Opioids Need a Subsitition

[JennCajun]

Hey guys,
I was in a firearms accident on the 26th of May and was on fentanyl for the first two weeks, and Dilaudid for 3 months. Ive been off the dilaudid about a month, and have been taking Tylenol 3s. These arent really working at all though to help with my pain so Ive switch to Tramacet. Ive only been on the tramacet about a week, and while its better than the tylenol 3 I still have severe pain. The reason I got off the dilaudid was only because it wasnt working either. I really dont want to be on strong strong drugs, that have high potentiental for addiction, but I really need to switch to something that will help with this pain. Currently, its debilitating and I cant get out of beds most days. Ill list what Im taking below so not to get suggestions Im already taking. The pain is mainly nerve pain, facial pain (every bone in my face was broken), and back pain (this is what keeps me in bed) Im an 18yo female, and I feel super old. I really cant live my life with this pain, I would really appreciate suggestions.

Medication list:
Effexor 300mg
Abilify 2mg
Lorazepam 4mg
Seroquil 100mg
Lyrica 100mg
Celebrex 100mg
Naproxen (Prescribed) 1000mg
Tylenol 3 - up to 6 a day, or combined with Tramacet a total of 6 of the two.
Tramacet - Up to 6 a day unless Ive taken Tylenol 3
Aspirin 80mg (This is for an enlarged blood vessel)

I hate being on so many drugs, but such is my life right now. PLEASE HELP

 

[Felonious Monk]

Have you considered medical cannabis? It would be more effective for your nerve pain and would let you replace the most pharmaceuticals (possibly as many as 7 or 8 from your list).

 

[Kittycat5]

You could probably cut out the Celebrex or Naproxen. Thats a duplication. Idk, you could switch to a tricyclic or duloxetine but the tramadol would be problematic and Effexor would need to be stopped. Maybe an NMDA antagonist like low dose DXM could help.

Question? Why worry about addiction? You already probably have less a predisposition than many of us here by saying you worry about it. If the Tylenol#3 helps moderately with some of the physical (or even neuropathic) pain, why not get something a bit stronger? Maybe something long acting. Dependence and addiction are different beasts.

 

[Ksa]

You got too much COX-2 inhibition, does your doctor know you take 4 separate agents, 1 of them strong (celebrex), which all inhibit COX-2? This places you at a higher risk of heart failure/heart attack. Vioxx was taken off the market for having a slightly bigger activity then celebrex in inhibiting COX-2, with your mix of drugs you're way above what Vioxx would do.

 

[Kittycat5]

Vioxx was about 10x as strong as Celebrex in terms of COX-2 inhibition. Aspirin and Tylenol dont have the same cardiovascular risks as NSAIDs or COX-2 selective agents. Think pretty much any of them are warranted here but yes, Celebrex and Naproxen is a duplication in therapy and one should probably go.

 

[strity1994]

Try Lyrica or Gabapentin (Lyrica is more ideal), I take a high dose when I need to do a lot of stuff. it numbs the nerves so you don't feel pain.its Pfizer's block buster drug , it's not a narcotic so sales are up millions. Just ask ur doc and he will be happy to give u

Edit: ur already on Lyrica. Up ur dose to 300mg, stay on it for a while the go up to 600mg (max)

 

[Kittycat5]

They are on Lyrica.

 

[Ksa]

Vioxx was about 10x as strong as Celebrex in terms of COX-2 inhibition. Aspirin and Tylenol dont have the same cardiovascular risks as NSAIDs or COX-2 selective agents. Think pretty much any of them are warranted here but yes, Celebrex and Naproxen is a duplication in therapy and one should probably go.

I was mentioning the total COX-2 inhibition, that is the total number of COX-2 enzymes inhibited, I shouldn't have called it activity:

You got too much COX-2 inhibition

The factor of 10 applies to selectivity. Vioxx inhibited one COX-1 enzyme per 300 COX-2 enzimes, Celebrex only inhibited 30 COX-2 per one COX-1 enzime. Celebrex is medicated on average 200mg, 100mg twice a day, patients on VIOXX only took doses of either 12.5, 25 or 50 mg.

So a patient on VIOXX did not inhibit 10x more enzymes than a patient on Celebrex.

 

[strity1994]

They are on Lyrica.

yep they need up the dose. as the problem is nerve pain, a high dose (all at once, not 2 or 3x a day) make me 100% pain free. I use when I know I need to function like a normal person and it does the job. The key is to use the medication in short bursts, like only when u need to fight thru the pain. If I'm lying on my ass on a Sunday morning ,I skip it. I will suffer through the pain so I can have a 100% pain free awesome Monday! Lots of planning is required to maximize effectiveness of pain medication. U can't be 100% pain free all the time so if that's ur goal forget it, remember short bursts like a machine gun. Go all out and get it done!

 

[thedukeofraoul]

Hey guys,
I was in a firearms accident on the 26th of May and was on fentanyl for the first two weeks, and Dilaudid for 3 months. Ive been off the dilaudid about a month, and have been taking Tylenol 3s. These arent really working at all though to help with my pain so Ive switch to Tramacet. Ive only been on the tramacet about a week, and while its better than the tylenol 3 I still have severe pain. The reason I got off the dilaudid was only because it wasnt working either. I really dont want to be on strong strong drugs, that have high potentiental for addiction, but I really need to switch to something that will help with this pain. Currently, its debilitating and I cant get out of beds most days. Ill list what Im taking below so not to get suggestions Im already taking. The pain is mainly nerve pain, facial pain (every bone in my face was broken), and back pain (this is what keeps me in bed) Im an 18yo female, and I feel super old. I really cant live my life with this pain, I would really appreciate suggestions.

Medication list:
Effexor 300mg
Abilify 2mg
Lorazepam 4mg
Seroquil 100mg
Lyrica 100mg
Celebrex 100mg
Naproxen (Prescribed) 1000mg
Tylenol 3 - up to 6 a day, or combined with Tramacet a total of 6 of the two.
Tramacet - Up to 6 a day unless Ive taken Tylenol 3
Aspirin 80mg (This is for an enlarged blood vessel)

I hate being on so many drugs, but such is my life right now. PLEASE HELP

so you're on a low-dose aspirin, naproxen, lyrica.. tramacet? really? I'm sorry but being an RN I know about the dilaudid (hydromorphone) standings in my area and others, with your nick being @JennCajun then I'm assuming you're in the southern US?

anyways, you switch to a nurse practitioner who can TREAT what you have been diagnosed with by doctors. tons of clinical practitioners are NPs and if that fails then go to a pain management doctor. that period of being on Fentanyl and Hydromorphone should be reduced to a weaker opiate, at least Percocet (Oxycodone)


reply if you're curious about anything else. I do know DEA, FDA and AMA have cracked down on long term narcotic prescriptions but if it is needed then obviously go to a doctor who knows what they're doing or can point you to one.. and to be in multiple SSRIs and other reuptake inhibitors is bonkers, considering you take (2) 2mg Ativans.

hope you have found some new info since..


~td

 

[thedukeofraoul]

also, FUCK the others too.. seroquel and also celebrex goes hand in hand with the effexor and abilify. you're tired from all the side effects.. for just pain you don't need all those brain drugs.. not at all..

 

[JennCajun]

You got too much COX-2 inhibition, does your doctor know you take 4 separate agents, 1 of them strong (celebrex), which all inhibit COX-2? This places you at a higher risk of heart failure/heart attack. Vioxx was taken off the market for having a slightly bigger activity then celebrex in inhibiting COX-2, with your mix of drugs you're way above what Vioxx would do.

What is COX-2? I take celebrex on the days I DONT take naproxen, and vice versa. Sorry should have cleared that up. I have noticed an increase in heart rate though..is this why? Thank you for your input btw

 

[JennCajun]

so you're on a low-dose aspirin, naproxen, lyrica.. tramacet? really? I'm sorry but being an RN I know about the dilaudid (hydromorphone) standings in my area and others, with your nick being @JennCajun then I'm assuming you're in the southern US?

anyways, you switch to a nurse practitioner who can TREAT what you have been diagnosed with by doctors. tons of clinical practitioners are NPs and if that fails then go to a pain management doctor. that period of being on Fentanyl and Hydromorphone should be reduced to a weaker opiate, at least Percocet (Oxycodone)


reply if you're curious about anything else. I do know DEA, FDA and AMA have cracked down on long term narcotic prescriptions but if it is needed then obviously go to a doctor who knows what they're doing or can point you to one.. and to be in multiple SSRIs and other reuptake inhibitors is bonkers, considering you take (2) 2mg Ativans.

hope you have found some new info since..


~td

Hey! Cajun was just the name of my cat I'm actually in Canada. Fentanyl is the most abused opioid drug here so that obviously was discontinued..not to mention I was put in a medically induced coma using it (They couldn't wake me up for 3 days after getting off the fentanyl) Yes, the dilaudid was terribly done by my doctors..I was on 12mgs a day most of it being long acting..then my doctor cold turkeyed me off it and left on vacation. I've never suffered withdrawn until then and it was the worse sickness and bodypain I have ever experienced. To be honest..I'd love to be on percocet as I know it works but its so abused here and as silly as this sounds..my mom administers my drugs as I developed short term memory from the accident and she refuses to let me be on anything stronger. I'm trying to get off the SSRIs as they don't help me..the doctors think I have PTSD which I swear I don't and these stupid pills fuck me up. The Ativan is because I'll get panic attacks..I only take them as needed. Thanks for your advice, sorry if I have a lot to ask!

 

[JennCajun]

In Canada so I'll be legalised soon but until then its not an option..I'm not.knowledagble about the medical stuff but do I have to smoke it? Weed makes me very paranoid

 

[JennCajun]

I use the seroquil as a sleeping pill..but I didn't know celebrex was a brain drug. Could you please explain?

 

[Raysu]

Ok I know you're young and there's a lot of hype about getting addicted to prescription meds but from being a long time pain management patient and having been an addict before I want to impress upon you that fear has no place in medication management and it directly adds to the pain as stress/fear/worry contribute to its intensity. It is better to take the doses as prescribed regularly rather than just for breakthrough pain because it allows the pain cycle to persist and can even worsen it. Otherwise you are having to play catch up and overall may require more medication to deal with it than had you taken the reasonable dose around the clock. A steady treatment plan is far more effective and more productive to the healing process than the back and forth swings of addressing breakthrough pain. Please explain this to your parents. Have them look into it and ask the doctors. They are not doing you any favors by withholding your medicine. Addiction does not come from taking medicine as it is directed-it comes from a thought process and misuse/abuse. Also for panic attacks IMO lorazepam did a piss poor job for me. Clonazepam was the most helpful in that regard. Do not consider PTSD as a stereotype. It seems like a valid diagnosis for any event involving a firearm. Just because it falls in the realm of a mental health diagnosis does not mean you are a "crazy person" or "unstable" or a psychotic mess. It stands for Post Traumatic Stress Disorder, which is a way of saying you have physical and psychological symptoms following a life changing or perceivably life changing event. That can range from having difficulties sleeping, changes in appetite, headaches, muscle tension, etc. these are not abnormal kinds of feelings. People experience things like this from changing shifts at work. This is just a oversimplified way of explaining this obviously and I'm doing so because it sounds as though you fall into a category I once was in where I saw no value and had no respect for mental health professionals. To me I saw it as weakness of character to see anyone in the mental health field. Maybe that's not you? Anyway I also want to suggest other avenues that I had benefit from which included acupuncture, massage therapy, CBT, reiki (which is even recognized and used to treat pain in cancer patients at hospitals directly now), hydrotherapy (fitness in a pool is both relaxing and easier on the body than land physical therapy), and meditation/guided self hypnosis (you can listen to them on YouTube and are great for relaxing and improving sleep. Medications have their place for sure but incorporating these kinds of things into your treatment plan is a more hands-on approach to recovery.

 

[Kittycat5]

Celebrex is not really a brain drug. It has been studied for various psychological conditions but isnt really used for anything other than arthritic pain these days.

To answer your COX-2 question, the body contains an enzyme called cycloxygenase (COX) that exists in 2 forms, COX-1 & COX-2. Traditional NSAIDs inhibit both to some degree and drugs like Celebrex were developed to selectively inhibit COX-2 because it was thought it was only expressed in the inflammatory process and not in the stomach or other healthy tissues. They were trying to prevent the ulceration and bleeding risks of traditional NSAIDs while maintaing the pain and anti-inflammatory actions but it didnt work out that way.

But dont worry about all that. If not taking together, I suppose thats ok. I still think you should pick one or the other and probably forget the Celebrex but its your decision.

To summarize all that was said by the various posters here that make sense you should find a pain management specialist, who can then maximize or change your current program and explore all non-pharmacological therapies that you can. You still have youth on your side so dont give up hope and keep fighting.

 

[SS373dOH]

.the reason I got off the dilaudid was only because it wasnt working either. I really dont want to be on strong strong drugs, that have high potentiental for addiction, but I really need to switch to something that will help with this pain.

1 hydromorphone is one of the strongest opioids you'll come acrossed for a prescription. The drugs that have the higher analgesic effects, will also in turn have the higher addiction potential. But you're already on 2 or 3 that carry that potential and a one or two of those may have been prescribed pre accident (lorazepam)?

 

[Felonious Monk]

In Canada so I'll be legalised soon but until then its not an option..I'm not.knowledagble about the medical stuff but do I have to smoke it? Weed makes me very paranoid

Legalization doesn't make it any easier to get your medicine.

My understanding of Canadian medical marijuana is that you should be able to access it now. You can access non-smokable forms as well.

 

[JennCajun]

Ok I know you're young and there's a lot of hype about getting addicted to prescription meds but from being a long time pain management patient and having been an addict before I want to impress upon you that fear has no place in medication management and it directly adds to the pain as stress/fear/worry contribute to its intensity. It is better to take the doses as prescribed regularly rather than just for breakthrough pain because it allows the pain cycle to persist and can even worsen it. Otherwise you are having to play catch up and overall may require more medication to deal with it than had you taken the reasonable dose around the clock. A steady treatment plan is far more effective and more productive to the healing process than the back and forth swings of addressing breakthrough pain. Please explain this to your parents. Have them look into it and ask the doctors. They are not doing you any favors by withholding your medicine. Addiction does not come from taking medicine as it is directed-it comes from a thought process and misuse/abuse. Also for panic attacks IMO lorazepam did a piss poor job for me. Clonazepam was the most helpful in that regard. Do not consider PTSD as a stereotype. It seems like a valid diagnosis for any event involving a firearm. Just because it falls in the realm of a mental health diagnosis does not mean you are a "crazy person" or "unstable" or a psychotic mess. It stands for Post Traumatic Stress Disorder, which is a way of saying you have physical and psychological symptoms following a life changing or perceivably life changing event. That can range from having difficulties sleeping, changes in appetite, headaches, muscle tension, etc. these are not abnormal kinds of feelings. People experience things like this from changing shifts at work. This is just a oversimplified way of explaining this obviously and I'm doing so because it sounds as though you fall into a category I once was in where I saw no value and had no respect for mental health professionals. To me I saw it as weakness of character to see anyone in the mental health field. Maybe that's not you? Anyway I also want to suggest other avenues that I had benefit from which included acupuncture, massage therapy, CBT, reiki (which is even recognized and used to treat pain in cancer patients at hospitals directly now), hydrotherapy (fitness in a pool is both relaxing and easier on the body than land physical therapy), and meditation/guided self hypnosis (you can listen to them on YouTube and are great for relaxing and improving sleep. Medications have their place for sure but incorporating these kinds of things into your treatment plan is a more hands-on approach to recovery.

Thank you for all this great information. I actually have Borderline Personality Disorder so I wasn't trying to throw out the idea of PTSD for that reason..its just I don't feel as if I have it. I'll definitely talk to my parents about it thanks.