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    chronic pain and addiction?
    mel0222 posted:
    I'm so glad I stumbled upon this site as I was researching non-narcotic solutions to my never ending back and knee pain. I have been on and off so many narcotic pain meds and combinations over the last 10 years that my heart finally gave out and I almost died with a congestive heart failure and heart attack. I am a 51 year old single mom and have had two bi-lateral TKRs, two knee cap reconstructions ( I don't have any now), and now I have several bulging discs and various other back problems. My neurosurgeon says I need a tri-fusion but that it is just asking for future back surgeries. I am currently taking 3600 mg of gabapentin (nuerontin) with no relief.

    My problem is that I have taken more than is prescribed of narcotic pain meds in the past in an attempt to just make the pain stop. Withdrawals from natural opiods ( oxycontin, Fentanyl patch,Norco) was horrific as well as synthetic ones. I am so very afraid to embark on that path again but am so miserable. Sleep is rare as there is no position that doesn't throb. I too have tried acupuncture, chiropractors,and even medical marijuana (I'm from CA). I am on SSD and medi-cal since I cannot work so I am very limited as to what the government will even cover. Are there any suggestions?
    ctbeth responded:
    Dear me10222,

    Your post, to me, raises more questions than answers.

    Would you mind clarifying a few things and then it will be easier to get a better pic of what's going on with you and address what you are asking.

    I am confused about the CHF diagnosis and the "heart attack" related to narcotic meds.

    I have been taking opiates for years and have never heard or read that CHF or cardiac problems are long-term dangers of opiate meds. Are your cardiac issues resolved now?

    What do you mean by tri-fusion? Do you mean multi-level or three separate areas fused, such as cervical, thoracic, lumbar?

    Has your MD told you that your particular situation would be akin to, "asking for future back surgeries"? If not, perhaps he/ she can tell you what this risk may be related to your personal situation.

    It does not matter if the opiate is natural or synthetic, a molecule is a molecule regardless.

    There is no difference in withdrawal.

    Codeine and Morphine are both natural and the primary occurring opiates (narcotic pain killers) from raw opium (as is Thebaine, which is not used commercially).

    Most opiates are derived from Morphine or Codeine.

    Heroin is technically called diacetylmorphine. From the name you see morphine.

    Heroin is a semi-synthetic drug that is effectively built on morphine. The difference between the two drugs (chemically) is very small.

    OxyContin (Oxycodone) is also a semi-synthetic drug. Its name is derived from Codeine because Codeine and Thebaine are the 'base' of the chemical structure.

    There are only small differences between Codeine and oxycodone.

    Oxycontin, Fentanyl, and Norco are all semi-synthetic.

    So, it looks as if you had been taking more meds than prescribed and have run out, or will run out before your new Rx is due, but it is not clear if this is what is happening with you now, or you are talking about a past situation.

    Since you're not getting adequate pain management to sleep and your pain isn't being managed with the Neurontin, and unknown if you are currently prescribed an opiate and have run out, or if you are not being prescribed anything other than

    If you are so miserable and not taking an opiate, perhaps it's time to discuss this with your MD. If you do not feel safe with pills and fear that you'll take more-than prescribed, how about discussing options with your MD?

    Better to address this with your MD before the potential problem, than to have meds that may make you feel unsafe.

    An implanted delivery system (pump) would be filled at the MD's office and you would not have to handle meds.

    The patch (fentanyl, Butrans) may also be a delivery method that one would be less-likely to abuse. Sorry about the word, "abuse" but taking more meds than prescribed is abuse.

    Last, have you tried the marajuana for sleep?

    I think that Medi-Cal is a state, not a federal program. Do they publish a list of meds that they pay so you and your MD know what are your options?

    I hope that you'll write again and that I haven't mis-understood too badly what you are saying.

    mel0222 replied to ctbeth's response:
    Wow, thank you so much for your response and questions CTBeth. Thank you as well for clarifying all the origins of the pain medications, it was very informative. Let's see if I can clear up some confusion.

    Before my CHF and heart attack, my nurse practitioner prescribed several combinations of meds: methadone, Fentanyl patch, anti-depressant, anti-anxiety, RLS meds (Sinemet), sleep meds, and others to manage my pain, depression, anxiety attacks, insomnia, etc. I was on the highest dosage allowed on most of them. After doing some research, I believe that my meds were mismanaged. I occasionally took extra to try and kick the intense pain but never got my prescription refills early. As a result, my nurse practitioner is apprehensive and will not prescribe anything that may be addictive or narcotic; not even a muscle relaxer. I am not currently on any narcotics. As I look at my previous experiences with pain management, narcotics seem to affect me mentally in such a way that I feel in bondage to a substance. The only option I would consider would be the Fentanyl patch. This method of pain control would not be so easy to abuse. I'm just afraid that the morphine would put me in that mental state of wanting more. I'm trying to be perfectly transparent here so I can get the best advise from others who may have been or are in the same situation.

    I just got the results of my echo and my heart has completely recovered. However, I am afraid to tax it unnecessarily.

    My neurosurgeon explains that my L2 to my L5 needs to be fused together, a multi-level fusion. He explained that the vertebrae above and below would eventually wear down from the rigidity of the fusion and would have to be reconstructed or fused at a later time as well. My spinal cord is being compressed in my lower lumbar from arthritis as well as the exiting nerves and bulging discs. In addition, my left knee replacement has a mechanical problem and causes so much pain that I cannot walk most times. I need surgery on it as well but the Medi-cal system takes a year or more to go through the steps.

    Yes, Medi-Cal does have a list of meds that they cover. Again, they make a patient go through ridiculous and unnecessary steps to finally get to the solution or desired affect. My NP will make me go through a referral to pain management in order to get any relief. That's another reason why I was seeking a non-narcotic solution.

    Yes I have tried marijuana for sleep. I cannot smoke it because I was a cigarette smoker before my CHF and the edibles and oils I have taken make me feel awful. The few times I did manage to get the dose at a level that didn't make me sick, I slept but woke up in more pain than if I hadn't slept well. My system just doesn't like it. Besides, it's very expensive and I am on a very limited budget.

    This is all very frustrating for me because I have always been a very productive person. I have a driven personality and all my other surgeries and osteoarthritic knee problems didn't stop me for long. This back issue has kicked my butt and put me down. I hate being dependent on the government and without an income of my own. I really want to get to a solution so I can get back to work. Thanks so much for your interest in my particular situation. I look forward to your response.
    ctbeth replied to mel0222's response:
    Hi again,

    Thank you so much for the reply. You've really been through a LOT and have some really important decisions to make.

    First, I am pleased for you that your cardiac work-up is okay. That must be a huge relief.

    Just my personal experience: I have a cervical and lumbar fusions both. You can click on my little pic and read, "my story" so I don't need to write it out again.

    My lumbar fusion is L3-4, L4-5, L5-S1.
    It was related to trauma, so I didn't have much of a decision. I did know that the disc superior/ above the fusion have a higher-than-normal incidence of herniation.

    Indeed, after five years, the L2-3 does show some disc bulges, but this doesn't cause me pain- not significant pain anyway.

    While the incidence of herniations is so, this is a calculated risk and NOT a definite fact.

    Many of us have had fusions and do not require additional levels fused. Please ask your MD what the actual percentages of additional levels requiring surgery and what your specific risks may actually be. In consideration of the risks that your surgeon can tell, it may actually be in your best interest to have the surgery.

    You have made it pretty clear that you do not want to go on the way you're you're living now.

    Have you had any epidural steroids, RF ablations, or other less-invasive (than surgical) treatments?

    The med "cocktail" that you've described is pretty crazy heavy:

    " methadone, Fentanyl patch, anti-depressant, anti-anxiety, RLS meds (Sinemet), sleep meds, and other..."

    Is Sinemet now used for RLS? I have only given it for Parkinsons. I'm not disputing; I haven't worked in a hospital in a few years now (neuro RN).

    Fentanyl patch plus Methadone is also an uncommon combo, as both are long-acting meds.

    Would your nurse practitioner refer you to a pain management MD?

    Your situation sounds pretty complex and pain management is a specialty that can offer you more options than just opiate meds.

    If you do need this level of analgesia/ pain management, your being so open and honest about your responses and history will make you a very responsible and trustworthy patient. I cannot speak for another person, especially a pain management MD, but, if I could, I would welcome a patient who is so willing to do things the right way.

    One last thought: Perhaps you and your pain management MD could discuss the possibility of an implanted med pump, aka "morphine pump", or spinal cord stimulator, which is one of the treatment modalities that I have, and I LOVE it.

    Trust me~ most of us here know the frustration, about which you speak, of wanting to get back to work and feeling as if we're doing something constructive with our lives.

    First, you need to get your pain managed.

    I am so glad that you came here; there are some amazing people here.

    Is your name MEL 0222, or ME-10222?


    mel0222 replied to ctbeth's response:
    Again, CTBeth, you have a wealth of information that is already so very helpful, encouraging, and comforting to me; thank you. First, my name is MEL 0222. Sinemet IS a medication for Parkinson's, however, when RLS was first recognized and named, Sinemet was the only medication that helped relieve the infuriating feeling in the legs, and for me, the arms as well. Dr.s did/don't know why since they really don't know what causes the restlessness in the first place. Since then, Mirapex and Requip have been formulated. I now take Mirapex and it is working for me at this point. It seems as though the levodopa is the component that calms the crazy, annoying sensations.

    It is very encouraging to me that you have had the very fusion that my doc is recommending and that it has helped you and not caused further complications that are debilitating. I used to work in physical therapy about 20 years ago. Granted, back surgeons have learned much since then, but I have heard so many horror stories from patients who have been on their 3rd, 4th surgery with no success, if not a worsened situation. Since I have had so little success with my knee replacements, I am a little wary of starting that process with my back. Three surgeries on my left knee with more needed, and two on my right in the same situation. If I could just get my pain to a place where I can sleep through the night and be able to find a job where I can alternately sit and stand, I could live with it, I think.

    An additional challenge that affects my healing process concerning surgery is that I am on Medi-Cal. Though my neurosurgeon is gracious in my office visits, I believe that the fact that all parties involved in a 6 or more hour surgery not getting reimbursed financially as they are accustomed to affects his enthusiasm,. He has mentioned the costliness of it. He is the only neurosurgeon in my area that takes Medi-Cal patients. However, if I truly believe that surgery is necessary, he would have no choice but to perform it (if Medi-Cal and the hopsital would approve it). My surgeon did recommend the implanted TENS, and spinal cord stimulator which was denied by Medi-Cal; it's cheaper for them to put me on drugs :-{. He did not suggest the spinal pump because he does not do any narcotic pain management, he leaves that to the primary care givers. Between my fibroid tumors, endometreoisis, total hysterectomy, knee replacements and reconstructions, I have had about 10 surgeries in the last 20 years. Then my CHF and heart attack put me in the hospital for 10 days as well. Honestly, I am just really tired of hospitals and surgeries. True, I do not like my life in constant pain and non-productiveness either. This conundrum I have been in much prayer about. I am forced to choose the lesser of two evils.

    Yes, my primary will refer me to pain management. She did do this prior to my CHF but Medi-Cal sent me to a chiropractor! Can you believe it? He took one look at my MRI and list of meds and said he couldn't help my pain because of the extent and nature of my back issues but I should get off most of my meds. Really? If my primary and I can not come up with a non-narcotic solution that I can live with, I will try again. The contracted insurance carrier with Medi-Cal has changed since the first of the year so we will be working with a different insurance group.

    I have had three epidurals. The first two were a godsend!! I got relief for three weeks; sooo amazing. I had forgotten what it was like to get out of bed without being brought to tears. The third did not touch it. Could it be because of the gabapentin? I don't think Medi-Cal will pay for any more. Steroid shots have been ineffective. They didn't work for my knees either. I have not heard of RF ablations; I'm going to have to research that.

    Well, I could probably go on for hours but am limited to 4000 characters. Thanks again CTBeth; I look forward to more of your wisdom.
    ctbeth replied to mel0222's response:
    Hi Mel,

    This is interesting about the Sinemet. I'm glad that it helps.

    I have but a minute: Is there any chance that, now that the carrier has changed, your MD could try to get approval for the spinal cord stimulator trial? The trial will show whether this modality will be helpful to you.

    Below is the site for St Jude's medical, the company that makes my spinal cord stimulator. There are a few other companies, too. I post this one because it is the one I have- and LOVE. It has changed my life. I still take Morphine Contin, but at a significantly-lower dose.

    Since you have been living with disabilities for about ten years, have you applied for SSDI?

    I know that Medicare (SSDI insurance) does pay for spinal cord stim.

    Gotta run now, but I hope you'll write again.
    If you have any questions or would like to talk to me about the spinal cord stimulator, I'd be most obliged.

    Hang in there, my friend,

    cweinbl responded:

    The rate of addiction among chronic pain patients is between 1% and 3% (see and . Thus, if you have not had a prior addiction disorder, you have no reason to fear it. I suggest that you took too much medication not because you were an addiction risk, but because your pain medications were not properly managed. Many of us here have used opioids for decades without any problems beyond constipation.

    We often benefit more from using several types of medications concurrently. That includes using a long-acting opioid as the mainstay plus a short-acting opioid for breakthrough pain, which might have reduced your need to use too much of the long-acting drug. Add to this an anti-depressant. Anti-depressants inhibit the reuptake of Seratonin, a powerful painkiller produced by our body. Add an anti-inflammatory and, if you have referent pain, add an anti-convulsant. It was not until I was using all of these at the same time that my pain was better managed.

    Mind-body techniques can also help, including but not limited to: biofeedback, systematic relaxation, meditation and Yoga. If all else fails and you refuse to have fusion, you can try the spinal cord stimulator or the intrathecal infusion pump. BTW, I've had four spine surgeries, including multi-level fusion. They all failed. The success rate is deplorable. I now not only have all of prior damage, but the damage done during surgery, when a resident accidentally gouged out a piece of my right S1 nerve root, I also have a ton of fibrosis, which basically defies treatment and impinges nerve roots.

    For a good picture of the efficacy of all major spinal interventions, see this comprehensive research:;12;699-802.pdf .

    Good luck.

    annette030 replied to ctbeth's response:
    Several anti-Parkinson's Disease are currently being used off label for RLS, I tried one of them, and was deathly ill, vomited every hour and lost track of time entirely. Sinemet being used in this way does not surprise me at all.

    Take care, Annette
    annette030 replied to mel0222's response:
    I am so glad that the Mirapex is working for you, it made me sicker than a dog when I took it for RLS.

    I don't know what the answer is to your problems, I just wanted to tell you that I am thinking of you. Best of luck to you.

    Take care, Annette
    Onehurtguy replied to annette030's response:
    I don't see where the "addiction" comes into play here, unless you've been diagnosed or label as one by your MD.

    There is a hug difference between becoming dependent on a medication, and being addicted to one. I for instance am dependent on my pain management medicine, same as I am with my high blood-pressure pills. You need them both to live through the day. Having said that though, if when you run out, you're trolling the bad side off town at 2am seeking out medication illegally, you may be an addict. That example alone isn't concrete proof of your addiction, but it should definitely make you double take in the mirror the next day.

    If you see a pain management physician for chronic pain issues, and you're not getting enough medication to control your pain, you most certainly need to speak up to him/her to let then know that your pain is out of control. If after they give you what you feel you need with respect to milligrams and times per day and you STILL run out in two weeks, you need to take a look in the mirror again. Maybe speaking with a psychologist or similar to address the mental part of managing pain would be a good idea. You don't have to have"issues" to see a psychologist, it's always good to get things off of your chest, talk to them about your pain and frustration, etc. they can give you ideas and exercises I an attempt to augment the effectiveness of traditional medication.

    You should never feel ashamed to speak your mind in a medical circumstance, and don't let them tell you how much pain you do and don't feel. Just remember to be calm about it, leave the drama at the door.

    Best of luck, keep your head up. There's always someone worse off than us somewhere.

    mel0222 replied to ctbeth's response:
    Hi CTBeth, thank you for that website, it was interesting to research. That seems it would be effective for me. I am surprised/disappointed that my neurosurgeon didn't mention it. He did speak of some new electrical procedure that deadens the nerves; not a TENS unit, that didn't help one tiny bit. It didn't involve implanting anything though. However, Medi-Cal does not cover it anyway. My educated guess is that Medi-Cal will not cover anything but pain meds, since that is the cheaper option for them.

    I am on SSD, thankfully, since I am a single mom with a "dead beat dad". I am so very grateful for my parents who are helping us stay in an apartment so we have a roof over our heads. When I applied, everyone told me to get a lawyer because no one gets approved the first time. Well, the physician's panel must have agreed that my back and knee were bad enough to grant it right away. However, I do not qualify for Medicare until I have been on SSD for two years. I was just qualified this past December so I have a long way to go.

    My next plan of attack is to get a referral to pain management. I'm hoping this new carrier will send me to a bonafide MD because last time I went this route, I was sent to a chiropractor who told me my back was too severe for him to be able to help me. Duh! Oh the system is so frustrating at times. I have asked to be sent to an anesthesiologist but Medi-Cal will not cover that. Grrr...

    I truly appreciate the advice and suggestion; keep them coming. Thanks Mel 0222
    mel0222 replied to cweinbl's response:
    cweinbl, thank you so very much for the links. I have been looking for some good solid medical research for some time and have not found any that satisfy my quest for knowledge concerning my lower back pain.

    Also, describing why I was prescribed so many meds in order to manage my pain was never really explained to me in a satisfactory way, I was just told I "needed to get off this cocktail your taking." However, I am still convinced that my "cocktail" contributed to my CHF and heart attack; though my NP ignored the danger signs of consistent high blood pressure, attributing to the level of pain I was experiencing. For this reason, I am hyper cautious of what meds go in my body.

    I now understand the difference between addiction and dependence. I would never hit the streets, looking for a dealer of opiads; although, to be perfectly honest, I did think about it. It is so very frustrating, as you know, to not be able to get beyond the constant pain. It wears a person down and affects every aspect of our lives. I have observed that my NP and I were not successful in reducing my pain to a manageable level so I figure, why deal with the risk and side affects of pain meds if they weren't helping enough anyway. Although, I did have a sleepless night last night because I just couldn't get into a position that relieved the pain.

    Your experience with unsuccessful back surgeries is exactly why I do not want a fusion. I have had so little success with all of my knee surgeries and am highly prone to developing scar tissue, more than the average person, so I want to avoid that if at all possible. I am so sorry that it has been a long journey for you. There just has to be another solution outside of surgery and a "cocktail" of drugs. I do employ biofeedback as I was trained in it years ago for migraine headaches. Again, it's very difficult for me to get into a position that doesn't hurt enough for me to concentrate on relaxation techniques.

    My biggest frustration is I am bound to what Medi-cal will approve, which isn't much. So until I qualify for Medicare in two years, I am stuck in the situation I am in. I will not stop searching for a solution though and this social website is already a huge help, learning from other peoples' experiences and knowing that there are others out there that hurt as bad and much worse than I do. I can be grateful for so much. Prayer and looking to God for strength is what gets me through each day.

    I truly am so sorry for your pain and unsuccessful journey with effective solutions. Again, thank you for those websites; I intent to further explore them.
    mel0222 replied to annette030's response:
    Annette, thank you for your response. Isn't RLS the most frustrating, annoying, infuriating abomination in the world?!?

    Oh, I would take pain any day to that awful feeling. I am so sorry that that the RLS meds have not worked for you. The Sinemet worked for years but now my doc will not prescribe it for me because it is off label and used for Parkinson's. I have tried Requip in the past with no relief. I agreed to try the Mirapex if he would prescribe it at a high dose and three times a day. He agreed. I was pleasantly surprised. Up to this point in my 52 years, Sinemet was the only one that worked. It did elevate my blood pressure and heart rate though. Now with my recent Congestive Heart Failure and heart attack, I have to be careful what I take. Thankfully, the Mirapex is working and doesn't affect my bp and hr. I am also taking gabapentin (Neurontin) for my back pain and RLS so I think that the two together is contributing to my success. This is a good thing since my back and left knee make it impossible for me to stomp around the house in order to make the crazy feeling go away.

    I am so very sorry for your unsuccessful attempts at controlling your RLS. What do you do then? Maybe the Gabapentin would work for you? Have you tried it? In its description, RLS is mentioned. I take the maximum dosage allowed. It makes you sleepy at first but that side affect subsides with time. I hope that scientists find out soon exactly what causes it and a way to make it stop.

    I am thinking of and you and will add you to my prayer list. Uncontrolled RLS could drive a person insane, seriously! Hang in there Annete and keep seeking a solution. Mine was an all day annoyance, not just at night, so relief was essential to my sanity. I hope yours is not that bad. Take care.
    mel0222 replied to Onehurtguy's response:
    Thanks for that input onehurtguy, it is encouraging to understand that I am not an addict, I was just dependent. Though I didn't ever search for relief in illegal ways, I certainly thought about it. However, I knew that if I ever reached that point, I needed to admit myself into a rehab center. It is so very frustrating when my system adjusts so very quickly to the level/mg prescribed. I am not currently on any narcotic pain meds but am pretty miserable. For awhile, after my CHF and heart attack, I was able to keep my pain to a 6 or so. I have lived with pain so much of my life with all my abdominal and knee surgeries that I am used to living with it.

    However, recently, my pain has increased to an 8 because of something I did to try and relieve and heal my back. My neurosurgeon and chiropractor suggested I buy an inversion table and begin, very slowly, to use it to decompress my lumbar and let healing nutrients get into my damaged nerves. Well, I did as prescribed at the percentage of tilt and time but when I turned myself upright, I got a searing pain in my lower back, much worse than before. It turns out that I tore many connective tissues and need to treat myself with alternate heat and cold, ibuprofen and muscle relaxers. It ain't helpin'! So, I have regressed and am having a hard time getting any sleep because of persistent pain. I'm thinking I am going to have to ask for a referral to pain management again.

    I think it's probably a good sign that I have no cravings to get back on pain medication except to manage pain and I don't miss it one tiny bit. I really don't want to do that if at all possible. I can accept the pain if I get some relief throughout the day and night. I was at that point until this mishap. I'm hoping my pain will respond soon to my PT at home.

    You are right that there are so many people that are in so much more pain than I and have much larger hurdles to cross. I am finding much comfort and encouragement from this social site already. There really is some wonderfully knowledgeable and compassionate people our there. I'm grateful. God bless.
    Onehurtguy replied to mel0222's response:
    Hey Mel, you are welcome, I'm glad to be of service.

    Have you had an MRI to figure out exactly what is happening with you back? It sounds like you've got some serious issues, and being so, you may want to stay away from your Chiropractor. I don't believe in them, outside of a little massage.

    People with spinal issues can be permanently damaged by a Chiropractor, and when you think about it, I hope you see that they are not MD's, have no training in Neuroscience, and are nowhere near qualified to diagnose your spinal problem. The fact the they would attempt an "adjustment" on someone with spinal problems should speak volumes about their ethical disposition and incompetence. One little tweak on someone with disk or nerve issues could paralyze them, yet they decide to treat you without an MRI or knowledge of your condition.

    If I could live without pain medication, I would in a heart beat, I don't have that option. If I wasn't such a wimp, I would consider one of those Spinal Stimulators like Beth has. It just proves how much tougher women are than men... Maybe you should look into that vs. going back to the meds?

    Now as far as surgery goes, you are the only one that knows when it's time to have that done. I waited 3 years after my car accident to have surgery, as it was the absolute last thing I wanted to do. After years of PT, Epidural injections, doctor after doctor, you name it, I was there, twice. It wasn't until I lost feeling in my left leg and started dragging my foot that I was left with no choice. I had three disks stabilized with mental cages, titanium rods and screws, etc. they had a name for it, I call it "painful". As far as my leg/foot goes, the surgery was successful, but the low back ache is the same today as it was before surgery. I'm thankful that at least the nerve issues are 90 percent better, but the low back pain is constant, and never stops, EVER! I've resigned myself to living my life in constant pain, and for the most part, it is controlled with medication. My struggle now is to try and maintain a reasonable level of medication, as with anyone taking pain killers form7 years, tolerance is an issue, which is exactly what brought me to this site, an attempt to learn more about what other people in the same boat have had success with.

    Now I'm rambling, sorry!

    Stay strong Mel, do what you can, know that you're not alone, and ask for help when/if you need it. Be logical and responsible in taking pain medication, and know that you are in control of it, not the other way around.


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