Talking to my Doctor

[somuchtosayx]

SWIM is in a lot fo back pain and want some hydocodone. SWIM has arthritis in his back and bone spurs. Swim has been put on several differnt NSAID's such as Mobic, Celebrex, and Volteran. Although SWIM enjoys recreational uses of hydro, he actually needs them quite often and he needs help tlkaing ot his doctor. SWIM doens't want to seem like a drug seeking addict, but at the same time, he knows that opiates are usually the only drugs that help chronic pain. SWIM has considered seeing a pain specialist, however he has no insurance and is already paying out of his ass for the Orthopaedic doctor. Any suggestions???? SWIM just wants somehting that works.

[Nagognog2]

Ask the ortho for a letter of reference, and save your ¢ for the pain-specialist. It's all specialists these days - one for each finger and vertebrate. The orthopedist is likely scared of losing his/her medical license if more than a certain amount of narcotics are prescribed. The pain-specialist is better equipped to deal with such.

[Forthesevenlakes]

Be open to advice and medications outside the opiate realm that a pain management specialist will dispense as well. SWIM has seen medications as diverse as amitryptiline, gabapentine, and cyclobenzaprine prescribed for chronic pain. It all depends on the pain and what works, what doesnt. Some patients respond better to non-opioid medications alone or in conjunction with opioids. Get a reccommendation or letter of reference from the ortho and compile SWIY's medical records. When SWIY does see the pain management specialist it might help to have a list of medications (both OTC and prescription) that SWIY has used, and be able to state which if any helped. Dont be afraid to ask if its okay if SWIY checks in with the doctor after a couple days to let him/her know if the treatment SWIY gets is working.

This probably goes without saying as well, but in the event that SWIY gets prescribed narcotics, DONT take them recreationally anymore. This will drive up SWIY's tolerance extremely fast, make the medication less efficacious for pain, and lead to problems with addiction a lot more quickly.

[somuchtosayx]

SWIM thanks you for your help. He think he will try the pain specialist and is considering non-opiod meds as well as definitely not using any opiods recreationally.

[somuchtosayx]

Just an update. Swim tlaked to his doctor, and was honest about needing somehting a little stronger for "as needed" purposes. Swim was prescribed Tamadol. Says it works great for the pain. Not too much euphoria at all, just a nice feeling if lying down. Does however give you energy, and very difficult to sleep Do not recommend taking if you are going to bed within 4 hours, or else you will be up for a while due to it's Serotonin properties. Now SWIM has to go back to the doctor and try something else because his back pain usually comes in the evening, and he has sleeping problems as it is.

[Dropinem]

Sorry for saying numbers instead of mg.. for swi it would take 100mg of tremadol to get a good high and it would take 15-20 viks to get the same...but swi thinks 10mg hydro/ 50-100mg trems is a good combo...it seems like the hydro's kick in faster and by the time that peaks the trems start to kick in and swi think its a good balanced high

[somuchtosayx]

Well SWIM has an orthopaedic and a general physician, and although SWIM has been patient with their reccommended drugs, neither seem willing to prescribe any that actually work with out major side effects. Tramadol was too energetic and SWIM doesn't liek the come down, left him feeling depressed. Damn doctor's these days are ao afraid to prescribe any opiates because of all the negative publicity about them, despite that fact that only 4% of all users to are prescribed vicodin abuse them. WEll thanks to the 4%, SWIM has to go on in pain. Damn Doctors

[Forthesevenlakes]

Most narcotics prescriptions reccomend taking 1-2 pills for pain, and Tramadol is usually in 50 mg doses, so 100 mg at a time is not an extreme, "drug seeker" type amount. SWIY should not be afraid to mention this to a doctor. But SWIM really thinks SWIY should start hunting for a new doctor...perhaps look into a free/sliding-scale clinic in the area if money is an issue.

[somuchtosayx]

Well SWIM has tlaked to his doctor and updated her on ineffectiveness of thr Trams. She reitterated that fact that SWIM should do some physical therapy as soon as possible, rather than just lifting weights. SWIM was going to wait a month or so but is considering going sooner. SWIM's doc also wrote a script for Flexeril muscle relaxant. SWIM hopes this hopes, and doens't just knock him out. Will keep you updated

[Forthesevenlakes]

theres a good chance flexeril will knock SWIY out, so try taking it at night first, it tends to make most people sleepy. Is the doctor's idea for SWIY to take tramadol during the day, and flexeril at night? If so, maybe have a pot of coffee going first thing in the morning, since Flexeril tends to make SWIM very, very groggy the next morning.

[somuchtosayx]

Well SWIM has been using the FLEXERIL at night. The drowsiness isn't nearly as bad as it was the first day. Now it only makes him a little tired. SWIM has used all the tramadol in 3 weeks (forty 50mg pills) and doesn't care because he didn't like the SSRI properties about them. The FLEXERIL doesn't help all the much with the pain. SWIM wonders if it's because of the type of muscle relaxant, or if all muscle relaxants are ineffective pain killers. SWIM has had a few hydrocodones (10/500). SWIM used to take them recratinally about 3 months ago, and now needs about 20mg to gain any theraputic effect, and double for recreational effect. SWIM is upset that he let himself abuse the hydros because now when he really needs them they just don't work the way they should.
SWIM has made an appointment with doctor to seriously consider narcotic pain killers as an option. SWIM will give the bottle to his wife and let herregiment the doses as needed.

Soo... SWIM has a couple questions:
1. If a tolerance raised quickly, will it also lower quickly?
2. How long to drop the 20mgs down to 5mgs for a theraputic effect. (SWIM suspects atleast a month of no use in order to lower it at all. SWIM never used them that often. Maybe 10 mgs two days in a row, than 20mgs two days in a row 2 weeks later. So overall only 4 times in one month, but the dose went up dramaticly compared to the initial 7.5 mg needed for a mild buzz 2 months ago.)
3. If SWIm acquires a prescription of say 30 7.5/500 for "as needed" and waits a month for his tolerance to go down, should one pill be enough for theraputic effects.
4. Also, since SWIM will no longer be using them recreationally, how long would a tolerance grow from 7.5mg once or twice a day, maybe 2-3 days a week. (overall about 4-5 pills a week)
5. What would you suggest to SWIM in this scenario?

SWIM is worried that because of his past occasional abuse, he will never be able to get a theraputic effect from a typical doctor's presciption. Hydrocodones however are the only thing that has ever worked with the least amount of side effects. SWIM doesn't want to become addicted, but the pain is becoming too much. SWIM realizes that he can't abuse the pills and look for a buzz anymore, SWIM must use them properly and only for the occasional severe pain (about once or twice a week) Any help or suggestions would be greatly appreciated.

[Forthesevenlakes]

muscle relaxants do not really relieve pain in SWIM's experience, unless the pain is directly due to muscle tension. they're more effective in promoting sleep even if one is in pain.

keep in mind that tramadol will up SWIY's tolerance for narcotic painkillers as well, this could be part of the reason that SWIY has a higher tolerance to hydrocodone. while tolerance to opioids builds quickly it can take weeks or months for it to lower to baseline, unfortunately.

SWIM thinks it would take at least a month, but perhaps up to 3 months of abstainence for 5 mg to have the same effect it once did. however SWIM is just going off his own experience, others may have different input. 7.5 mg might be effective after a month for pain control, however, since a painkilling dose is usually lower than a recreational dose. SWIY would probably see tolerance grow after a couple weeks even using the pills a couple times a week...so expect the dosage to have to increase after a few months.

SWIM thinks that SWIY can still get analgesic effects from a doctor's prescription, despite past abuse. SWIM would suggest using as many other therapy options as possible to help with the pain, and making the necessary lifestyle changes to aid in this. Use the tramadol for minor pain, and the hydrocodone for more major pain, but only when absolutely necessary. a small dose of DXM (15-30 mg), or grapefruit juice taken an hour before the hydrocodone can also help potentiate a normal dose and make the analgesic properties more effective. Also talk to SWIY's doctor about ways to perhaps make a plan to treat the problem (if possible) so that SWIY does not have to be on narcotics forever. good luck!!!

[thegoodfight]

Originally Posted by Forthesevenlakes

muscle relaxants do not really relieve pain in SWIM's experience, unless the pain is directly due to muscle tension. they're more effective in promoting sleep even if one is in pain.

keep in mind that tramadol will up SWIY's tolerance for narcotic painkillers as well, this could be part of the reason that SWIY has a higher tolerance to hydrocodone. while tolerance to opioids builds quickly it can take weeks or months for it to lower to baseline, unfortunately.

SWIM thinks it would take at least a month, but perhaps up to 3 months of abstainence for 5 mg to have the same effect it once did. however SWIM is just going off his own experience, others may have different input. 7.5 mg might be effective after a month for pain control, however, since a painkilling dose is usually lower than a recreational dose. SWIY would probably see tolerance grow after a couple weeks even using the pills a couple times a week...so expect the dosage to have to increase after a few months.

What is stated above about the muscle relaxers is definately true. There are many muscles in or around the back that can cause a lot of pain that seems to be back related when if fact it is mucle pain, causing the back pain. The Piriformis (sp?) muscle in the buttock is above/on-top of the sciatic nerve (and all other nerves to the legs). When this muscle is tense/cramped it can cause severe leg pain and pain in the foot. Most docs will think it is a pinched nerve in the L5-S1 disc and not really look at the piriformis muscle.

Swim disagrees about the 1-3 month tolerance decrease. Swim was off opiates for 5 months and when swim stated back on the for legitimate pain, his tolerance had lowered VERY LITTLE! If Swim had taken 60mg before swim stopped, it would take ~50mg for the same effect and Swim had lost 20lbs. Swim thinks it really depends on the preson.

[oxalot]

It does not sound like SWIY has any serious back pain if SWIY can lift weghts, I am sure the Dr. has considered this and it really does look kike SWIYbe drug seeking in this case. I won't pretend to know what anyones pain is like as for SWIM , he takes 300mg oxy/day for CP. no amount can bring on a real high any longer though. I would suggest if one needs to switch to opiates to get relief they would consider not telling the Dr. of the heavy lifting one can do. SWIM does not recommend lying about drug use because your records tell the tale unless you start fresh somewhere. And this is limiting also as you say most Dr.s won't begin with opiates. Also I have experience with pain Dr.s and they are even more paranoid than most because of the undo pressure they recieve from the DEA. The coppers would much rather arrest a Dr. who would never consider fighting back like the types who sell the illegal stuff. If you do have an extensive med record of suffered pain then I'd try online Dr. They have to have records like anyone else but are more forgiving about what to give. They may up tramadol dose or even go straight to hydro. Remember they have an obligation to sell as well as heal. They are expensive (but Dr. visit/referenceis included) Do home work on who is legit. Most won't rip you but there are juristrictional laws to consider.