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

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@rybee,

I Was going to change from oxy to methadone for chronic pain, & I recall my pain doctor saying he'd be heavily involved for a few wks until we got to the right dose. But because of him stressing just how it is such a potentially dangerous med due to it's long half life & accumulating in the liver, I decided to stick with what I knew. My understanding was that pain relief would likely be inadequate for a week or more as it is very gradually titrated for safety reasons.

Rtp
 
cuivre said:
Of course there were good doctors who would come in and say, "I see you've been here a lot. Do you know what helps, or did you feel better last time?" and this happened more and more the longer it went on. However, the nervousness surrounding what kind of doctor I would find when I finally got to the hospital didn't go away until I simply stopped having to go.
Click to expand...

Your whole post was excellent but I wanted to highlight this section.

I wish more doctors were like this but they're not. Maybe it's bc most patients are stupid or lying. Maybe it's bc most docs have a superiority complex. But as an intelligent informed patient I could make the doctor's job 90% easier by just telling them what I need. To me they're just a toll booth, I generally know what's wrong when I go in..

I suffer with a condition that's hit or miss with narcotics as well (well, more managing side effects---GI issues), so many doctors are reticent to dispense and it took me a long period of suffering to get into PM. I've seen some SHITTY ER docs though, but I've also seen some pretty good ones.
 
Thanks for the kind words felonious.

Wouldn't it be nice if they were all like that? In some ways I understand why doctors may be a little wary about patients who come in armed with information because some of them are bound to be completely incorrect about what they think is right. Or lying, yeah. Even the ones who are well educated probably don't know as much as the doctor him/herself on the whole (unless that patient happens to be a HCP, too).

However, first off, some patients might actually be better educated about their own (potentially rare) disease than an ER doctor whose job is to know how to treat a wide variety of conditions in crisis. Many doctors told me they had never met a cluster sufferer in person. Second, so many doctors equate being educated about certain medications-- especially narcotics and benzos-- with having an addiction. Of course in my case and many others it may be true in addition to having great pain, but that's besides the point. I don't know what the harm is in having an honest and direct discussion without judgment when a patient demonstrates they are capable of holding one. There is no harm in it. It's not as if anything we say can change the doctor's mind if s/he decides we actually don't know what we're talking about, so why more of them aren't incapable of even allowing us to give our own opinion without making all kinds of assumptions is baffling to me. God-complex, like you said.

That's pretty much what happened to me, too, in terms of the long journey to PM. I had also been in pain management before and had a terrible experience so was reluctant to go back. Actually, my first PM doctor for this condition almost ruined it again but just before I got fed up I found my current one. He's the best. Every time I had an appointment during which we had to change a dose the very first thing he would ask is what I thought we should do. Now I've been on a stable dose for almost six months and haven't been feeling this well for a long time.... except my intestinal tract, too.... and we are both just thrilled about it.
 
Does anyone experiment with anti-inflammatory foods? I cook with lots of fresh turmeric and rosemary (I think the turmeric especially has anti-inflammatory properties) and I also have lots of pineapple. I think a healthy diet in general helps, but the worst thing ever is when I over-eat, specifically because my pills won't kick in properly if my pain flares up. I think also that walking around with a bloated stomach can be hard on my spine. Percocet seems to work best on an empty stomach, but when my metabolism is up and running (so I might have it not first thing in the morning but a little later after some tea, and lemon juice or powdered health supplements mixed with water).

Why does morphine feel so different compared to oxycodone when they are both opiates? I've searched for an answer to this question and can't really find a reliable one. But for myself the effects were totally different, oxycodone causing an energetic feeling with morphine much more sedating. Oxycodone improves my motivation and initiative whereas morphine makes me a little lazy despite the excellent pain relief - I've always found this drastic difference in effects so strange.

What about prescription anti-inflammatories? I've never had success. I'm on one now that isn't doing anything; does that mean that they will all be pretty useless for me? It would be great if I could find one that actually helped. I have herniated discs but I'm still going through the diagnostic period where they are figuring out what can help. Most likely I'll just continue to take my pills and get on with life.

For whatever reason, things really seem to be working out for me lately. The universe works in mysterious ways. I guess that doesn't have much to do with pain management -but after 3 or more years of this bullshit, my life finally seems to be headed in a really positive and constructive direction. Will this shit ever toughen you up though.
 
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rave_itsrealfun!!! said:
Why does morphine feel so different compared to oxycodone when they are both opiates? I've searched for an answer to this question and can't really find a reliable one. But for myself the effects were totally different, oxycodone causing an energetic feeling with morphine much more sedating. Oxycodone improves my motivation and initiative whereas morphine makes me a little lazy despite the excellent pain relief - I've always found this drastic difference in effects so strange.
Click to expand...

While this doesn't really answer why and I don't know the answer myself, this is not at all an uncommon response. Despite all being opioids, many people seem to find morphine and its derivatives much more sedating than codeine and its derivatives. I'm not sure about the other -codones, but I've read at least a couple of studies which postulate that oxy actually works on slightly different receptors than morphine and a number of other opioids (kappa instead of mu). I don't know if this is generally accepted, a radical theory, or what... but if it's true it may partially explain the difference. Again I don't know enough about pharmacology myself to understand the distinct differences between those receptors and whether or not that could be part of the equation. At the very least you can be assured that you're not the only one who feels like that with oxycodone especially.
 
The difference between them is surprising, considering the similarity in molecular structure. I think the kappa / mu receptor theory is as much as science can explain to us at the moment, if that's even generally accepted, but I doubt that anyone fully understands it. All I know is they definitely affect the brain in a different way, or they would have the same effect on our consciousness.There is certainly a cross tolerance and similarities between them but in my experience it isn't complete.

I find that morphine and its derivates have more side effects such as itchiness, those nodding daydream visions, drowsiness, and constipation when compared to oxycodone (which I personally find has no side effects at all, apart from occasionally a little anxiety). I generally stick to oxy as it is what I'm prescribed, I find it the easiest to control my use with, and the most functional one but nevertheless I enjoy them all equally. Diamorphine is still probably my favorite, but the euphoria is quickly lost and replaced by sedation when redosing, whereas oxycodone is much more sustainable. I'm on oxycodone during work when I have to exhibit initiative and management skills to come up with results, and occasionally a morphine derivative while chilling out in my spare time - but those are more of a treat for me. The morphine derivatives can still be strongly mentally stimulating when used in moderation and in low doses, but for whatever reason oxycodone works a lot better as a regular pain med. I'm generalizing here but I do believe this is a common physiological response.
 
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^^Not to add anything new to the above posts, just IME in pain mgmt it's widely accepted that the morphone/morphones have a much heavier, lethargic feeling to then then Oxy & derivatives. Again not really a "why", just saying.

I've posted about trialling other opiates than Oxy & it's never been that great in terms of pain relief or euphoria. So, obv the slight action on different receptors does play a big part, as well as genetic makeup, Metabolism & dopamine release. Oxycodone in particular is known to hit the "reward centre" in the brain, making it particularly more addictive.

Actually fellow Cpp's, I've come across a number of ppl that swear by morphine, (oral), for chronic pain but now that I'm thinking on it,- it's pretty much older ppl. Maybe they've never tried oxy, it being much newer?? Any observations or thoughts?

Any pain patients that can say morphine is their drug of choice?

Rtp
 
I can't say that morphine itself is my DoC for pain or recreation but I can say that there seems to be something about the morphine/oxy combination that is GREAT for taking care of pain. I'm Rx'ed ER morphine and IR oxycodone and that is the best combination I've ever been on, personally, and way better than either of them were alone. I don't advocate the risky behavior of taking multiple opioids in larger-than-prescribed doses, but it's worth noting that the euphoria that comes from extra oxy on top of the morphine is also pretty sublime. Both the extra painkilling properties and the additional euphoria could have something to do with oxy working on the kappa receptors too.

So wait, Run, are you quite sure that oxy does work on different receptors than morphine? Or were you also just saying if it does, then the different effects make sense?

I also tend to hear older patients preferring morphine on its own. However, like I mentioned above I've seen it referred to the "gold-standard" cancer pain drug more times than I can count. I wonder if there's something about cancer pain that morphine treats particularly well? Or if it's simply used so often out of a sort of tradition from being such an old and widely-used drug?

Metabolism does change as people get older and often drug dosages have to be reduced for safe use in the elderly. Sometimes in a drug study I'll see that the half life is greatly extended in the elderly so stacking has to be taken into account, or that plasma levels were somehow different in participants older than 65 etc. etc. This could very well play into the perception (or actual trend) of older people having a preference for a drug that often doesn't work as well for those under a certain age.

This is all so interesting.
 
Then I hope my tolerance decreases in my retirement years! By then I will most likely have been on this stuff for decades, unless science advances to the point where they can just give me a shiny new spine.

I agree completely with the combination of them being extremely effective for pain (and exhilarating euphoria + all the positives apart from pain relief).

Are the more sedating and 'heavier' feeling opiates more dangerous? I often notice respiratory depression while using them - but it's my understanding that respiratory depression can be experienced with doses nowhere near OD territory. It's a particular worry for me because I have a panic disorder and I'm usually on a low dose of valium - this adds to my preference for oxycodone, as I prefer a more stimulating opioid for this reason. My doses are quite low though, and I think that due to my anxiety, if I notice any change in my breathing pattern at all I can dwell on it and experience a fight or flight response. This is a rare occurrence with the more sedating ones like opium, morphine, and hydromorphone. With oxycodone I can experience a more typical panic attack from excessive stimulation, which doesn't worry me anywhere near as much as a "sedating" panic attack. I generally react very well to opiates though or I wouldn't use them.

I drink a lot of caffeinated tea, and cacao while using morphine derivatives, and I drink chamomile while using oxycodone.

I never experienced respiratory depression with percocet. Perhaps this has something to due to its high affinity for kappa as opposed to mu receptors? I'm not sure if it's actually any less dangerous, or if it's all in my head.
 
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^respiratory depression would be doseage related not a side effect of your chosen opiate.

I experience "air hunger" at times, usually when I've missed a dose or am actually in full blown oxy wds. This can feel similar to anxiety attacks or respiratory depression. Rave, in your case I'd be concerned if that is actually what's happening with you. I believe you're incorrect in thinking that's far from ODing!

Anyone, cmiiw,

Rtp
 
^That's why I take oxycodone for my pain, to me it's a completely different drug than any other opiate I've tried with much less side effects. Personally I think that my reaction has to do with my panic disorder and how the slightest change in physiology can be blown way out of proportion. If I take a morphine derivative I have to be very cautious about how much I take if I want to get positive effects, despite always taking very low doses; this simply isn't the case with oxycodone since I have never experienced sedation from it regardless of the dose. Considering a cup of coffee or the tiniest puff of weed (like 20mg of weed) will send me to the ER, or dosing something like a 5 day supply of benzos to calm myself down, feelings of panic don't always make logical sense for me.

So the anti-inflammatories I have heard of are the maqui berry, turmeric, rosemary, and pineapple. Can anyone comment on natural anti-inflammatories, I am curious about anti-inflammatories - especially natural ones. Anything that could help keep my oxy dose down apart from experiencing agony.
 
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@rave,

Why are you pursuing natural anti inflammatories when you didnt feel prescription strength meds were adding anything of value to your regime?

I'm just curious. Is it just the doctors prescribing as protocol indicates for back pain or do you have raised inflammatory markers or an indication of inflammation?

Rtp
 
One option to consider, which would probably be the quickest way he's going to get assistance avoiding/coping with the withdrawal symptoms, is to book an appointment ASAP with a D&A counsellor probably at or via a detox clinic. They will perform a medical assessment and refer him to somebody to prescribe suitable medication.

Xanax for pain management? That's a new one.
 
Actually, I took Celebrex for a short period of time when my back was my biggest issue and it helped a lot. It wasn't enough on its on but it was an excellent adjunct medication. I know it's easy to poo-poo non narcotics or otherwise just things we haven't heard much about but that was a pretty great med for me... dunno what your specific issues are but try and keep an open mind! Certainly long term NSAIDs have their own risks, but I definitely think it's worth trying. Do your best not to pre-judge.
 
Hi everyone, a little a bit about me before I ask your advice :). I've started pain management for the first time at the end of last year, although I've had ankylosing spondylitis (a type of chronic degenerative arthritis) since age 11 (I'm now 24). At first, they prescribed me one hydrocodone 5mg a day, which was stupid because it didn't do anything and made me want to take more at a time to get that relief. Then, I was put on bupe patches, which again didn't work well, and cost hundreds of dollars with insurance. Now, I'm on 10mg hydros x 4 per day, which would help if I had a bit more self control.

I've had problems with opiates most of the time since I was 16 (they were the first drug I tried, and have been my DOC since, even though I've def fucked myself up physically from shooting them and long binges). I want to take my meds properly because this is the first chance of medically sancitioned relief after 12 years of excruciating pain. I know that I'll also have to take some form of opiates for the rest of my life, as my joints continue to break down and my spine fuses over time (it's how the disease goes), so I don't want to raise my tolerance too high now and regret it down the road. Do you have any advice how best to keep myself in check? I've been better with my self control recently, and my boyfriend holds on to my pills for the next weeks (I just keep the ones for the current week) in the script for me so I'm not tempted to use too much. Last week I ended up going into w/d because I used up my script too soon, and I had to use lope to keep myself well for training for my new job as a pharmacy tech (which I am loving and thinking about maybe going to school for pharmacy now!). I'm really afraid I'm going to fuck this up, but I can't go back to living like I have the past 12 years. A lot of my use was depression about my pain and my disease, and generally being so young but such a fucking invalid (ugh).

Any advice you have for keeping myself from fucking this up or using too much. Whether it's as simple as handing them off to a trusted family member or something else. Or even hearing your own experience, it'd make me feel a lot better. Thanks, Lucy.
 
Lucy- my mother now keeps mine in a safe that I do not have key or combo to it. She gives me my meds on a daily basis. This does help.
 
Yeah, my mom doesn't know about my problem, but my boyfriend has it hidden. Idk I kinda want to tell her, but I don't think I could get those words out. It would make a lot of sense about a lot of past things I don't want to dredge up.
 
Need some advice!!

Hello all, I have no idea where to post this I looked through the forms and I'm sure I missed something. Any way so here's my dilemma/problem. (Before I post this I want to be very CLEAR! I am in know way asking for what to say to my doctor, neither do I need to know where to go, or how to get any type of drug or medication) with that being said let me get to the point. I'm young, I had a rare disease called leg calf Pertheas disease when I was 9 years old I spent the majority of a year in a hospital, want through a pretty major surgery, full body cast and then rehabilitation(taught me to walk again). My doc told me and my mom then that I should take it pretty easy through my teen years, and by 30 years old I could very possibly need a full hip replacement. (I'm currently a few years away from 30) I didn't take it easy my teen years, who does? I had fun, play sports rode four wheels, dirt bikes, hiking, and just really was a physical young man. Well I didn't ever thing it would catch up to me this fast. About a year ago I started really having so back pain and hip pain, also knee pain. I toughed it out for a while then adventually made a doctors apt. first apt I could tell doc thought I was someone out looking for drugs and trying to score a script, so he prescribed me so powerful Tylenol, (never worked for my pain) Next time about a month later he gave me 20, 5mg hydrocodone a month. Those helped if I took 2 at a time like 3 times a day. Next we went to 30, 10mg a month, finally he sent me to x-Ray once he seen them he said I have severe curvature of the spine my right hip is quite larger than my left, so without hesitation he gave my 60 10mg hydros a/m. This helped for about two month, it's been about 6 months since then and they aren't really doing the trick I'm having to take to much of those I don't like all the Tylenol in it, I've read that's real hard on your liver I think? Anyway He told me that was as much as he could prescribe me, something about the government has there eyes on all doctors right now and at my age it would look terrible to give me more than that, so I guess my end question is, what are my options? What do I do? I hate being in pain and it's really putting a toll on my life,job, family, and just about every aspect of things in my life. I need some people that have been through similar situation to give me some advice please!! Thanks everyone in advance for responding! And sorry again for not knowing where to put this!
 
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