Effects - Cocaine a better pain reliever than opioids?!?

[kailey_elise]

Hi there. I'm mostly a lurker, though I do post occasionally when I think I might have an answer better than those already posted or a question not currently asked - like today.

A friend of mine ("SF") suffers with a chronic pain condition and is prescribed opiates (methadone & dilaudid) for the pain. Apparently, the pain has gotten much worse as of late; I was IMing with "SF" last night as many things were tried in an attempt to alleviate the pain: an additional 10mg methadone on top of the usual dose (I think it was 100mg in all by the end), 6mg Dilaudid orally, 1 frozen mudslide drink (vodka & Kaluha w/milk & coffee ice cream), 1 screwdriver drink (vodka w/oragne peach juice), then 10mg Dilaudid plugged (crushed, dissolved in water, then administered via enema), 30 minutes later another 6mg Dilaudid plugged, 1 hour later a final 4mg Dilaudid plugged, for a total of 20mg Dilaudid plugged & 6mg orally. "SF" intimated that no more was taken out of fear.

Apparently, not only was the pain still, well, painful, "SF" reported no real buzz - just a slight one for about 2 minutes after finishing the screwdriver.

Flash forward to this morning, pain is reported to be the same (even after "SF" took the normal morning dose of methadone, 30mg), but a friend came over in the early afternoon with some cocaine. "SF" partook of the cocaine and felt better - said the pain wasn't totally removed or anything, but it helped - MUCH more than the opiates.

Any ideas on how this could be? What chemicals/parts of the brain would cocaine hit that opiates wouldn't/didn't? Could the cocaine actually just be potentiating (sp?) the opiates and making them work better? And although this isn't the correct forum, anyone know why 20mg of Dilaudid plugged didn't work (not even a buzz to at least forget about the pain!), but 2 lines of cocaine did?

Man, I felt (and continue to feel) so bad for "SF", and I worry too, with the large doses of narcotics seemingly needed to make the pain subside. :'(

Thanks in advance for any help anyone can provide!

~K.Elise

[monkeygone2heaven]

cocaine does NOT act on the central nervous system pain centres, only is a local anesthetic. one of the main confusions. your friend may not get relief from opioids, not all chronic pain conditions (unfortunately) are relieved with narcotics, i'll be the fist to tell you as a) chrronic pain patient, b) neuropharmacologist!

NO basis whatsoever in using cocaine other than recreation. period. the only pain relief is topical anesthetic (e.g, numbing of your gums when you administer orally etc). is not effective in any known chronic pain condition. sorry!

[stoneinfocus]

I´m, suffering of chron. pain, also, and when I took the Line 1 to mirror, it really helped alleviating the pain.

Maybe some dopaminergic or any other neuronal synergy within opiates or pain perception that cocaine alters?.. swim wonders how medics can be so sure about most of their wisdmom and applications? -maybe they have to, to justifiy a sometimes useless and ethically cruel treatment, cause there has to be a landmark, when life has to take its toll

Usually, when one substance is a nightmare to some it might be gold to another and patients perception often are very distinct and exact, if the patient has to deal with a chron. condition.

And recreation -in its etymological meaning, is something very useful in regard to chronic pain management.

It might me depression, which would be alleviated, that worsen painperception?

[kailey_elise]

Originally Posted by co-incidence

I´m, suffering of chron. pain, also, and when I took the Line 1 to mirror, it really helped alleviating the pain.

That's exactly what SF said, & was totally amazed by that fact.

Originally Posted by co-incidence

And recreation -in its etymological meaning, is something very useful in regard to chronic pain management.

It might me depression, which would be alleviated, that worsen painperception?

I wonder about the depression as well; SF doesn't seem depressed (and I've seen SF through some depressive episodes!), but in my research it seems that many (most? perhaps even all?) chronic pain patients suffer some degree of depression, and that it can sometimes appear different than, er, "traditional" clinical depression. So perhaps SF & I are both missing the signs of depression, because we're looking for the traditional signs of past episodes? Who knows...

It would be so lovely if SOME company out there could come out with a drug that acted on the same (or at least many of the same) receptors as cocaine, without (or without many of) the negative side effects. *sigh*

I know that cocaine isn't solely a "topical anesthetic", that it works in the brain. I was wondering what exactly about it might be hitting the areas that interpret pain in the body. Perhaps the previous commentor doesn't understand the nature of chronic pain & how pain is felt/interpreted by people who are ALWAYS in pain.

Sadly for SF, cocaine isn't something you can take on a regular basis like other medications! *LOL* But, I'm pleased that SF found something that might work to help on those, well, not rare, exactly, but not common, either, situations when the prescribed treatments just aren't doing what they're supposed to do. Too bad it's illegal - I really hope SF finds SOMETHING legal that will help the condition!

Thanks for the feedback, everyone!

~K.Elise

[psyche]

Cocaine does have analgesic effects on central nervous system, altough I have no idea if it helps in chronic pain. Waddell and holtzmann(1999) found that alone cocaine produces analgesia in the hot-plate, but not the paw-pressure test. It has synergestic analgesic effect with mu- and kappa opioid receptor agonists. Studies show that these interactions are involved with noradreneric mechanisms, supraspinal mu and delta receptors and spinal mu receptors. So it surely does alleviate pain especially with such large doses of opiates.

[monkeygone2heaven]

could swiy post a link to those studies? swim is very interested.

there have been studies trying to link cocaine(dopamine) and opiate receptor up/down regulation and addiction and there may well be common substrates to those but most are a bit obscure, and in any case the links are not well-understood nor direct.

http://www.ncbi.nlm.nih.gov/entrez/q...=pubmed_DocSum

http://www.ncbi.nlm.nih.gov/entrez/q...=pubmed_DocSum (just title)

the simple fact swim was trying to point out but probably was too short in her reply, is cocaine does not (is not known to) bind to any opiate receptors and cause direct pain relief. cocaine, swim is sure, not a "better" pain reliever than opiates. but if we bring subjectivity into it, there is no point to talk about it. what is "better" for swiy, may not be beter for swiy2... etc...

one has to keep in mind there are various kinds of pain and this should be discussed with your doctor. - e.g, arthritis pain is very different from neuropathic pain. for example neuropathic pain iwll often not respond well to opiates.

now, that doesn't mean when patient pops a few pills they don't feel better. they can still feel the pain but might not care much about it -- if we are calling that pain relief than sure, anything under the sun can be a pain-reliever depending on person! but is that a good reason to become dependent on opiates?

the point made about "perception of pain" is a valid one. back to cocaine, when one is under a certain euphoric, good feeling, pain perception is improved. but one can achieve the same (decrease in felt pain without improvement in condition) with meditation and self-hypnosis. so swim would be surprised if any sane medical practicioner would instead propose trying cocaine. it's expensive, potentially addicting, not good for health. and it is not acting directly on the pain system. if we are talking about a terminal cancer patient, and cocaine is the only thing that helps them, maybe. but it is not a default pain drug.

swim is not trying to be "holier than thou" - she uses cocaine herself!! what she thinks is important is separating causes from effects, choices from wanting to believe. swim has known people taking opiates for pain relief and by the time they realise they've been abusing them, they're addicted. swim has avoided this by being brutally honest with herself. same goes for cocaine i think. one needs to be honest to herself about why the substance is being used. for pain relief? swim will be open minded and say, OK. but swim knows and loves cocaine -- its one hell of a drug ya know!!



ps: if someone is depressed, probably the worst things they can do is play around with dopamine drugs like cocaine and amphetamines. they may make a person feel good! but for how long? there is a "down" to these things and they make long term changes in the brain! this is nother topic but really important:

http://www.ncbi.nlm.nih.gov/entrez/q...=pubmed_docsum

http://www.ncbi.nlm.nih.gov/entrez/q...=pubmed_DocSum

http://www.ncbi.nlm.nih.gov/entrez/q...=pubmed_DocSum

http://www.ncbi.nlm.nih.gov/entrez/q...=pubmed_DocSum

[stoneinfocus]

While swim has now the ability to use meth instead of opiates, or with opiates and he must say, that it not only alleviates depression and pain better, it also adds to flexibility and physical constitution and he´s now awake, when he´s awake. Before, he was in pain taking opiates and maybe sleeping the half of the day, having periods of maybe 3 hours where he´d be nearly awake, but then being too exhausted and having to get a nap, with amphetamines he´s now up to 6-8 hours straight through awake, physically active and less in pain than with opiates.

He´s using cocaine sometimes and never came across a major tolerance to stims in his whole life, where he´s been using those at will, so he´s very optimistic, that it would stay this way, and even if not, it were already worth it and would be!

I can´t see what´s so diabolic on cocaine, at lease 1/2 of South America is on it and the sides are phyiscally less dramatic than abusing aspirine or paracetamol, resp. acetaminophen - imho losing the kidneys and going to dialysis every other day for a few hours, for the rest of your life, is worse than max.3 months of depression from the most sever and longest cocaine abuse?

Most of the links you´ve posted are mostly conducting tests of an animal model of addiction for parallels in humans.. swim can´t tell how worse an addiction could get, cause he never really had a bad one, except for mj and cigarettes, which he overcame and thereby reducing any risk of dependence to less then 99%, but there´re always some extremes: extreme users of a substance with no sides or only few and heavy users with all the sides, even short term users being in a from all sides overdramatized and so exacerbated mess.

I could give an exmaple where one would go through all the clinical sings of an addiction to neraly all conrtolled substances, with a slight amphetamine psychosis for a month and after a self-chosen 3 years off-period, returning to a yearlong controlled non-addicitve use of those, beside anything that is smokable , since statistical numbers indicate, that habitual cigarette smoking might be the curse and reason of all heavy addictions and intoxication problems, or so to say, an additcive behaviour, that would lead to the latter.

I couldn´t say that a doctor, thinking of cocaine as a pain remedy, would be insane, -let´s be clear about the fact, that, a chron. pain patient has no way -he´s either addicted to his pain, leaving himself and his life in a mess, or he´s addicted to take a remedy, i.e. opiates, or anti-depressives, or -you name it, any substance with a numbing or synergistic effect.

As swim came across this kind of logic he radically adapted to it over a few years and he couldn´t be more honest to himself or responsible for what he´s doing and finally, climbing across some narrow minded law-related borders and doctors opinions and limits, he might now be a criminal to some extent, but he´s got more of a life than before, and this is all that counts!

Cocaine shouldn´t be short ot expensive if it´d be exstensively marketed, relating to one of your arguments, not should the sides be too detrimental, if some would use clean stuff for what he might think has a purpose in his life.

[Alicia]

No way! a numbing sense maybe for throat and mouth and possibly eye surgery but no way in the way opiates work and feel..

[psyche]

I don't have links to aforementioned studies. The information is from the Psychopharmakology of herbal medicine by Marcello Spinella.

[lipglass]

SWIM was (is?) addicted to heavy duty dosages of opiates for 6 years & of course went through terrible WDs when said person ran out. Cocaine completely *stopped* the WDs during the time of cocaine use. In fact, that person now has a prescription for suboxone and hasn't needed to take it because s/he has cocaine. S/he is hoping that when the supply of coke runs out, the opiates will have been out of the body long enough to not even need the suboxone, at least from a physical sense.

So yes, although it may not make sense scientifically (I didn't read all the responses), coke works VERY well as a substitute for opiates for that SWIM that I mentioned.

[Alicia]

Originally Posted by lipglass

SWIM was (is?) addicted to heavy duty dosages of opiates for 6 years & of course went through terrible WDs when said person ran out. Cocaine completely *stopped* the WDs during the time of cocaine use. In fact, that person now has a prescription for suboxone and hasn't needed to take it because s/he has cocaine. S/he is hoping that when the supply of coke runs out, the opiates will have been out of the body long enough to not even need the suboxone, at least from a physical sense.

So yes, although it may not make sense scientifically (I didn't read all the responses), coke works VERY well as a substitute for opiates for that SWIM that I mentioned.

Yeh perhaps, but duration is crap with cocaine and not to mention the possiblity of a due addiction

[Nicaine]

Opiate receptor agonists also seem to have the ability to stop the symptoms of a cocaine crash (depletion of neurotransmitters)... SWIM has used kratom before and noticed that all depression/anhedonia went away. However, it returned when the kratom wore off.

[Free Spirit]

'X' also suffers from severe chronic pain since his early teens. Many painkillers came and went, even morphine based ones didn't do the trick. Finally, methadone proved to be the best painkiller, but still, there's always a certain amount of pain.

Fact is that cocaine does work as a painkiller in 'X's case as well. Even stranger perhaps is the fact that 'X' always wakes up in pain and in need of his meds 1st thing, except if he has had a few lines the night before... In that case there's hardly any pain the next morning, and he can even take his meds a little later.

Somehow it seems that cocaine not only 'boosts' the painkillers, but also lengthens their effect. And if it'd be psychological, it wouldn't work the next morning.

It's not sure how and why, but it does work. (It also helps against depression, but that's another story).

Your friend SF might want to take up with his physician to increase the level of methadone to a plane that works, and drop the rest of the meds. It's possible the other - lesser - painkillers block (or occupy) the receptors where one would want the methadone to be. For instance, if one mixes methadone and codeine, the latter will decrease the effectiveness of the first, thereby diminishing the painkilling potency overall. ‘More’ isn't necessarily better, and methadone on it's own is often more effective as combined with other painkillers (incl. alcohol).

NB: in order to prevent habituation and an increasing need for methadone, it’s advisable to reduce the amount whenever possible (i.e. when the pain is ‘doable’), only to increase when necessary. It’s good that it exists, but it still remains a ‘necessary evil’.

HTH