What should Swim ask for at the pain management??

[thegoodfight]

Please help Swim! Swim needs help deciding what pain meds talk to the doc about, for severe pain. appt was just moved and is in 28 hrs!!

Here is the situation: Swim has been on opiates for 3+ years. Swim has had some major injuries, one after another. These injuries are usually followed up with a surgery or two. Swim has had 8 months since his last operation and is in severe lower back pain with leg/sciatic pain. Swim has been getting really under-prescribed pain meds since the last operation. Swim has finally convinced his doctor that he is really in pain (needed help from those around him to "verify" his daily pain and disability). Swim went to a pain specialists that verified his MRI's and physical pain. The specialist thought my pain was legit and wanted to start swim on meds, but swim'd PCP was already perscribing to swim.

This brings swim to the question. What meds should swim ask for pain relief?
Current Meds:
10mg OC 2x ED
5/500 Vicodin PRN 6 hrss (swim taske 1 every 6 hours, actually 24 hours after each pill)

This is no where near close enough to ease the pain. Swim can take a 40 OC every 4-6 hrs and feel good (pain wise, not abusing at all). Swim has an ungodly tolerance for ANY substance. This is a dose that will allow swim to function normally and act his age instead of someone 50 years oldat than swim. Luckily It does not affect swim that much (as in being "high") because swim has severe pain.

Swim doctor told him to try the current dose out to see how it does. Swim got the pain management doc to switch the hydro to oxycodone IR.

The doc has mentioned: Morphine, Hydromorphone and fentanyl patches.

Idealy, swim would like to be able to get 30% more meds than needed so they can be taken at times of severe pain that always happen (and the doc never believe, one doc labeled swim a drug seeker b/c my flair-ups). Swim's pain is as real the death and taxes..Swim could continue on OC's but Swim can only ge the genetic ones as Swim don't know how to get others.. It would be nioce to be able to get something "abuseable" for those times once every month or so when Swim would really like to feel like Swim was alive and above near-death..

So, how does Swim approach my doc and tell him Swim's MAJORLy under prescribed w/o looking like a drug seeker? Swim could honestly break down and cry & cry in front of him as b/c this is so stressing and swim feels like swim has been a prisoner in swim's body for 3+ years.. Doctor knows my mental state and it is "firm"lol.. Swim just wants to be able to do a full days work so swim cand find a job, and be able to move the next day. Now swim can oly work 2-3 hours a day and then there is hell to pay afterwards.

Any suggestions here are GREATLY appreciated! Swim is about to lose it and has thought about calling the game of life quits more times than swim can count b/c the pain is so unbearable. Also, Swim was on 200mg OC / day and stopped in 3 days. Swim has done this 3-4 times to go through withdrawl. Let swim say that withdrawl is a PUSSY compared to the pain that swim lives with every day. 200mg ED and only unse 5, 5mg percs to wein off in 3 days.

[blinkKDX]

swim says being honest is your best bet.

you have to understand there are thousands of people who are "honest" but are really drug seekers. if the doctor understands you well and there's trust then there should be no problem..

but more so than anything, you dont want to give up on the game of life. we all have to play it. there are many dumb shits out there who think they know a thing or two, and you have to let them believe it sometimes so they can fill their ego, but swiy is always better than those people.

best bet. get a new doc if it falls through.

[thegoodfight]

Originally Posted by blinkKDX

swim says being honest is your best bet.

you have to understand there are thousands of people who are "honest" but are really drug seekers. if the doctor understands you well and there's trust then there should be no problem..

but more so than anything, you dont want to give up on the game of life. we all have to play it. there are many dumb shits out there who think they know a thing or two, and you have to let them believe it sometimes so they can fill their ego, but swiy is always better than those people.

best bet. get a new doc if it falls through.

Swim will admit to drug seeking, but it is not for recreational use. Swim is drugseeking for pain relief.


Swim would like to know if SwiNKKDX meant that the doc's are the dumbshit's who need to have their ego's pampered to or the or patients. Swim thinks swiy meant doctors..

[DrMuffy]

Well it sounds like the pain could be caused from many different things. SWIdr would think Soma, a muscle relaxer, would help SWIY out alot. Also, SWIY has got the right idea with fentanyl, it is very powerful and effective. Also if any pain is from nerve damage, one might want to try Gabapentin, which can allieviate this kind of pain (bbut there could be better meds for this). Also a skelator muscle relaxer like Skelaxin might be able to help for tension and strains on SWIY's skelatin. A mix of all these drugs though could cause many unwanted interactions, which would cause alot more side effects. Opiates (oxycodone, OC, hydrocodone, vikodin) can usually treat severe pain like SWIY has described, but since they do not seem to be helping, it may seem that the pain is coming from some other place that opiates do not target.....so SWIdr hopes these suggestions help SWIY out in his predicament. Good luck, and I hope SWIY's pain gets under control!

[thegoodfight]

Originally Posted by DrMuffy

Well it sounds like the pain could be caused from many different things. SWIdr would think Soma, a muscle relaxer, would help SWIY out alot. Also, SWIY has got the right idea with fentanyl, it is very powerful and effective. Also if any pain is from nerve damage, one might want to try Gabapentin, which can allieviate this kind of pain (bbut there could be better meds for this). Also a skelator muscle relaxer like Skelaxin might be able to help for tension and strains on SWIY's skelatin. A mix of all these drugs though could cause many unwanted interactions, which would cause alot more side effects. Opiates (oxycodone, OC, hydrocodone, vikodin) can usually treat severe pain like SWIY has described, but since they do not seem to be helping, it may seem that the pain is coming from some other place that opiates do not target.....so SWIdr hopes these suggestions help SWIY out in his predicament. Good luck, and I hope SWIY's pain gets under control!

Thanks for the response. Let me not that the opiates are working WONDERFULLY, but swim does not want to ask for a big jump from current script to what is actually needed to releve pain. Opiates have been the only thing that makes swim feel like he is half normal. The first substance used by swim was alcohol, which helped for pain. What was strange was after a month of drinking 3x a week (only at nights) swim could drink 3-4x more than those who were veteran drinkers. Swim seems to have an incredibly high tolerance for just about anything consumed Swim is just concerned that telling the doc about high tolerance will make the doctor think swim is just pill seekingm which swim is not.

Swim has tried Soma and found it effective only at high doses 1050mg (3 pills) every 4-6 hours, and that was only mild-moderate relief.

Gabapentin seemed to help some at high doses, ~800mg but lasts 4 hrs or so.. Lyrica has also been used but doesn't seem to help as much. Swim was on 450mg/hr

Skelaxin is a no-go as it effects swim very strangely. Bad stomach/bowl cramps and twitching. Swim has found baclofen and zanaflex to work, but over time the help diminished dramatically. Swims thinkgs it might be good to changes every 2 months of so with these meds.

Swim has also been told that a morphine pump could be considered. This is the last thing that swim really wants (but is open for suggestions). Swim doesnt' like electrical thinkgs in Swim's body.

Swim loved OC's as they help at high doses. What are SWIY's suggestions on hydeomorphone (is that diludad?) vs Fentanyl?

[DrMuffy]

Well if SWIY asks for a fentanyl patch, the doctor would probably know youve done your research and are an experienced drug user, or you are in alot of pain 24/7. Just be honest and tell him SWIY is in constant pain nd needs releif and fentanyl patches are pretty hard to abuse for the inexperienced drug user, so he might give it to you. As for hydromorphine, it is almost as powerful as herion (diamorphine), so the doc probably wont give it to you unless he trusts you and that you are in ALOT of pain. Also if he asks if SWIY abuses drugs, just say u wouldnt be askking for harder-to-abuse drugs like (fentanyl patches) if SWIY was a druggie, because SWIY already has access to plenty of easily abuseable drugs. So basically just be honest and frank with SWIY's doc, and hopefully he will get out his pen and pad.

[thegoodfight]

Originally Posted by DrMuffy

Well if SWIY asks for a fentanyl patch, the doctor would probably know youve done your research and are an experienced drug user, or you are in alot of pain 24/7. Just be honest and tell him SWIY is in constant pain nd needs releif and fentanyl patches are pretty hard to abuse for the inexperienced drug user, so he might give it to you. As for hydromorphine, it is almost as powerful as herion (diamorphine), so the doc probably wont give it to you unless he trusts you and that you are in ALOT of pain. Also if he asks if SWIY abuses drugs, just say u wouldnt be askking for harder-to-abuse drugs like (fentanyl patches) if SWIY was a druggie, because SWIY already has access to plenty of easily abuseable drugs. So basically just be honest and frank with SWIY's doc, and hopefully he will get out his pen and pad.

Thanks a lot for the info SwiDrMuffy (like the name BTW). Swim really doesn't want to have these to abuse, but like swim said, that one night a month or when swim goes to a wedding (as a date and doesn't want to be there)swim would like something to help kick back!

Swim thinks the best plan is to stick to OC's now as they are working (but the script needs to be increased!!). Swim's doc know swim used to use drugs (weed and coke) and doc knows it was because swim had A LOT of pain (hence weed use) and coke - for severe ADD. Swim has not used either in over a year (which is MAJOR change for swim). Also pain management states swim is in legit need, swim's doc is being understanding.

Since the drug types are figured out, swim really needs to figure out a way to demonstrate swim't elephant-like tolerance. This is what is holding swim back. meds work , but not when there is ehough to last!

Suggestions on tolerance greatly appreciated!

[thaprepster82]

Most Docs that have been in the game long enough can pretty much tell what the deal is after talking to the person. If swim is seaking pain meds for real pain management the the doc will prob do xrays and tell if he has has surgery and if hes tellin the truth. I agree with the above post be honest. if not find another doc.

[DrMuffy]

^^^^^SWIDrMuffy says thanks for the compliment, and hes glad he could help! Tolerance to oxycodone, expecially in high doses like in the OC pills, can increase very rapidly and one can become dependant pretty easily if used often. SWIdr is not sure wether fentanyl and oxycodone will interfere, but the fentanyl patches and lozenges on a stick are hard to abuse, but can provide much greater pain releif than that of morphine. In fact it is measured in MCG instead of MG (like acid) because of its steangth.

It might be a wise decision to just up to OC dose (if possible), but if a fentanyl/oxy mix is medically acceptable, then SWIdr suggests that SWIY stays at the same OC dose, and adds a fentanyl patch to to equation to GREATLY increase the analgesia. Also, this is a weak opiate but worth mentioning due to its lack of tolerance build up, tramadol combined with OCs can also produce good analgesia (although not as much as fentanyl), nd docs feel better prescribing tht than most any other opiate. Hope this helps, SWIdr is sorry that SWIY is in so much pain, please update us on the situation as time goes by!

[ardyrr]

years ago swim a motor bike crash ,not long after a car crash,after getting a habit from chemist drugs swim started drinking tusselix forte [a cough medicine in Australia] when they banned it [after 18 months] swim realised he had a monkey on his back [gorilla to be exact] thats when swim started heroin,the pain would come and go depending on the quality of the smack,after dying 3 times plus many years in and out of jail and rehabs swim finally got onto Methadone.After 20 years swim has a family ,owns his own home and owns and operates his own business with 4 employees,if it wasn't for methadone swim wouldn't be here today and swim is also happy.Methadone isn't for everyone but maybe swiy should enquire about it,it could be worse,after 3 years of prescription dope swiy also has a monkey on his back by the sounds of it.

[thegoodfight]

^^Thanks DrMuffy for that info. Swim has had tramadol 100mg's. Swim had to take 7-8 to get any type of pain relief and also got a euphoric feeling from it (which was ok for swim!). Swim was supposed to take 1 pill every 6hr, but that did nothing at all. It would be interesting if swim tried tramadol while on the OC.

Swim always had a gigantic tolerance. Swim could drink 3x more than swim's friends and be in control while they were sloppy. Same for drugs.
**Do some people just have natrurally high tolerances for drugs/substances?

^ardyrr- r r , lol Thanks for the suggestion about methadone and swim is glad to hear you are doing well!! Isn't that Demerol? The reason swim is skeptical about this is swim doesn't want people to think it is because swim was on Heroin... People see methadone and the thing heroin 100% of the time (at least people who don't have chronic pain). Swim also fears that if swim is switched to methadone and it doesn't work well they might not switch swim back to OC's.

[DrMuffy]

Methadone has and will usually be associated with heroin withdrawel programs, but SWIdr wouldnt worry about people thinking that SWIY was a heroin addict because the ones close enough to SWIY to know what meds he takes would already know he has chronic pain and needs it. But SWIdr would be careful because it can be a great pain releiver, but withdrawal and tolerance can be a bitch. Why dont SWIY tell your doc his story, and then discuss with him the list of options you are willing/want to do, like increasing SWIY's OC mgs, and if he wont go with any of SWIY's gameplans, then go to another doc, preferable a pain management specialist.

[Nagognog2]

Avoid methadone. It causes addiction that makes heroin look like a hangnail regards withdrawl. Hydromorphine works great! BUT it acts and stops working fast. Ditto for fentanyl. Morphine works for a long time - but only when injected. As an oral pain-reliever it lacks effect for many folks. So oxycodone is likely going to be the best bet.

Be very careful not to get into using it as a recreational drug though. It is an addictive opiate-narcotic and no one is immune. And very few doctors (who aren't in jail) would boost the dosage for what was obviously compensation for recreational purposes/addiction. They'd be more likely to offer one an operation instead. Most doctors are actually quite intelligent - even if they live on an ivory tower and have trouble acting human with their patients.

[thegoodfight]

Originally Posted by Nagognog2

Avoid methadone. It causes addiction that makes heroin look like a hangnail regards withdrawl. Hydromorphine works great! BUT it acts and stops working fast. Ditto for fentanyl. Morphine works for a long time - but only when injected. As an oral pain-reliever it lacks effect for many folks. So oxycodone is likely going to be the best bet.

Be very careful not to get into using it as a recreational drug though. It is an addictive opiate-narcotic and no one is immune. And very few doctors (who aren't in jail) would boost the dosage for what was obviously compensation for recreational purposes/addiction. They'd be more likely to offer one an operation instead. Most doctors are actually quite intelligent - even if they live on an ivory tower and have trouble acting human with their patients.

Swim thanks you for the heads up on methadone withdrawl, that is soming swim want to avoid. Do you mean hydromorphine stops working fast as in it has a short half-life (not time released), or the drug only releaves pain for a few months..

Swim is happy with OC's and is more than happy to stay on them. Swim figures that it will take a few months to get the dosage correct to where Swim is not in a lot of pain.

BTW what is a "normal" dosing of OC for someone with a Very bad lower back?

[DrMuffy]

Yes, exactly as SWInagognog says, methadone should be a "non no" in this situation due to its withdrawel. One qustion for SWIthegoodfight.......What is his position on rectal administration of drugs (mainly just morphine)? Because if SWIY chooses to go the morphine route, it is much easier and safer to self-administer morphine suppositories than morphine injects. This question really only applies for the morphine because of its poor absorption rate orally.

[thegoodfight]

Originally Posted by DrMuffy

...What is his position on rectal administration of drugs (mainly just morphine)? Because if SWIY chooses to go the morphine route, it is much easier and safer to self-administer morphine suppositories than morphine injects. .

Swim has never had anything administered rectally (except a colonoscopy, but Swim was unconsious). Swim doesn't know how to do that and it sounds very painful. Is it a pill or what? This sounds painful. Swim would like to keep that part of his body a virgin How much more absorbtion does one get from rectal vs oral, and do you use the same pill or do they prescribe somethig else?

[DrMuffy]

Well SWIY might want to look at this thread: http://www.drugs-forum.com/forum/showthread.php?t=22807

There is a big differeence between oral and rectal absorption rates, and to tell SWIY the truth, rectal administration isnt all that bad. Some people just get past sticking something in their ass, but when it comes to morphine, it is definatly worth it. Also SWIdr has a thread stickied on the opiate forum on how to administer substances rectally if SWIY was wondering how you do it.

[thegoodfight]

^Swim thanks SwiDrMuffy again!

Now how does Swim get rid of the terrible opiate itching? It is driving swim crazy!

[DrMuffy]

Haha, SWIY might want to UTFSE (Use The Furom Search Engine) for more info on this subject, but generally an anti-histamine would help such a benadryl, phenergan, hydroxyzine, and such.

[ardyrr]

methadone is without doubt the worse drug swim has ever had the misfortune to withdraw from,with hanging out for more than 8 months and no reduction in severity or sleep,swim knows of many people on methadone because of pain related reasons,I'm not condoning the use of methadone but for swim it was perfect as nothing else worked,but once you are maintained on methadone unfortunately you are on it for life

[monkeygone2heaven]

swiy might consider taking gabapentin regularly if it helped (it's meant to be taken that way, not PRN) for pain of neuropathic origin.

swim has known dozens of chronic pain patients. it is impossible to not develop tolerance if you are taking opiates regularly so what swiy's going through will be a constant struggle - swiy's body will always need more, never less. the best strategy is to not increase for as long as you can. if there is any way whatsoever of bearing the pain (maybe with gabapentin added? or massage, acupuncture) and lowering (instead of increasing) the vicodin for a week to a few weeks, swiy may be able to get the more relief from the original dose.

that said, if swiys sure you're undermedicated, swiy should be clear and assertive. swim doesn't know where you're located but if you're in the US, look up the law on pain control. they're actually required to keep patients as pain-free as possible.

swim agrees with the above -- there are things to try before methadone. pain clinics have become all too eager to prescribe methadone last few years. when that happened to swim, swim never filled her prescription for methadone and started seeing anotehr doctor.

good luck,

mgh

[oxalot]

I must agree with monkey. I have been CP patient for many years. Gabapentin does work but as with all of the extra stuff you get along with opiates/opiods for CP you have to stick with it. That is one thing that can get you out of a program. Not following what the dr. says. I know it's a dance but wouldn't you rather dance with the same one as with no one at all?

[foospharm]

I take Gabapentin for pain and it has 3 important properties,1)Patients who have been on IV gabapentin and oral; gabapentin, "Patient is administered 10mg intravenously while on gabapent. It has occur to Doctors that morphine bioavailabily has statistically been reduced between in a patient %50-%75. This action between the two medications, Morphine and Gabapentin, has been documented and researched extensively.However other opiates still being reserched are unknown whether or not to have similar bioavailabily drops if any at to tjat pf morphine. 2)Gabapentin goes hand in hand with the law of diminishing returns. The more taken, the lower bioavailability of the medication in your blood stream is found.One could seemingly take 5,000mg of gabapentin and have less of the drugs intended effects if one were to tke 900mg.Note:The dosage amount are just an example of the law of diminishing returns.It would take a little hunt to find the graphs details such example more preciously.3)Gabapentin is not broken down the liver. Instead it goes through digestive system into the blood and back out the same way.Gabapentin is a GABA analogue.It doesn't pass through the BBB, or (Blood,Brain,Barrier). It mechanism of action is unknown ,but it is believed to trigger parts of the body and brain when taken to activate a biochemical reaction giving Gabapentin its primary anti-convulsant properties and used in many case for pain and adjuntive therapy. I have a griend who take 600mg 4 time daily . He say that by spreading out the times he take its the drug is more available in his sytem and works better. He halso tole me though it either takes effects and work or si,ply does nothin taken. He say it's hit or miss with this medication regarding pain.

[trannyboy]

Hello, I am new but I thought I would respond to your post. Swim was in a similar position having to tell the doctor what drug was best to be prescribed... long story but in the end swim choose hydromorphone and would choose it again. Currently swim is using the 50mg/ml hydromorphone but started with the 250mg powder so that swim could mix concentrations as desired to minimize the volume of the injection. Once the injections became large enough that swim could dose 50mg/ml acurately swim just got the 50mg/ml strength to eliminate mixing it up themself. Good luck and stick with subQ not IM or IV. I can explain if you'ld like but at the end of the day subQ is the way to go with hydromorphone.

trannyboy

trannyboy added 214 Minutes and 9 Seconds later...

Ok I promised to come back and finish my post but I gotta say hydromorphone is by far the best SWIM has used, still it isn't for everyone. One of the rare benefits of hydromorphone is that you can adjust the dosage to the current pain level for instance some doses SWIM takes is 10mg and others 25mg based solely on the pain. The other interesting thing is when the pain killing effects wear off quickly (compared to others) you don't always need to take the same dose or at the same dosing time; as such it much easier to titrate off of without serious withdrawl then any other drug SWIM has used. I have read some studies about this but I don't remember the reason for this effect. For variable pain levels I think it is the best drug. You get nearly the same effect with subQ as with IV abiet a bit slower onset with subQ but not much 5- 10 minutes difference. However it should never be used IM because its absorption pattern isn't stable or fast in some cases up to an hour before effect with IM. This is a known effect of hydromorphone.

You mentioned using different narcotics/ cycling and that is actually a really smart idea for avoiding or minimizing addictions. The goal is to use different classes i.e. codiene/ morphine/ hydromorphone/ fentanyl etc derivitives and rotating them. This keeps tolerances lower and for someone who is going to be on them for a moderate amount of time it can avoid addictions entirely in some. Many pain management doctors believe that hydromorphone and morphine are different enough to be used together in a rotation schedule.

I would stay away from any of the super long lasting drugs like methadone because the longer they block the pain for the more severe the withdrawl period is. This is another benefit of hydromorphone and fentanyl types. In hydromorphone's case the acute withdrawl is less then 3 days for some even 24-48hrs and it is over.

As for talking to the doctor be honest but don't talk about any misuse because they won't treat you if you abuse their trust regardless of their egos. Dr muffys advice is spot on in a lot of ways and the other medications might be appropriate for you. Best of luck and remember if the doctor isn't treating you properly find another doctor. If you are telling the truth you will find a PC doctor who will treat you properly even if you have to travel. Oh and be very careful about misusing your medications because like others have said no one is immune to the powerful addictive potential of these drugs and that is true no matter what how personal strong/ in control you believe yourself to be.

trannyboy

[EyesOfTheWorld]

My monkey would say try to get a decent dose of oxycodone/oxycontin......in swiyour condition, 20 mgs 3x day wouldn't be unreasonable, and for that "one day" that swiyou wants an "abuseable" amount, just forego all the days dosing and have 60 mgs at once. of course this will mean pain for the rest of that day, SWIYou might want to ask the doc about getting a small script for something to take for incidents of breakthrough pain, ie: pain that the Oxy doesn't touch. Ideally hydromorphone.
On Gabapentin: SWIM takes it for nerve pain and to help sleep when rattling off lack of benzos, and he must add that until SWIYou is used to it don't plan on having anything to do the next day as the desire to spend the day in bed will be stong. It is a very tiring drug in high doses.
SWIM sympathises as he has much the same problems, on a slightly smaller scale, he gets his treated by his PCP w/ 15mgs hydro 4x day, 50mgs tramadol 3x day and 10 mgs diazepam (for muscle spasm and anxiety) 4x day, plus self medication when needed with heroin, alcohol etc.