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    For the Expert(s)
    bren_bren posted:
    Do opioid medications suppress the immune system; thus inhibiting the body's ability to heal? Is this on a large or small scale? I'm receiving prolotherapy treatments and have been asked to eliminate all opioid medications or the prolotherapy won't work. Thanks, B
    annette030 responded:
    Hi, Bren_Bren

    How is the prolotherapy going? I have not heard of this problem, it sounds like another excuse to get people off of opioids to me. But, let me know what you find out, and if the prolotherapy works for you.

    I have been on opioids daily for about 14-15 years now, I never catch anything contagious, and had surgery last year without the surgeon mentioning this problem with opioids. I healed up fine after the surgery, no problems at all. About 20 years ago my neurosurgeon warned me about smoking and the effects that had on healing, in fact he refused to do surgery on smokers.

    I know you would be able to tell by checking your breakthrough meds and how often you need them if the treatment were working to decrease your pain. You could also taper off of the long acting opioid if you were having less pain.

    I do not know why or how the opioids would suppress the immune system and prevent the prolotherapy from working. You know that I don't really believe in prolotherapy anyway, but these are not subjective things, did you ask the doctor who is giving you prolotherapy for studies to show what he believes to be true about the immune system and opioids?

    I thought you started prolotherapy a long time ago, when did they ask you to get off of opioids? If they asked before you started prolotherapy, that would be one thing, if they asked you to get off of them later on after you had had a lot of prolotherapy treatments, that could mean something else.

    Keep in touch.

    Hugs, Annette
    bren_bren replied to annette030's response:
    Thanks for writing, Annette. Though I experience a wide range of pain in various areas, the prolo helped my SI joint upon completion of treatment a year ago. The doc dismissed me because after 6 visits he didn't think my body was responding well. He told me to get my body back in balance (hormone levels, energy, etc) then to pursue again. Here I go a year later to the guy who worked beneath the one who invented the treatments. I have to get an MRI to learn of any other contributions to my pain (I.e. hip labrel tear). If its positive for this I will get prp (plasma replacement) if not, then aggressive prolotherapy to the areas of pain to rebuild ligament, tendon, other tissue damage. Injections provoke the bodies' immune response to target the areas for healing. I believe it can help some people. Just hope I'm one. I will be pumping many hormones into my system to simulate pregnancy, as that was when I experienced less pain. He has insisted I come off 100 Mcg's of Fentanyl in 60 days, then all other narcotics after that. Prolo increased my pain, which didn't feel better until a few months after treatment. This new doc insists that the drugs interfere with the body's ability to heal. This really is the short version of the story. I still have many questions about my own faith, and that is another element in the process-grabbing hold of mental roadblocks and giving my body up to God...? That hasn't helped parent a 3 yr old or do dishes yet... So, tongue in cheek (I'm more scientific than religious); I am so desperate. I just need to know if the med's ARE going to inhibit healing (studies would be nice) so I can convince myself & get in a better state of mind. I don't handle pain well. Don't want want to go off the deep end either, you know? If I feel the treatments are working I have no problem stepping down. If they are as painful as last time, it's going to be rough coming off the med's. Doesn't it take several months to wean off Fentanyl? Thanks for responding. I hope all is well with you & hubby! Excuse typos- have to write on mobile phone now. Take care, hugs back at ya, B
    annette030 replied to bren_bren's response:
    We are both fine, we saw our doctors last week & adjusted meds, etc. Just a tune up.

    I have not read any studies like you describe, I would ask the doctor who told you about it to provide you with links to support his statements.

    Birth control pills simulate pregnancy, that is how they prevent conception. I don't understand how artificially taking hormones to simulate pregnancy puts your "body pack in balance" hormonally?

    I would never put a number of days as an absolute for tapering anyone off of fentanyl, or other opiates for that matter. We are all different. Can you do it in 60 days, probably so. Will you have withdrawal symptoms, don't know, you will find out though, lol.

    My husband came off of morphine once on his own, and methadone twice with no withdrawal symptoms at all. I was present for the methadone tapers as I did them myself (his doctor told me I could as an RN with previous methadone tapering experience). I did it faster than 60 days, but it is a slightly different drug, and he was not having withdrawal symptoms, or I would have stretched it out.

    I think God helps those who help themselves. If you believe in your doctors and the treatments they offer, I believe you will do fine. If that is the placebo effect, that is fine with me.

    I really advise everyone read "Managing Pain Before It Manages You" by Dr. Margaret A. Caudill, MD, PHD. It is a great book for managing any kind of chronic pain.

    Take care, Annette
    bren_bren replied to annette030's response:
    Hi Annette, Want your opinion. What would you do in my shoes scenario. My pain doc transferred to a hospital PM facility & disclosed to me that the BT med's I am prescribed are not prescribed to any other patients anymore because the DEA has "forbidden" him to write that type anymore (roxicodone 15mg's). the prolo doc has advised me to ween off Fentanyl completely, which may require an increase in BT med's down the line. Eventually he wants me off all narcotics. If prolo works, I'm fine w/ this. If it doesn't (which my pain doc is not convinced it will; as it made pain worse for a while before, w/ a different doc), I don't think my Pain doc will offer relief close to what I am getting now. He has allowed me to continue on this same regimine for over a year because I am an old patient. My husband thinks I'm worrying too much- may be- but I want to be prepared and not regretting this path. It's hard to find adequate relief for my condition, and over time I believe I have developed a sort of hyperalgesia w/ the pain med's. It could result in a lower dose requirement in the future, but if my pain doc doesn't write any scripts close to the strength I take now I could be setting myself up. The hormone therapy is designed to get my body to think its pregnant (where I had experienced less pain), also should set my body up for optimal healing. I'm just frustrated thinking one doc is of the opinion I can do all these crazy things & get better, while the other is shaking his head, holding his tongue & not speaking up much in my interests. Need help from anyone who could possibly see where these docs may be coming from. Thanks for your time, B
    TDXSP08 replied to bren_bren's response:

    Letting go of your body to God you already have !

    God put the opium plant on earth and showed us how to use it to make drugs that supress the pain,it is a plant a living thing like you and I ,yet God gave us the ability to use that plant very early in our evolution how many other plants has he dropped in front of us and taught us how to use effectively to get the most benefits from, we are out there every day searching the globe for other natural items good for us,but this one was a gimme a free one.

    i unfortunately know nothing about prolo or narcotics making the body less able to heal, you would think if that was true surgeons would not be giving them to patients after surgery and patient stays would be longer and patients would be really bitch'in about there pain every time they got their over priced aspirin for pain.

    What ever your decision, as far as how you proceed make sure its your decision and that you can live with the ramifications of it. You have my E-mail don't be a stranger even if its just to vent or bounce ideas i will as always listen.

    i have no small step for man, but i have 6 tires for mankind,Watch your Toes!
    annette030 replied to bren_bren's response:
    First, I would not even bother with prolotherapy, so I wouldn't be in your shoes, that said, I will try and fill in the blanks as best I can.

    The DEA does not forbid the use of oxycodone 15 mgs, my pharmacy has been unable to get a hold of those for as long as I have been on them (more than a year) and they substitute 5 mg. tablets instead and adjust the instructions. If your doctor can no longer write for them, I would question him carefully, if the DEA has "forbidden" him from prescribing them, they might take away his narcotic prescribing privileges altogether. It must be for some reason.

    Only you can decide what to do, as far as all these things they they tell you. I would ask them for links to "evidence based medical research" that shows what they say is true, or even plausible. At least you can read and see where they are coming from.

    If hormone therapy to make an unpregnant female, you, feel pregnant so you have less pain is fine, why is taking opioids wrong? Or less natural? I just do not understand their reasoning.

    I really think one should use many tools to feel better, but only you can decide for yourself which ones to use.

    Keep in touch.

    Good luck, Annette
    ctbeth responded:
    Why would taking opioid medicines inhibit prolotherapy from working?

    Opioid therapy shouldn't have any effect on the immune system. Please ask the person who told you this to show you studies and published reviewed articles with scientific evidence (not testimonials) that prove that opioids suppress the immune system.

    The concept of not allowing a patient to take pain meds because it's not natural, but suggesting taking hormones strong enough to suppress menstruation is okay. Sounds pretty flakey to me.

    Please carefully consider and become familiar with the potential adverse effects of hormone therapy. It can do significantly more harm than opioid therapy (long as the directions are followed accurately)

    I suppose I could look it up, but I'd like to know from you, who is doing this: what is prolotherapy? I know that, at least for one, you have had horrible problems with your knee(s). I do not know anything else about you or prolotherapy.

    I hope you're okay,

    bren_bren replied to ctbeth's response:
    Hi all thnx for input & concern. TDX I don't have your email. Beth, do you have a "throw away" email account you can post? WebMD has rules I must abide by, so I don't want to post this doc's name here. I have links to site, videos of his his explanation on how opioids stifle the immune system. I have to dig deep to find research to support his statements, but there is info on references in a book he wrote. I have chronic pelvic pain, low back pain & leg pain. A true diagnosis has not been determined but it feels like SI joint dysfunction, pudendal neuralgia, sciatic nerve irritation. I have had it for 6 years. I have a hard enough time finding med's that alleviate the pain because I have become so tolerant. I can't imagine living w/ this pain w/out the option of opioid analgesics because it is so intense. Prolo is the injection of dextrose into the ligaments, tendons & other soft tissues. It binds to those areas of pain & allow for strengthening, cellular regeneration. The body's immune response attacks it (the foreign agents) & sends healing to the injected areas. This may be an oversimplification, yet I put it in Layman's terms-how I understand it. If the immune response is suppressed (via opioids) then the maximum healing effect is deterred...I just don't get how much. I really wish these PM doc's would answer my ? It has become buried, so it's not likely at this point. Take care, and thanks for responding everyone, B
    ctbeth replied to bren_bren's response:
    Hi Bren-Bren,
    Here is the link to an abstract regarding opioids and possible suppression of immune response. I did not purchase the article. The studies cited are rat studies, so unk how it relates to humans other than the common, "studies on rats infer that it might..."

    Below is a ink suggestive of similar, but an easier read:

    There is some new-to-me info in both articles.
    cweinbl responded:
    The effect of morpine as an immunosuppressant has been established with abundant research, especiall in the 1990's. However, the effect of today's synthetic opiates (narcotics) upoon the immune system is not as well understood.

    Prolotherapy is designed to activate the body's immune system to rebuild damaged ligaments and tendons by creating damage where injected. Thus it is logical that physicians implenting the treatment would prefer that the patient not be using morphine. I'm not sure that synthetic opiate derivatives fall into the same regimen.

    I guess the bottom line is would it be worth going off opiates and dealing with the crashing pain that remains, in favor of using a treatment with no real obvious efficacy for degenerative disc disease or spinal stenosis. As far as I'm aware, Prolotherapy is designed ot treat ligament and tendon damage.

    I would get a second and third opinion from physicians who have no stake in delivering Prolotherapy. They should provide an objective response.
    annette030 replied to bren_bren's response:
    Finding stuff to support his opinion in a book he wrote, sounds strange to me. It is like the video of him telling us his opinion. If it is so clearly fact and it has been determined by evidence based research, you should not have to "dig deep" to find this info. A simple search on Medscape or some other medical search engine should turn it up for you.

    If those PM docs don't answer your questions, perhaps it is because they do not know the answers.

    Take care, Annette
    annette030 replied to ctbeth's response:
    Hi, Beth

    I went to the second article you posted and read the abstract of the study, it was also based on rats only, and seemed to vary from drug to drug. Interesting, but it seemed to me like it only meant that more research was in order.

    Thanks for the links.

    Hugs, Annette
    annette030 replied to annette030's response:
    Hi again, Beth

    The article was dated as published in 2006, so more research might have been done since then.

    Hugs, Annette
    annette030 replied to cweinbl's response:
    In rats or humans, in the 1990s? The studies Beth posted links to were done on rats only.

    Do you happen to have any links to this research? If not, I can Google it myself.

    Thanks, Annette

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