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

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I personally have never been on a steady opiate for pain management. I've always just white-knuckled through, because I have IBC and opiate induced constipation was not something I could afford to bring onboard. So...now at 54, I don't think MY AGE would be a factor. This pain is going to "cost" me my life, if some regimen of partial relief is not reached...soon. Again, med trials thus far have failed, but include MSContin, Fentanyl, and Oxycodone. No, no and no!

I am aware that the younger you are, the more reluctant PMs are to start opiate therapy. That's also why they tell you that 50% reduction in pain is a WIN. Your pain will never be totally relieved, as doses would be too high. You would rapidly reach the max of dosages and tolerance, the top step on the ladder...so to speak. Please don't shoot the messenger. It's just facts, especially in today's environment of overly cautious prescribers. The DEA is their shadow program. Recreational use, drug abuse, and diversion on prescription meds have screwed over CPPs.

Pecca, if you are 50ish with medical documentation to substantiate your diagnosis/prognosis, I would think you would be able to get PM.

Lucy...Your age may limit you, but there are other CPs on forums that are treated with opiates. I will offer this, FWIW...The Neurontin and/or Lyrica are helpful as an adjunct med for peripheral nerve pain. I hated the Neurontin when prescribed it for L5/S1 Sciatica pain. However, it's been a lifesaver since onset of SHINGLES in my eye. It settles the "wiggly fire ant colony under my skin" feeling. Otherwise, I'd claw my eyeball out and throw it across the room.

Erik...Thanks for your thoughts and suggestions, too! Are you in PM now?
 
I need to know more about equivalencies as the tables I have read on medical sites can be difficult to follow.... I also am curious about how different people tolerate different formulations, and whether anyone has managed to plateau at the same level for a long period of time, etc.... Many other questions, but of course I am tired now and having trouble thinking of them....Oh, also about what other chronic pain patients due to fight depression and fatigue......
 
Dixichik--yes, neurontin (gabapentin) has worked amazingly for my fibromyalgia.

Trust me, I don't ever believe I will be comfortable, but I'm glad I stopped white knuckling it. I hate sounding like a complainer though. I'm lucky that they are prescribing me meds right now, but I follow the rules and have years of evidence to stand on, so I think that helps. I'm going to start being more honest though so they can help me get to a level where I'm comfortable.

I'm sorry you have IBS. I was tested for that/chrons a long time ago and I'm so lucky I don't have either one.
 
I am new to this site, but I when I was given my diagnosis by a team of Johns Hopkins Doctors, they explained Arachnoiditis as an incurable condition where the constant neuropathic pain is only rivaled by some of the more cruel forms of cancer, and burns,but that I couldn't expect the relief of death, but that with pain mgmnt the pain might be reduced enough to be tolerable and still enjoy parts of life.... What I wasn't told was how uncaring and difficult the pain magmnt Doctors would be and how all the pain and frustration, not to mention the bleak outlook for the future, would accumulate into an almost insurmountable frustration with not only myself and my condition, but also with the medical community and the government with their constant interloping into the writing of opiate perscriptions.....
 
I resist Methadone because of the method of administration in my state, the stigma, and some stories I have heard.... I tried Fentanyl but it REALLY agrevated my Sleep Apnea problems; currently I take both an extended release opiate as well as Immediate release Opiates for breakthrough pain as I try to be "somewhat" active....I also take anti-depressants, muscle relaxers, anti-anxietals, and anti-inflammatories .........
 
I have pain mgmnt, and have been reducing my pain levels , and yes, I do understand the reasons why they don't wish to further reduce my pain , opting to prolong the time frame that these meds will be effective....of course, if my quality of life isn't good enough to be worth living, then what's the point in prolonging it ??
 
I TRULY UNDERSTAND your pain and your utter frustrations, Pecca.

Frankly, I cannot answer the SAME questions I ask for myself. I'm told no regular use of Toradol (excellent anti-inflammatory) w/risk of kidney and liver damage. Yet I ask WHY will I need healthy organs if I am a corpse?

Bleak, indeed. :(
 
This is such a phenomenon.
The fact that people are afraid of high dose opioids. And I understand why dont get me wrong im in a way also quite afraid to break a leg being on 80mst a day, but even more so the inherent fear caused by their prescribing doctors.
Sometimes we forget that doctors are just people they have off days and experience life and emotion just like us. They'd rather stitch up a kids knee in the next room, "fixing" their problem and improve their life instantaneously. But we the chronic pain patient they cannot just "fix" and they are in the people fixing bussiness but were the unfixable. And that frustrates them, all their years of study and they can't fix you.

Yes they are professionals and should be respected. I mean they hold basically your "comfort of living" aswell as your very life in their hands. I have suffered at the hands of inconsiderate doctors many a time.. But we have to keep advocating for ourselves to the end or till we're able to find the help we need/deserve. And yes doctors will always keep you on the lowest possible opioid dose possible because of the tolerance conundrum.

Yet in my experience the right doctor/s may make a life altering difference to one's life.
I have been on and off opiods for 10years now and I have a high tolerance.

There's another thing I found out about opioids and opiod switching, you become tolerant to one e.g morphine at a high dose but for instance fentanyl at a lower dose might be effective. Meaning opioids/opiates are the same, but their actually totally different in the way of onset and mechanism of action. They have different sites that they work on in your brain to provide pain relief/ producing different side effects across the board.

As mentioned in a post above genetic testing can give a indication as to which you should/shouldnt use?
But most of the time its trial and error..

Personaly I am in pain now! So I don't fret much about the future. Taking life expectancy ect into consideration, Why must I suffer now and not enjoy life ? The chronic pain makes one depressed and you sometimes ponder on eating a lead "pill" but that might just be me..
S
 
No, Stef...It's not just YOU, sweet. I want/need relief NOW, too. I've struggled for so very long with no relief in sight, beyond a dulling of the pain with Darvocet and then Tramadol. That's why I enrolled in PM. My story is laboriously detailed in what one might refer to as the BL DaVinci Code of a thread/posts.

My problem is not that I don't NEED big gun opiates for PM. My GI will not tolerate/absorb/metabolize the necessary meds. Either I can't get the pills past my "GI pouch" at all, causing chest pain that mimics heart attack. OR...The meds are so constipating, NO laxative concoction will move my bowels for upwards of 11 days, threatening obstruction. I'm between a ROCK and a ROCK.

The gel patch of Fent was the only thing that ever gave me relief. That was back in 2005-06, but doctors weren't keen on 48 hour dosing. I spent the 3rd day in what I know now was horrid WDs. I chose PAIN, the devil I know vs. no access to the 48 hour dosing. This time round in February 2014, we tried the Fent patch again...a very different animal...the matrix style. It gave me no relief, just soaking night sweats that wreaked a putrid chemical smell. It also left me unconscious in my own drool throughout the day.

As for doctors...One is beyond BLESSED if they have a caring and compassionate doctor. I had one for most of my life. Back when doctors wore many hats in small communities. (administrative, board chairman, GP, OB/GYN, general surgeon, all around great human being) He always asked about my mom, husband and MIL. He knew every patient on a first name basis, and they him. I attended his funeral in June. I would venture to say that most of our town attended Doc's funeral. They don't make em like him any more. He saved my life many, many times.

My current GP and my PM are robotic, overbooked with no desire to treat me as a whole. I'm rushed in, rushed out with no real solutions for pain that will haunt me for the rest of my days on earth. SO...MY FEAR is that with todays medical environment of fear and oppression of PM docs (by DEA) I don't want to start a med that helps me, only to have it taken away. I can't make sense out of nonsense. People who abuse prescription meds, or worse...divert them for profit...have royally screwed those of us in PAIN. We're not looking to get HIGH. We're hoping to be able to get UP out of our bed every day without tears.

I cannot submit to opiates that cause severe rebound pain. Oxycodone seems to do that to me. I also cannot be sedated, as I have a shitload of responsibility on my shoulder, both professionally and personally. I have to have a clear mind, even if my body suffers. It does. I do. I need HELP. Somebody, anybody who is willing to share what has worked long term for them?

FWIW...GENETIC TESTING only confused me more. I am no student of science or chemistry. My PM doesn't seem to consider the results of tests. He knows I need an ER med but can't afford it.

Sorry for rambling. I just feel so hopeless, sad and alone. I'm here if y'all want to talk. :)
 
Runtoparadise said:
I just had to google "Modafinil", & I did see a mention of the CYP enzymes. That's unfortunate, about the codiene.
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Especially since it's over-the-counter in Australia. If the codeine did anything, I could skip this whole process entirely.

I was asking about your PM dr as..,just from the outside looking in, it kinda looks like you're wasting money going to her.

Sorry if that sounds rude, absolutely not my intention. What I've seen of the meds you're prescribed, your GP can easily do.
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My GP, my psychiatrist and my rheumatologist have all refused to prescribe for me because I have comorbid psychiatric and chronic pain conditions. I think the PM people are a bit of a waste of time, too, but at least they have an onsite psychiatrist with experience prescribing for pain.

Is your pain caused by fibro? I had a vague feeling it is. Cmiiw pls. I know how terrible that can be!
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Yep, fibro. It's bullshit.

Are you going to PM in the hope that you'll eventually get something written up that will actually relieve your pain ? It seems you've been extremely patient in this lengthy process!
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That's the aim. I sadly don't feel like I have any option than to jump through the hoops and waiting periods.

Can you do your physio at home it do you have to go to a clinic?

I see a physio in a home-based clinic, but she gives me exercises to do at home as well.
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SKR said:
@ Sixbuckets, I wrote a big post directed at you the other night but I lost the damn thing. I gotta go to work but I'll get back to you. I really hope you have fewer hoops to jump through and you get some bloody pain relief soon, you're being really put through your paces which is normal, chat soon.
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Boooo Bluelight.
 
Can't you then switch to injections? But yea you say you are opiod intolerant.... Does your condition allow for nerve blocks? Man its so hard when you have cncp chronic non cancer pain. Stick with the process of your pain management doctors eventually you will get the relief. Be relentless. Keep pushing forward. On the thing about affordability: thats why I switched from fentanyl patches to mst. I couldn't afford paying cash for those tihings 1500pm vs 35pm with state hospital co pay.. The state doesn't stock fentanyl patches so yea.
 
CfZrx...I asked you on a separate thread (I think) about understanding the results of genetic testing for metabolism. I had them done, but I still don't understand the results. I don't get the science or chemistry of any of this stuff.

Stef...What kind of injections? It's not that I'm opiate intolerant, it's the method of administration, I guess. GI issues that most take for granted trump pain relief. Yes, I've had nerve blocks and facet injections, both cervical and lumbar. Endometriosis is MUCH like a cancer, as it is mutant cell growth. However, I don't have the hope of dying. I've got to find a way to live with it.
 
I have been prescribed Zanaflex (tizanidine) for my muscle spasms and tightness. It's the first muscle relaxer I've used that works. Has anyone else tried it? Also did anyone else expeirence intense nausea?? It really is amazing, especially with my hydrocodone, but the nausea/dizziness was killing me earlier at work.

I hope you all are having low pain days!
 
Hello everyone I am on oxycodone 10mg 4-6 times a day for herniated disc,ruptured disc,and degenerative disc disease. Anyhow I've been on the oxy and somas for 4 years through my family doc and every 6 months I take a drug screen. Last drug sceen I took cameback negative on all drugs and I was quite surprised. I found out the test he ordered is a 5 panel drug test and doesn't look for oxys but when I brought this to his attention he said that opiates should have popped up and that I was wrong.Anyhow he ordered me a gc/ms test but before the results were back(it takes at least a week) my script ran out and they wouldn't refill it.I finally got them to fill it but now he's kicking me out and wants me to go to pain management. Is this common doctors not knowing the tests they are ordering? I've been calling pnmgt docs and all of them are sounding skeptical on why my doctor would stop seeing me after 4 years and a few wouldn't even schedule me. Has anyone else been through anything like this?I'm afraid I'm gonna lose my script even though my doc(that magnanimous prick) is willing to write me one more(wow I get 120 which is a 3 week supply) until I can find an office to take me. I also want to hear the results of this gc/ms test because I want an apology(ill hold my breath) and it sucks when they make you out to be a fiend. Hope I don't get in trouble for moving my post but need to know if anyone else has been treated this way and if I have any recourse! Oh and I just mentioned the tests as being pertinent to my story I want no replys about the tests specifically(did my own research on them)​
 
@ run to paradise The pain is really hard for him to describe ( he often calls it "body neuropathy ") although often it sounds similar to what I have ~that my drs. call fibro(often the catch all name for unspecified widespread body pain). I can only describe MY pain as my bone marrow hurting because it is deep and everywhere. He doesn't describe his as deep like that but it is the same in being all over pain and feeling like an electrical current is buzzing through the body. Well the BF had his pain clinic apt. They agreed that Cymbalta would be a good fit. Also that he might be a good fit for LDN (low dose naltrexone) therapy which is showing some promise in experimental use for chronic pain. Down side being that its an opioid antagonist so he has to clear his system of the opioids first. So we hope to get the Cymbalta on board before totally weening off narcotics. They also suggested that the reason narcotics might not work well for him is not because of tolerence but rather Hyper analgesia from opiods. I personally tend to disagree with that because he has not taken high doses of narcotics or taken them for a long time. So my new questions are. Has anyone tried LDN therapy? Also, has anyone heard of someone having hyperanalgesia from opioids right away...from the start of therapy.
 
ZeeBee--I experience that same pain in my bones. I always described it as if someone was trying to snap my leg in two. I had to go to the hospital a few months ago because I was experience that as well as intense nerve pain running down my leg from my hip. It is terrible.

I do think gabapenin (neurontin) has helped some bit with my nerve pain--they're calling it fibromyalgia. My rheumy diagnosed me with it earlier this year. I'm sorry you're going through this, and I hope you get help.
 
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