. Being there for people in need and in distress is why im doing what im doing now career wise which yoou know all about as ive told you but id rather not broadcast publicly just now. If it comes of though it will change my life forever!!!

 

[Doomed2pain]

You are one of the most caring people you will rock the next job I'm sure. Last time I went a and e for pain they treated me like I was a heroin addict and were going to send me home til my friend shouted at dr and said if she kills her self due to the pain or the wd kills her I'm suing you! Then the consultant in charge came and sorted me out but I felt so degraded

 

[chase_in_56ace]

Yes. It needs to be compounded and usually combined with an nsaid and maybe baclofen. Good for neuropathy.

Thx for the info Kitty do you know the name of the cream? Also, I don't seem to have a physical Rx for it as it was something sent to the compounding pharmacy that I was told to call about. I'm going to call my PM doc tomorrow and get the details again as I was told to be prompt about this...

It feels so good to have a New doctor who writes me oxycodone IR at 30mg again. Being 23 and in south Florida I'm definitely in the minority. Things are not the way they used to be down here. Pharmacies now demand to know what's wrong with me, Why I'm on such strong opiates, how long I'm planning to take them and what's the "treatment plan" to get off of them. It's a mess and very tricky to fill this stuff. Pharmacies also refuse to fill meds for doctors out of their county. My clinic has an Office in Palm Beach AND one in Broward county however, so I REALLY lucked out. Because of this I can fill CII meds in either county.

Oh and FYI ABOUT THE FENTANYL THING: Fentanyl is not a typical opiate. Withdrawing from it is akin to Benzodiazipine withdrawal and is considered a medical emergency. I had an atypical seizure once coming off of 175mcg of duragesic fentanyl. It binds so hard to the receptors some studies allege it actually damages certain neuropathways. Whatever the scientific case may be, be extremely careful coming off of Fentanyl. It is reserved for very, very rare cases of severe round-the-clock pain for a reason!

 

[Doomed2pain]

Trust me, I do not even remember what it feels like to not be in agony, I can no longer walk and I'm usually bed bound. Any opiate wd can kill me due my neuro condition and I had 3 grand mal seizures that we know of possibly more that no one saw, I was very unwell and it took over 24 hours for my body and the medication to reach an equilibrium.

And I'm not a soft woman I used to be a semi pro cage fighter and I'd fight full contact with blokes with 5-7 inch height advantage and up to 20 stones in weight, I can take pain but my condition scores highest on the McGill pain scale at 46.5 out of 50 for chronic pain conditions closest to my condition scores 42 and is wait for it, amputation of a limb with no drugs or anaesthesia of any kind that's all they can liken it to. The pain never ever stops and 8/10 is a good day

 

[BigG]

Trust me me and D2P arnt beginners when it comes to fentanyl and ive been doing this shit for nearly 20 years.......

Just to clear up a common misconception about Pregabalin and Gabapentin.....they are NOT Gabagenic. Tbey dont act on either the GABA A or GABA B receptors. They are NMDA agonists that also block certain neurotransmitters such as noradrenalin, glutamate and substance P. This is why they are sometimes prescribed off lable for general anxiety disorder. But they dont act like benzos and gabagenics.....the pharmacology involved is complex......I cant say what I for a living but ive spent 15 years in theNHS in England in both clinical and management roles and am involved in emergency healthcare on a daily basis. Knowing that when you get out of bed in the morning what you do makes a difference in someones life and can make the difference whether someone lives or dies is the greatest most rewarding feeling in tge world. Compassion and love for your fellow human beings is the most important thing in the world..........sorry for. rambling but I saw some things at work this week that made me realise tge true value of human life and affected me profoundly.....god bless all and stay safe... G x

 

[chase_in_56ace]

Englandgz, I apologize if my tone sounded condescending. You both absolutely sound experienced with Fent, I was more giving a general warnings to any opiate - naive that may be reading this thread

Hope everyone is having a good pain day! Patiently waiting for Daddy dukes to arrive with my Soma and Lyrica refills, just about the only drugs (besides NSAIDS) aside from opiates that significantly curb my pain levels. I'm in 6.5/10 pain today due to poor sleep last night

what are everyone's pain levels today? Also what do you feel are the worst exacerbating factors for your pain? For me, it's quality of sleep and the weather. Particularly the humidity I've found can have pretty sharp impacts on my inflammation.


BTW, beautiful post englandgz. Life is so complex.. however, made simple and rewarding, when then love of God is communicated through a human's touch..

 

[BigG]

You werent being condescending at all and you are.correct that not.everyone has the same level of experience with opiates such as fentanyl. Years ago it was reserved only for use in multicomponent anaesthesia and palliative care but is being used more and more in cases of chronic pain. Thanks mainly to the development of transdermal delivery systems. It does however warrant caution in those who may be naive with its use and certainty shouldn't be used by those naive to opiates in general outside of a hospital setting.

The worse exacerbating factors for me are undoubtedly work and the frustration in not feeling free to convey how much I suffer to work colleagues in case it prevents me from being allowed to do the job I love. If they knew how much pain I was in they would undoubtedly have me on so called light duties permanently which I would hate as thats not the direction I want my lifes work to continue along at all. So I suffer......and I say nothing to anyone.
Thank you for your kind comments re.my post, it is much appreciated. To serve other people and strive to alleviate their suffering is mans most noble endeavor and brings your own personal strife into staark context sometimes.
God bless everyone and stay safe and painfree.....G x

 

[Rybee]

Trying to limit my MS Contin and Oxycodone use lately but in awful pain today. The MS Contin just doesn't seem to do anything any more, and to be honest it never did much in the first place. At an equipotent dose I much prefer Fentanyl and Oxycodone, hell even Tramadol if it's no more than 400mg. Just given in and taken 100mg of MS Contin and a quick 20mg bump of Oxycodone to try and kick in faster.

Already mentioned in previous posts that I'm switching to Tapentadol at my next consultation (10 days or so). I really hope it's better for pain than morphine is. I don't think my consultant will prescribe me any more Oxy as he wants me off of it, which is fair enough. He's been in pain management for ~40 years so I trust him. On 100mg of Dosulepin/Dothiepin and other than making me akin to a zombie, it's not doing much. Been great for sleep though...

Had a few job offers come through last week... I just can't see it possible to hold down a job whilst I'm in so much pain, which is why I handed in my notice for my last job. My job just became untenable, I couldn't focus on anything other than being in pain. I sure hope Tapentadol is going to help, and the Dosulepin/Dothiepin kicks in soon... Been on it for 4 weeks now though.

I've had lower back pain before and it's sorted itself out within 3 months or so and I'm good as gold. This has been going on for 6 months now and I'm honestly at the point in which I don't believe it'll get any better. It's just quite upsetting when I read of people with chronic life-long pain and the misery that they have to endure. I can envision myself becoming part of that group if things don't progress.

Very miserable right now, it's nice to have the support of BL though. Some of you guys are great and very supportive. My friends and family who've never experienced chronic pain just don't get it... The usual advice I get is 'Go to your doctor, they can prescribe you a really strong painkiller called Codeine which you can't even buy in the pharmacy - did me right good for my headache'. I've given up explaining what I take for pain management and I just kind of nod in agreement like 'yeah thanks, I'll make an appointment to see my doctor'... it's just not worth explaining it to someone who doesn't get it.

So thanks to everyone on BL. You're all fab

 

[TheLostBoys]

Trying to limit my MS Contin and Oxycodone use lately but in awful pain today. The MS Contin just doesn't seem to do anything any more, and to be honest it never did much in the first place. At an equipotent dose I much prefer Fentanyl and Oxycodone, hell even Tramadol if it's no more than 400mg. Just given in and taken 100mg of MS Contin and a quick 20mg bump of Oxycodone to try and kick in faster.

Already mentioned in previous posts that I'm switching to Tapentadol at my next consultation (10 days or so). I really hope it's better for pain than morphine is. I don't think my consultant will prescribe me any more Oxy as he wants me off of it, which is fair enough. He's been in pain management for ~40 years so I trust him. On 100mg of Dosulepin/Dothiepin and other than making me akin to a zombie, it's not doing much. Been great for sleep though...

Had a few job offers come through last week... I just can't see it possible to hold down a job whilst I'm in so much pain, which is why I handed in my notice for my last job. My job just became untenable, I couldn't focus on anything other than being in pain. I sure hope Tapentadol is going to help, and the Dosulepin/Dothiepin kicks in soon... Been on it for 4 weeks now though.

I've had lower back pain before and it's sorted itself out within 3 months or so and I'm good as gold. This has been going on for 6 months now and I'm honestly at the point in which I don't believe it'll get any better. It's just quite upsetting when I read of people with chronic life-long pain and the misery that they have to endure. I can envision myself becoming part of that group if things don't progress.

Very miserable right now, it's nice to have the support of BL though. Some of you guys are great and very supportive. My friends and family who've never experienced chronic pain just don't get it... The usual advice I get is 'Go to your doctor, they can prescribe you a really strong painkiller called Codeine which you can't even buy in the pharmacy - did me right good for my headache'. I've given up explaining what I take for pain management and I just kind of nod in agreement like 'yeah thanks, I'll make an appointment to see my doctor'... it's just not worth explaining it to someone who doesn't get it.

So thanks to everyone on BL. You're all fab

Rybee.......how long have you been on Ms-Contin? Everyone's body chemistry breaks morphine down differently. Mine breaks it down very well so it does wonders for my pain.

Have you thought about upping your dosage of morphine or how about Opana & Dilaufid for BT pain since most doctors like yours don't like prescribing oxycodone.

My doctor tried me on it but I don't like oxycodone (I'm one of the very few who hate it), it makes me very irritable & angry towards others so I stopped taking it after a month.

I'm good on my hydrocodone & somas & morpgine when the pain really kicks in.

Did I read that correct that you've been taking pain meds for around 40 years?

Also, have you thought about signing up for disability?

Trust me, I do not even remember what it feels like to not be in agony, I can no longer walk and I'm usually bed bound. Any opiate wd can kill me due my neuro condition and I had 3 grand mal seizures that we know of possibly more that no one saw, I was very unwell and it took over 24 hours for my body and the medication to reach an equilibrium.

And I'm not a soft woman I used to be a semi pro cage fighter and I'd fight full contact with blokes with 5-7 inch height advantage and up to 20 stones in weight, I can take pain but my condition scores highest on the McGill pain scale at 46.5 out of 50 for chronic pain conditions closest to my condition scores 42 and is wait for it, amputation of a limb with no drugs or anaesthesia of any kind that's all they can liken it to. The pain never ever stops and 8/10 is a good day

Oh my goodness, I can't even begin to imagine the pain you endure every minute of your life........is there a pain medication that gets your pain level down to a 3?

Good luck & God bless!

I'd love to try a ketamine topical cream but no go in this country my pain management sucks, the warmer weather is definitely a relief though from October to May I go through absolute hell I wouldn't wish it on anyone, with the exception of my PM drs they all deserve it they've done nothing but cause me pain

I went through a bad fentanyl withdrawal last week wed, thurs, fri, sat, sun, mon evening. All because my pharmacy messed up, oh it was horrible definitely worse than methadone wd.

I know how you feel about pain doctors......most are a joke & think you're not as bad. One time I felt like saying, "can I hit you with a baseball bat across your back as hard as I can" to see if you can get over the pain w/on the proper pain meds but then I thought, I better not cause he might get pissy & we all know they have the power to cut us off our meds.

 

[BigG]

Rybee.......how long have you been on Ms-Contin? Everyone's body chemistry breaks morphine down differently. Mine breaks it down very well so it does wonders for my pain.

Have you thought about upping your dosage of morphine or how about Opana & Dilaufid for BT pain since most doctors like yours don't like prescribing oxycodone.

My doctor tried me on it but I don't like oxycodone (I'm one of the very few who hate it), it makes me very irritable & angry towards others so I stopped taking it after a month.

I'm good on my hydrocodone & somas & morpgine when the pain really kicks

We dont have hydrocodone, oxymorphone or. Dilaudid in the UK (but do have hydromorph Contis which is somewhat similar). Also our bodies don't "breakdown morphine differently". People can be more orless sensitive to all drugs but the active component of morphine is morphine and things like bioavailability and half-life are fairly constant so not quite sure what you mean???.

Rybee - loved the story about peoples ignorance about what your going through (asking if you had tried codeine). The other day someone was asking me if Id ever considered asking the doctor about this "new painkiller called tramadol" but to be carefull because its "the strongest one there is"..... I just nodded!!!..... Sometimes (or in my case all the time) its not even worth telling people what you relly go through.

 

[granddeception2]

Florida humidity in 2010?

 

[Rybee]

Rybee.......how long have you been on Ms-Contin? Everyone's body chemistry breaks morphine down differently. Mine breaks it down very well so it does wonders for my pain.

Have you thought about upping your dosage of morphine or how about Opana & Dilaufid for BT pain since most doctors like yours don't like prescribing oxycodone.

My doctor tried me on it but I don't like oxycodone (I'm one of the very few who hate it), it makes me very irritable & angry towards others so I stopped taking it after a month.

I'm good on my hydrocodone & somas & morpgine when the pain really kicks in.

Did I read that correct that you've been taking pain meds for around 40 years?

Also, have you thought about signing up for disability?

I've been on MS Contin for 6 months now, with a brief transition to Fentanyl and then back to MS Contin. My average daily dose was 100mg and 4 weeks ago I tapered down to just 30mg when I started my Dosulepin. So now I just take 30mg daily and a maximum of 2x10mg Oxycodone. I don't want to rely on opiates and need to come off of them to see whether the Dosulepin is working. If I carry on taking them and my pain drops, I wont know whether it's the opiates or the Dosulepin. I have taken 200mg of MS Contin but the pain relief it provides seems no more than 50mg. Anything from 50mg+ just seems to have no effect on my pain, thought just dopes me up which I don't enjoy, I don't like the feeling at all.

As englandgz74 says below, we don't have Hydrocodone, Hydromorphone or Oxymorphone in the UK. It's pretty much Fentanyl/Methadone/Morphine/Oxycodone so a bit more limited than in the states. Interestingly, using various conversion charts to find and equipotent dose of Oral Morphine and Oxycodone IR, the Oxycodone seems much better at alleviating my pain. I know a fair bit about opiates, but my knowledge is limited when it comes to detailing their mechanism. That said, I've only just started taking Oxycodone a few weeks ago, as opposed to 6 months for Morphine, I've read a bit about 'opiate rotation' so I don't know whether that is the reason behind me finding Oxycodone better at killing pain. My pain is spinal nerve pain, so I don't know whether Oxycodone would work better for that type of pain than Morphine, as opposed to say a broken arm. My pain consultant said that Methadone would probably be more effective than Morphine at killing my type of pain because of its mechanism. Though he said it wouldn't be suitable for me because I suffer from quite bad heart palpitations and it can be tricky to dose because of its long half life, and considering that we want to get me off of opiates, Methadone wouldn't be the best option right now.

No, sorry! I may have worded my post wrong, my pain consultant has been an anaesthetist/algiatrist (algiatry is the study of pain so I guess that's what he's called!?) for 40 years. I've suffered with lower back pain since I was 17, so ~8 years on and off now.

We dont have hydrocodone, oxymorphone or. Dilaudid in the UK (but do have hydromorph Contis which is somewhat similar). Also our bodies don't "breakdown morphine differently". People can be more orless sensitive to all drugs but the active component of morphine is morphine and things like bioavailability and half-life are fairly constant so not quite sure what you mean???.

Rybee - loved the story about peoples ignorance about what your going through (asking if you had tried codeine). The other day someone was asking me if Id ever considered asking the doctor about this "new painkiller called tramadol" but to be carefull because its "the strongest one there is"..... I just nodded!!!..... Sometimes (or in my case all the time) its not even worth telling people what you relly go through.

Haha that's good that you can relate to what people suggest to try. I mean bless them for their good intentions, they're only trying to help. I can see why they think that... I mean 8mg Co-Codamol usually states 'WARNING - Can Cause Addiction, Do Not Use For More Than Three Days' which is quite worrying to someone who's naive to the use of opiates!

I agree about not telling them... as I said, when people first started suggesting things I used to explain what my pain is like, what I'm taking and why their suggestion isn't so brilliant but yeah... Now it's just easier to nod and say 'Oh that sounds brilliant - thanks very much for the advice...'

Due to start Tapentadol (Nucynta) and I've read some really good reviews about it, both on BL and on other Medicine websites. I'm just keeping my fingers crossed and hoping that it's at least effective as Oxycodone and maybe review the Dosulepin if it doesn't start to kick in.



You've probably said a million times in this thread before, but I don't post in here very often, but may I ask what type of pain you have and what you take for it?

 

[BigG]

I have a type of arthritis coupled with joint damage from a severe RTA and various sporting injuries. I take methadone 60mg x 3 / day and Lyrica 300mg x 2/day. Along with various NSAIDs. My job is in emergency healthcare. Methadone is an NMDA agonist as well as an opiate agonist and so is helpfull with neuropathic pain (Lyrica is also an NMDA agonist so they compliment each other well). The reason why methadone is unsuitable for some people with heart problems is that above certain doses it can cause a disturbance in cardiac rhythm known aš ventricular tachycardia and a condition called Torsades de pointes . This manifests itself as extended QT intervals (try googling this if you would like to know more....it taies too long for me to type out on my cell phone!!). Over about 100mg requires regular.ECGs to monitor QT interval especially if tken concurrently with other drugs that also have this effect on cardiac rhythm. Ive never had any problems personally though. My goal is to get off all narcotic pain medicine and however difficult this may sound it is one that I am determibed to achieve.

 

[TheLostBoys]

We dont have hydrocodone, oxymorphone or. Dilaudid in the UK (but do have hydromorph Contis which is somewhat similar). Also our bodies don't "breakdown morphine differently". People can be more orless sensitive to all drugs but the active component of morphine is morphine and things like bioavailability and half-life are fairly constant so not quite sure what you mean???.

Not everyone's liver metabolizes morphine well so hence me stating that everyone's body works differently with morphine.........

I can take 15mgs of Ms-Contin & get pain relief for 3 hours while other people need 50 MG's to get the same relief.

Its all in how your liver metabolizes morphine itself.

I've been on MS Contin for 6 months now, with a brief transition to Fentanyl and then back to MS Contin. My average daily dose was 100mg and 4 weeks ago I tapered down to just 30mg when I started my Dosulepin. So now I just take 30mg daily and a maximum of 2x10mg Oxycodone. I don't want to rely on opiates and need to come off of them to see whether the Dosulepin is working. If I carry on taking them and my pain drops, I wont know whether it's the opiates or the Dosulepin. I have taken 200mg of MS Contin but the pain relief it provides seems no more than 50mg. Anything from 50mg+ just seems to have no effect on my pain, thought just dopes me up which I don't enjoy, I don't like the feeling at all.

As englandgz74 says below, we don't have Hydrocodone, Hydromorphone or Oxymorphone in the UK. It's pretty much Fentanyl/Methadone/Morphine/Oxycodone so a bit more limited than in the states. Interestingly, using various conversion charts to find and equipotent dose of Oral Morphine and Oxycodone IR, the Oxycodone seems much better at alleviating my pain. I know a fair bit about opiates, but my knowledge is limited when it comes to detailing their mechanism. That said, I've only just started taking Oxycodone a few weeks ago, as opposed to 6 months for Morphine, I've read a bit about 'opiate rotation' so I don't know whether that is the reason behind me finding Oxycodone better at killing pain. My pain is spinal nerve pain, so I don't know whether Oxycodone would work better for that type of pain than Morphine, as opposed to say a broken arm. My pain consultant said that Methadone would probably be more effective than Morphine at killing my type of pain because of its mechanism. Though he said it wouldn't be suitable for me because I suffer from quite bad heart palpitations and it can be tricky to dose because of its long half life, and considering that we want to get me off of opiates, Methadone wouldn't be the best option right now.

No, sorry! I may have worded my post wrong, my pain consultant has been an anaesthetist/algiatrist (algiatry is the study of pain so I guess that's what he's called!?) for 40 years. I've suffered with lower back pain since I was 17, so ~8 years on and off now.


Haha that's good that you can relate to what people suggest to try. I mean bless them for their good intentions, they're only trying to help. I can see why they think that... I mean 8mg Co-Codamol usually states 'WARNING - Can Cause Addiction, Do Not Use For More Than Three Days' which is quite worrying to someone who's naive to the use of opiates!

I agree about not telling them... as I said, when people first started suggesting things I used to explain what my pain is like, what I'm taking and why their suggestion isn't so brilliant but yeah... Now it's just easier to nod and say 'Oh that sounds brilliant - thanks very much for the advice...'

Due to start Tapentadol (Nucynta) and I've read some really good reviews about it, both on BL and on other Medicine websites. I'm just keeping my fingers crossed and hoping that it's at least effective as Oxycodone and maybe review the Dosulepin if it doesn't start to kick in.



You've probably said a million times in this thread before, but I don't post in here very often, but may I ask what type of pain you have and what you take for it?

Is Levorphanol available in your country because I've had it & it works awesome for pain.......its actually my favorite opiate of all time.

 

[Rybee]

I've absolutely never heard of it? Seems similar to Tapentadol.

 

[BigG]

Not everyone's liver metabolizes morphine well so hence me stating that everyone's body works differently with morphine.........

I can take 15mgs of Ms-Contin & get pain relief for 3 hours while other people need 50 MG's to get the same relief.

Its all in how your liver metabolizes morphine itself.

Are you referring to first pass motabolism? Alarge percentage of oral morphine is destroyed during the drugs first pass through thr liver. This causes oral morpgine to have such a poor bioavailability. The firgure is fairly constant but can vary from person to person. The actual number depends on a number of things. Its often a case of trial and error with opiates but many physicians arnt willing to give patients the benefit of the doubt when it comes to such things and automatically asume that you are."drug seeking" if you claim to need a higher dose. This is such a shame but it is the world in which we live unfortunately.

Leverphanol isnt available in the uk.

 

[chase_in_56ace]

I've never had success with Tapentadol.. your experience may vary. 100Mg of Nucynta = ~15mg of oxycodone for me, of which I prefer the latter. Multiple chronic pain patients switched to it when it was first approved in the states and even had mild withdrawal symptoms.. just a word to the wise. Having taken it, I believe neither its strength nor potential for abuse warrants it being CII in the states. It is a very strange drug.

 

[tunesey]

I have a fractured Orbit thets the bone behind the eye. Although painful at the time they decided they could fuck up my vision even more by operating to put a titanium plate behind my eye. The ER doc gave me some dihadrocdene and said if the pain gets too bad you can always take an extra tablet of 30mg. I went home and the pills he gave me helped and made me comfortable and sometimes I took the extra 1 tablet.

I recently had a chest infection and because of the open fractures behind my eye the infection went behind my eye I was in severe pain and the ER doc gave me the same medication.

Now I have an ear infection that has gone right behind my eye I was in so much pain last night my wife drove me to the ER being bank holiday Monday it was full and a four hour wait was at hand. There were no seats babies crying and I in screaming pain thought fuck it I went home rode out the pain and saw my doctor this morning. He wasn't my regular doc so told him of my history. He asked what medication I took in the past I told him dihadrcodeine and the ER doc said I could take an extra 1 if the pain got too bad. I was immediately treated with disdain and sent away with some antibiotics and some 30/500 co-codomol. Fucking doctors I am in some real pain here so I thought fuck it I have a CWE on the go 13 tabs cos I tend to loose some codeine in the process then I am off to bed hopefully pain free and im gonna watch the wolf of wall street

 

[maddy0405]

Any one use kratom for pain?

 

[BigG]

Xtcgirl uses it for pain a lot.....that and crushed poppy pods......shes the person to ask.