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    lindseyvanbeek posted:
    My problem is that I don't just build up a tolerance to meds after taking them for a while. One of two things happens with almost every single medication I have tried: either they don't work at all when I take them OR they stop working completely after a few times of using them. I have problems with pain killers, anxiety meds, anti-depressants, sleep meds, and even antibiotics. I've discussed this problem with multiple doctors and they either don't believe it or don't know of any ways that could possibly help with it. I have only ever found one medication for getting rid of my migraines that help. It's called Esgic Plus, and apparently its considered controlled even though it is one of those meds that is barely addictive. It has a tiny amount of butabital in it and from what my doctor says, they get afraid that people will misuse it or try to sell it. I mean I went to high school and I know the basics about drugs because it is a major discussion topic in adolescents, but I have never heard of anyone even wanting to buy this med. And having taken it myself, I really don't understand why anyone would want to because it doesn't give you a euphoric or relaxed feeling at all. My neurologist knows that this is the only medication that works for me right now and he knows that my tolerance for it is very high, but he still won't prescribe more than the normal dose. He is actually reluctant to give it to me at all. And I understand doctor's concern about dependence on meds and all that but when there is an actual NEED for it and they don't give you any kind of help with it, I just don't understand that. Thankfully I just found out that I'm going to be able to see a brand new neurologist in a couple of weeks and I'm getting a referral to a genetics counselor for the metabolism problem so hopefully that will help me with my situation. Also, they have tested my thyroid and they tell me that it is functioning normally so I guess that's not the problem. I just stress all the time about the problems I have with medications. I live in constant fear and terror that something will happen one day like a car accident or a bad fall that will leave me in a lot of pain. If something like that happens, it is incredibly likely that the doctors won't believe me about my tolerance problems and my pain won't be effectively treated. I have already had two minor surgeries and experienced more pain than I should have because doctors don't believe that I have any problems with meds. I just don't know how I am supposed to live with that fear.
    Peter Abaci, MD responded:
    Hi Lindsey,

    I think it would be helpful to start by differentiating acute pain from chronic pain. Acute pain is the typical pain we experience from an acute injury and is associated with things like swelling and inflammation in the tissues. Chronic pain is pain that lasts longer than six months and exists well beyond an acute injury or event. I typically think of chronic as the disease itself, as opposed to just a symptom of an injury. As a disease, chronic pain is often a whole-person experience, meaning it impacts our physical body as well as our mood, thoughts, relationships, and sleep.

    Medications that may work well for acute pain may not be effective for the long-term management of chronic pain because chronic pain is a much more complex problem. In other words, if you had an acute pain problem, for example surgery, there is every reason to believe that your doctors will be able to manage your acute pain well. Because medications often don't provide simple or easy solutions for more complex chronic pain problems, I often write about other ways to manage pain that have been proven effective.

    With respect to your headaches, neurologists typically start with what type of headache they are treating and proceed accordingly. For example, there are migraines, cluster headaches, and tension headaches. Some of the medications they recommend are more preventative, while others are abortive, meaning they are used to shut down the headache once it starts.

    As you mentioned, butalbital is addictive because it is in the barbiturate family. Barbiturates are a class of sedative medications that act as central nervous system depressants. Tolerance usually develops over time. You should look into the effects barbiturates have on people when used for a prolonged period of time.

    My advice is that you continue to explore with your doctors the best and safest way to manage things long-term, and that you discuss other treatments beyond just medications to give yourself as many healthy options as possible.

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