Chronic pain Support - Acute pain control Part II

Author

Acute pain control Part II

maureen@keanenutrition.com

2005-12-23, 12:56 am

I posted several well thought replies to those who replied to my
earlier post, including one blasting the doctor who gave me chemo and
surgery I didn't need and who probably caused the fibormyalgia, but
they are nowhere to been seen. I guess they got lost some place. Just
love Google.

So I will reply again.

Someone suggested a drug holiday before going into the hospital.

Does this work? Is is possible to decrease your morphine dose and lower
your tolerance? I had it in my brain that once you reached a level of
opiates you could not go back. You would always need that dose of
morphine to control pain in the future. My pain has decreased (from
neurontin and L-Dopa) and I don't need as much as I once did. In the
past three months I have already cut back to 180 mg/day. Will my
tolerance decrease now? If I were to cut back to several 5 mg
oxycodone a day and the pain returned (very common with FM) could I get
substantial pain relief from 5 or 6 oxycodone? Or would I have to go
back to the 180 or 360 mg MS Contin?

I have an extensive rewrite of one of my books due Jan 1 so I won't be
able to rewrite the lost posts and blast said doctor (Hisham Tamimi of
the UW in Seattle- the quack who caused my FM and pulmonary
hypertension. May he rot in hell for what he did to me and many other
women). Wonder if I could put that in my sig?

Maureen in Mukilteo

OldGoat

2005-12-23, 5:55 pm

Dear Maureen,
Over the past 10 years I've had about 3 drug vacations, with the only truly
effective one was going to Oxycontin to Methadone (for about a year) and
then back to the Oxycontin. I wish I could tell you it made a difference and
helped the tolerance issue, but we just picked up where we left off. If you
haven't tried it, methadone is an all day and then some pain med, so it's
got an extremely long half life in your blood stream. The oxycontin is
significantly stronger, but you're lucky to get 8 hours out of one.
So my vote is no- a drug vacation doesn't do a whole lot of good, but please
do not be disheartened. Everyone on the planet has different results, and it
could be huge for you. You also need to remember that while you are
hospitalized your drugs will be coming to you via a vein which increases
potency 3 to 6 times what an oral dose would do. So don't let the numbers
throw you off.
A good anesthesiologist makes all the difference in the world. Don't be meek
and mild, raise Cain till they readjust your med pump for an opioid tolerant
patient.
Post surgery they were playing games with my meds too I told the wife to
bring me a change of clothes and my oxycontin and 45 minutes later I was in
the car on my way home. This is the second day out from the surgery. I
called my pain docs who agreed they were being morons (in fact after I had
street clothes on they offered to turn the pump up) and handled my pain at
home quite nicely. Just as well, the room mate was in to watching
infomercials and talking on the phone all night. A hospital is no place to
rest and get better. They wake you up to take a sleeping pill or stick a
finger up your XXX every hour or two. Toss in a loser roommate, and home is
the only place that makes sense.
As far as your taper, that's between you and your doc, but he better make
sure there's an "opioid tolerant" sticker on your chart, highlighted
followed my lots of exclamation points.
Keep in touch and I wish you nothing but success and smooth sailing through
this and pray for you to have a permanent fix on the other side of this
procedure.

Best of Luck--og

<maureen@keanenutrition.com> wrote in message
news:1135304273.036097.246930@g44g2000cwa.googlegroups.com...
>I posted several well thought replies to those who replied to my
> earlier post, including one blasting the doctor who gave me chemo and
> surgery I didn't need and who probably caused the fibormyalgia, but
> they are nowhere to been seen. I guess they got lost some place. Just
> love Google.
>
> So I will reply again.
>
> Someone suggested a drug holiday before going into the hospital.
>
> Does this work? Is is possible to decrease your morphine dose and lower
> your tolerance? I had it in my brain that once you reached a level of
> opiates you could not go back. You would always need that dose of
> morphine to control pain in the future. My pain has decreased (from
> neurontin and L-Dopa) and I don't need as much as I once did. In the
> past three months I have already cut back to 180 mg/day. Will my
> tolerance decrease now? If I were to cut back to several 5 mg
> oxycodone a day and the pain returned (very common with FM) could I get
> substantial pain relief from 5 or 6 oxycodone? Or would I have to go
> back to the 180 or 360 mg MS Contin?
>
> I have an extensive rewrite of one of my books due Jan 1 so I won't be
> able to rewrite the lost posts and blast said doctor (Hisham Tamimi of
> the UW in Seattle- the quack who caused my FM and pulmonary
> hypertension. May he rot in hell for what he did to me and many other
> women). Wonder if I could put that in my sig?
>
> Maureen in Mukilteo
>

ipgrunt

2005-12-23, 5:55 pm

Maureen,

In my opinion and experience, the successs of opiate abstinance in
reducing tolerance depends on how long you've been dependent on
opiates. In my early years of long-term opiate therapy I could take a
month or two off and the percocets would again work, for a month or
two. Today, after more than 10 years of effective long-acting opiate
therapy, no amount of respite could lower my tolerance.

I once heard a lecture about receptor sites and how they multiply as
the theoretical basis for tolerance. This was presented by a drug abuse
counsellor and was non-scientific, but it made sense to me at the time.
I've learned since that the dynamics of the process are more complex
than simply filling more available receptor sites.

Scientists really don't know much about the dependence/tolerance
mechanism, though many animal studies are in progress. NMDA antagonist
drugs seems to be of some help. One study claims reversal of tolerance
(in rats) with NMDA antagonist therapy. Consequent opiate and
NMDA-antagonist therapy seems to slow down tolerance with morphine.
Google: "NMDA antagonist" AND dextromethorphan for further info.

I've been using low-dose ketamine for years, and my opiate doses have
stabilized, though I must confess that I have never experienced a
reversal of tolerance.

How great it would be to go back to the time when a couple of Vicodin
would give me some relief!

The skinny is that for those CPers who are as tolerant of opiates as
you and I, specialist medical management of pain control for surgery is
a necessity.

I'll give you a mild example. I had an abscessed tooth a couple of
months ago, and the pain I experienced from that tooth was worse than
anything I've had from my chronic problem. 10s all night long! I was
swallowing 90 to 120 mg of oxycodone (6 to 8 of the 15mg tabs) every
3-4 hours just to stay sane. Needless to say, I ran through my monthly
breakthrough meds rather quickly, and I revisited my dentist for a
script, who was amazed at the dosage of painkiller that I required.
After a trip to the PDR where he couldn't find oxycodone in a 15mg
formulation, he called my pain doc and that helped ease the process of
getting him to write what I needed to get through that week.

My advice is that you find a good anesthesiologist/pain manager who
will help you during your times in the hospital. Our needs are very
different than the typical patient, and surgeons simply do not
understand why 10 or 20 mg of oxycodone p.o. would not handle the most
severe pain in anyone. They are honestly afraid of pushing us into
respiratory arrest if they give us any more opiates, and they are
completely justified in feeling this way. Still, medical schools do not
teach this stuff!

When you tell a doc that you take 200mg of oxycodone a day, they think
that you have the numbers wrong. They'll say something like "You must
be mistaken. That amount would kill a horse" or something equally
commonsensible. If they are good docs, they'll try and figure out what
dose your "really on", for instance, they'll ask, how many pills a day
do you take, and then assume they are 5mg oxycodone pills. If they are
the usual run of the mill uninterested know-it-all kind of docs,
they'll ignore your statement completely as they plan to give you the
same pain control they give everyone else. Anyone who asks for more
pain meds must be a junkie, right?

Get some help from a pain doc with this....you'll need it.

Good luck,

--ipgrunt