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    opiates and pain
    An_245033 posted:
    I believe there are studies that indicate that opiates over-ride the body's own natural pain relieving neurotransmitters and then combine that with increased tolerance overtime and you have the perfect storm. Your pain continually increases as does your tolerance and dependence or addiction (as far as I am concerned they both lead to the problem of withdrawal, it just sounds nicer to call it dependence. The addict was looking for a high, the patient was looking for pain relief but they all lead to dependence/addiction and withdrawal.) Most doctors are being forced to reexamine their prescribing of pain killers because we are experiencing a prescription drug epidemic. Don't let anyone fool you into thinking this is all about illicit drug use. Our medical community and drug companies helped a great deal in creating this epidemic. For example: They were prescribing opiates to young adults for various things and if it was necessary to medicate a young person they should never prescribe over 2-4 days worth of pills and then it should have been seriously re evaluated. Most dependent people don't know where their pain level is because the fear of withdrawal is so great and may take months to overcome the pain of withdrawal to see where the real pain level is. I believe, yes, brain damage is a side effect, just based on the fact that depending on your age, the ability of your brain's neurotransmitters to begin to work properly again could be permanently damaged. Those of us in the medical community need to face the fact that we own some of this terrible problem. I for one have learned that drug companies cannot be my only source of education in regards to medications.
    ctbeth responded:
    For me, who has titrated my prescribed dose down from time-to-time to self-evaluate whether my prescribed opiates are treating pain or dependance, I know, unequivocally, that I am treating pain.

    Still, I take MSContin three times a day. It does not, nor can it or anything, completely take away all, ever most, of the pain I experience. As my doses are wearing off, I do experience significantly more pain. This confirms to me that I am, indeed and truly, being medicated properly to treat pain, and not just dependance.

    Still, I so wish that I could stop taking anything at all. I hate the side effects and seem to be bothered more-so than most by these phenomenon.

    I am eager to read others thoughts on this.
    annette030 replied to ctbeth's response:
    Me too. I have also occasionally cut back on my pain meds and have found the same thing as CTBeth. We are also both disabled RNs.

    What kind of healthcare professional are you, An_245033? I am curious where you fit into the medical community.

    Have you read about the difference between addiction and dependence? It rarely takes "months to go through the pain of withdrawal" with opiates. Where exactly are you getting this information?

    Take care, Annette
    trs1960 replied to annette030's response:
    I agree, they say we shouldn't have to suffer with pain and doctors should prescribe us appropriate medications to eliminate pain, but sometimes you have to wonder how much differance there is between a prescription and a baggy?

    I went from Fentynal, Opona and MS Contin to nothing in aout 6 years. I occaisionaly use Suboxone, but I don't like it and it really doesn't help the pain I just keep giving it a chance as my doc says stats show that people who use it have much lower rates of going back to opiads.

    It's been a long trip and I could write a book on my bad days, God knows I've read enough books to get here.

    Last year I was down to Norco and Methadone and kept decreasing my dose. When I told my doctor I was quitting cold turkey he told me he was worried, but with the knowledge he helped me gain he thought I might be able to do it and offered to help in anyway possible.

    It's been about 6 months and I feel good. As Dr Art Brownstien discusses in his book, your back can be your friend and he uses it to guide his life decisions. When the back starts to talk, it's time to listen.

    My doc has told me he would write me about any prescription I want as he waived a small portion of my records in the air. He said, "but you may be strong enough to succeed without them. He told me it takes a strong mind to win over pain and drugs...I don't know if you ever win as accepting pain may be a win over drugs, it still means you're accepting pain.
    But pain is pain and I don't care how mch morphine you take you're still in pain and as discussed it's a yo yo as the pain signals are change by the piads in your neurotransmitters and your tolerance builds up, soon you in as much pain as you were without the drugs, but you're so F'd up you think you need more drugs to catch up.

    Good luck to all and to each his own.

    annette030 replied to trs1960's response:
    Well put. I tend to agree with your last sentence more than anything else. "To each his own", everyone must make their own decisions about medical stuff.

    My personal opinion is that Suboxone is the latest methadone, we will see after it has been around as long as methadone has. Then we might know what its side effect profile and safety rate really are.

    Take care, Annette
    ljude38 responded:
    I believe the phnomena you are speaking of is called hyperalgisia. Ive seen it many times workiing in a drug detox dealing with patients mostly detoxing from opiates. Many of the patients formed dependence after an MD prescribed for accident, injury or long term pain. An absolute shame in the medical community I have seen over the past few years is opiates being prescribed for fibromyalgia. It is my opinion that opiates prescribed in large doses for an extended period for nonspecific boarders on negligence.
    annette030 replied to ljude38's response:
    Excuse me, but you work in a rapid detox clinic. How much experience do you have with patients on a continuing basis, for weeks and months, or even years? My understanding of rapid detox clinics is that they sedate patients with anesthetic agents, and then reverse the opioids in their system, then allow them to wake up and discharge them. It is like a day surgery.

    What is your working title? Are you a doctor, a nurse? You have repeatedly stated that you work in a detox clinic, but have never said exactly what it is that you do.

    Hyperalgesia is a fairly rare condition according to all the literature on the subject that I have found. If you have access to links of evidence-based medical studies regarding this problem, I would love to have them so I can read them at my leisure.

    Since few people have FMS by itself, but usually have co-morbid conditions it is rather difficult to say exactly what is causing their pain. Is it better to let them live in pain or to treat it? I certainly do not think opioids should be first line treatments for chronic pain, but they are one tool that we have access to, why not use them along with other treatments?

    Take care, Annette
    trs1960 replied to annette030's response:
    Both of you have good points and yes, we chronic pain sufferers are not the typical rapid detox patient, but the knowledge of drug use is important for us all to understand.
    I agree that Suboxone is the new Methadone. My best friend started taking it 3/day for a few months. Things didn't work out and his withdrawels were some of the worst he's been through. I'm glad I never took more than a few and didn't get hooked.

    I take Norco occaisionaly. It's really not the right drug for long term anelgesic treatment, but everything stronger really screws me up. Methadone isn't too bad, but MS Contin, Fentynal, Opana Oxycontin, Morphine etc ends up making me clinically depressed if not psycotic. It's scary and miserable. I would have died if not for working with my doctor and getting help in time.
    trs1960 replied to trs1960's response:
    With respect to dependancy vs addiction. It's my understanding that people in pain metabalize the opiads differently and while they do become physically dependant, it is different than the drug seeker that is mentally addicted. It's been a few years since I read about this a few years ago so the facts are not crisp, but addiction in those that are suffering pain is a very small percentage.

    Drug seekers and those that are prone to addiction have a difficult path if they end up fighting chronic pain.

    jeaniegolf replied to trs1960's response:
    Yes, you are right...those of us in chronic pain react differently to the opiads. I don't get high - I get relief!! Unfortunately, where I live now I can't get any help because the pain mgmt. doctor does not believe in "short-acting" meds that wear off because they are not good for you. After trying six different drugs (with awful side effects) I gave up. I found this site while looking for a chronic pain support group in my area. Somewhere there is an answer and it is a comfort to hear from other people who understand.
    TDXSP08 replied to trs1960's response:
    I will once again hop up on my soap box and declare my belief between addiction and dependance is one word "INTENT" the addict seeks the drug for the purpose or intent to get high or wasted or whatever altered mental or physical reaction they are seeking from the medication.

    A patient who is dependent is taking the medication with the (in our specific cases) intent of relieving some of their pain whether its there long acting med or their break through med they are trying to reduce their pain scale from the 10 side downward,no one unless they are dead will be absolutely pain free and those who attempt that usually become that dead that is.

    I myself just came through last week my pain or prescription trial's that i do periodically and for the umpteenth time i found i still need my pain meds,but i would rather challenge myself and be in some nasty pain for a couple of days than to blindly take medications just because they are prescribed.

    i don't want to take them a day longer than needed or mis an oppurtunity to lower a dose winter is always harder on my bones and muscles because of the cold, so i always want to see if i can adjust my dose down when the weather breaks.

    True life behind the Fentanyl patch

    i have no small step for man, but i have 6 tires for mankind,Watch your Toes!
    CaliforniaCruisin replied to ctbeth's response:
    Couldn't agree more. For each day of debilitating pain that requires my Norco medication, I take two to three days away or more, I make my self suffer untill the pain becomes so bad I can't deal without management. It's like they say "No pain, No gain"
    annette030 replied to trs1960's response:
    I feel really bad for the addict who also has chronic pain to deal with.

    I think the pain management clinics that have addiction specialists to help with these patients are the best option.

    Take care, Annette
    ljude38 replied to annette030's response:
    Its obvious to me that you have had fairly good experiences with opiate medications from your many posts. Good for you. I wish you well. I hope they continue to work well for you. Im sharing my experience and need to explain myself no further. You take care
    ljude38 replied to ljude38's response:
    It is very true that addiction lies in a small percentage of a pain MD's caseload of patients. 1-5 % of people in a pain clinic are truly "addicted" to the medication. This is much different than tolerance and dependence. When one takes opiates for a long period of time their body will adjust to the medication and need more and more to get relief from pain. This is where the origional post fits in. So many people have been taking their medication for so long they really dont know what their pain baseline is and eventually are medicating the effects of withdrawl as opposed to the pain that got them on the medication to begin with.

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