"Managing Pain Without Opioids- Changing Patient Perceptions"

[Thundarstick]

This subject was alluded to in another thread, but I thought it deserves its own.

The fact that opioid use appears to be leading to users being less tolerant of pain, and I wondered how long it would take to move into practice. I open my company E mail this morning and there it is, a seminar on moving away from opioids for long term pain management!

I wonder how this is going to be received by the public? What do some of you who are on pain management think? What have you seen happen in family or friends who have been on long term opioid pain management?

[Wayne Smith]

Some of my clients are struggling mightily with it - and so far succeeding. So far my pain is controlled and contained through the use of a back brace.

That seminar sounds like the one I attended earlier this year.

[MrWolf]

I have been on the same dosage for about four years now out of probably ten years. It does not work as well as it used to which could either be tolerance or my condition deteriorated which is probably what it is. As it is, I am still up every hour or so every night. Wonder if whomever wrote the seminar is in constant pain or someone just saying it is all in your mind. I would not wish my pain on my worst enemy.

[GhostHawk]

My wife has been on Codine 3 for 14 years. She got off twice. First one was a real corker.
After some 3 months clean she came to me, broke down. "I don't want to live like this!"

Ok, so I encouraged her to go to a PA that has long history with the both of us, but who is out of network.

She had tried 7 different doctors, none would perscribe it.

Our PA did, as long as she was seen 3-4 times a year. 160$ out of pocket. Ins won't touch it.
Ok, do it.

Then 6 months later the insurance company gave her instead of her usual 180 tabs for 90 days. Gave her 14 tabs and said no more for 3 months. Hence the second withdrawl. This one was easier. Helped that she was retired. If she had a bad day she stayed in bed till noon.

Then she came to me. Bill the insurance won't pay for my Codine 3's. Yep, knew that.
43$ for 3 month supply if we pay for them ourselves.

Cindy, eventually they will close that loophole as well. But what the heck. Go for it. Your covered by Wild Bill.

She still deals with pain every day. I know I have a fairly high pain tolerance, and I don't think I could live with hers for 2 weeks without checking out.

I see no sign of her tolerance descreasing. For her the Codine just helps to remove it enough from front and center of your mind to where she can tune it out.

Most of this is unprovable by scientific measurement.

All I know is this. My Cindy on Codine 3's is a gentle compasionate loving person.
Cindy without, think grizzly bear on a bad hair day with missing cubs. Stay OUT of her way. She will rip you a few one and tear off your arm and beat you to death with it.

[bikerbeans]

The ONLY reason opiod use is under attack is the big drug companies don't make high enough profits on the sale of opiods. If opiods are gone then it easier to sell their new designer drugs. Also, opiods complete with medical marijuana, another cash cow for the rich.

BB

[WinchesterM1]

My wife is a nurse and I have a bad back, my wife told me to take 400mg of ibuprofen and 400mg of Tylenol at the same time every 6 hours and that’s is what works for me when I’m in a lot of pain it doesn’t kill the pain 100% but it makes it tolerable

[1911sw45]

I been to them and don't trust them. Like any government program its no good!

[mattw]

My wife was almost killed in '06 in a car accident that was not her fault. They guy almost go both my kids as well. 14 broken ribs, both feet and ankles, 5 closed skull fractures, 2 cracked vertebrae, several bones in 1 hand and 12 surgeries later she is in lots of pain and suffers moderate TBI.

With her TBI, if she does not sleep she does not function. The best thing that she has found is a high dose of major opioids before bed, she will sleep 4 to 6 hours this way and can keep her brain functional. If she gets to tired, it is off to dysfunctional lands and 14 to 16 hours of medicated sleep.

My point, if her pain meds at bed were taken away... I am not sure she could choose to live. Our 2 girls, 12 and 16 have been what has driven her to keep her life as near normal as possible. I think that medical weed would be a huge help for her TBI and pain, but in this state it could cost us a lot. Firearms ownership being the biggest thing, we both love to shoot and have a decent collection that would be taken in a heart beat since we are legal owners and a huge part of the problem in IL.

[jmort]

Tylenol and ibuprofen
NSAIDS are bad mojo
A one-two for your kidneys and liver and other below average side-effects
That is an effective combo for pain
Morphine does nothing to harm the body except cause constipation
We have thrown the baby out with the bath water becase of loser addicts
Sad really

[Rick Hodges]

I find the original post's theory interesting, and alarming ….. it has long been known that opioids and other addictive drugs create a tolerance to the drug....it takes more and more to have the desired effect. I am not at all sure that the patient builds an intolerance to the pain.
My point is we used to see the drug as the source of the problem, (it loses effectiveness with continued use). Now it is the patient's fault (decreased pain tolerance) and not the drugs? It feels like a dangerous shift in emphasis that does not bode well for the patient, nor for pain management in general. We went through this ridiculous way of treating people...IE refusing morphine and opiates to terminal cancer patients because the might become addicted. Where is the balance point?

[Markopolo]

I would say to this,

Horse Puckey. I have had my back broken in 2 places, and have Harrington rods and pins all over the place. I take way way less opioids then what I should take. I allow myself 1 tramadol or maybe 2 per morning and have been on this regiment for about 8 years. I do not want some long distance person who doesn’t live with what I live with telling me how to live with my afirimities. It works for me. I agree with what Ghosthawk says. It removes enough of my pain in the morning so I can go out, Hunt, fish, cut firewood, mushroom hunt, fix the truck, work on the roof, mill lumber and build. It removes enough of my pain so it is out of my center focus, and can then put the pain more in the background. Yes I know when I have forgotten to take my pill, and my body reminds me, but I am extremely disciplined about it though. No matter how bad it gets in the afternoon, or the evening, or how bad the demons come at night while I am trying to sleep, I don’t allow myself any other comfort. Just once in the morning. I have tried every nerve drug there is, and nothing touches it. So I use the tramadol, a synthetic opioid, once per day, and I have my somewhat quality subsistence life and can do most things the doc tells me not to do, but are required by the type of life I lead. Yes, I gimp around in the afternoon, sometimes bent over a cane, sometimes I don’t or can’t even get out of my chair in the afternoon, but I will not surrender to addiction or pain, or become a junkie cuz I do what the doc’s say I should do. Those are my choices. Some days I don’t do a heck of a lot, and some days I do more then I ever done before. I don’t do other drugs, not even legal pot, I don’t drink except a beer after cutting firewood. Horse Puckey to those that say I can’t do what works for me. I dont sell my pills, I don’t share them, and I don’t allow myself to slip into full bore addiction due to the lessening of tolerance. I guess After 7 spinal surgeries, we will see if they take away my one small comfort. At least I am walking again. So far, due to my history, nobody is attempting to change my methods. I hope not. It’s all about discipline I guess...

I may be ranting. I apologize.

Marko

[Beagle333]

I have been using Percodan (Aspirin and Oxycodone Hydrochloride) on and off for 30 years this year. It is what I need to bring the pain down to a level where I can continue about my day and not have the pain dominating my consciousness, and it also dulls it just enough for me to get some sleep at night. I don't use it every day, only as needed. I might use it for 15 days in a row, then take a 5 day break (as directed by my pain management doctor), and then I might not need it for 6-8 months at times. But I have taken it on a regular basis for the last 2+ years and I will need some proof that a replacement works as well or better than opioids before I'm willing to give it up. It's not easy to get, even now. I have to fill out more questions than I do to buy a handgun.

[EDG]

First Darvocet, Darvon, or other propoxyphene drugs were outlawed. The FDA claims that propoxyphene was related to more deaths than the opiods at the time. Now that we have had a lot of people switch over to opiods and die I am not sure that the FDA can still claim that Darvocet kills more people than the opiods.
I know that I took Darvocet for many years and it was effective plus I never seemed to have an withdrawal issues nor did it clog me up. If I take hydrocodone the stuff makes me itch and I often have a bad attitude while taking it.

It appears the health care industry does not really want to cure many of these chronic pain causing conditions. They would put themselves out of business if they did. We are sort of trapped by the conflict of interest that exists. The money makers would rather have everyone addicted so they have a guaranteed source of revenue. Even if you have none of these health issues you are still paying out the nose. While the patient on medicare covers 20% or so of the cost you pay the other 80%. So many times a medicare patient will pay $180 month for all their meds. Expensive right? The government, using your tax money, may be paying over $1000 a month and that is for many millions of retired folks.

[DougGuy]

I guess I am one of the lucky ones that doesn't need pain management regularly. They loaded me up with opioids when I had tonsil cancer in 2013, which I stashed and do hoard religiously, but by the time I had surgery for lung cancer in 2018 attitudes had changed drastically and it was like pulling hens teeth to get written for a handful of 2mg dilaudid.

When I was in the hospital after surgery they had a demerol pump all I had to do was push the button every 15mins and bang it would go IV. When I got home I took 12mg hydro the first day, 10 the next, 7.5 the next, 5mg next day, down to 2mg then nothing. It worked. They tried me on gabapentin and celebrex in the hospital and let me tell you they both sucked. Had me where I couldn't even walk without the whole hallway jumping around with every step. I do well with opioids as I am keen on not getting hopelessly addicted to them but then I have never had chronic pain to deal with either. They have their place and I don't think any amount of medical meandering is going to eliminate them completely.

I can and will say this.. Once diagnosed with lung cancer I employed the Rick Simpson method of using high thc extract cannabis oil in conjunction with chemo to manage any mets after surgery, I found the oil definitely helped me wean myself off the opioids very quickly, it is an efficient pain manager, and it boosts appetite. This ain't the cbd oil you can get everywhere nowdays, this is full extract, comes from the buds, stems, whole plant. This is the stuff that is needed to kill cancer. Over the counter cbd will not do it.

I had a skull to thigh PET/CT scan last week, 6mo after surgery, I eagerly await the findings and pray for a clean scan.

[Markopolo]

Prayers sent Doug!!!

[Land Owner]

We've turned to the alternate Chinese medicine of acupuncture for pain relief with excellent results. My spousal unit had rotator cuff tendonitis. Perhaps this isn't the "same" as broken backs, ribs, and neck, but it debilitated her professional music career as a Classical Pianist. We sought acupuncture rather than the mind numbing opioids, which the doctors were willing to prescribe. Miracle of miracles the acupuncture WORKED the very first time and she has had no relapse, but a few follow up pin cushion sessions, since.

I took my arthritic and fluid swollen knee, 2X normal size, to the acupuncturist. I became the pin cushion for a change. It helped slightly and the insertion of the pins WAS NOT A BIG DEAL.

something to try. it could not hurt. it might help.

[beechbum444]

I've watched this unfold for years SSNRI (selective seritonin and norepineprine reuptake inihiitors) do a great job at treating chronic pain but it's an off label use . They are FDA cleared to treat depression .it appears that most of society doesn't want to be labeled as depressed......a taboo subject . Watch the time intervals on nsaids and dosage .... they can damage kidneys

[Walks]

I feel your pain, because I share it too. 21 years of it. Feel off a ladder, busted both knees, rt collarbone, cracked 3 vertebra and wrecked 7 discs.
I've had 3 knee surgeries, 1 shoulder surgery and I don't know how many things done to my spine. Darvon was great, Vicodin was real good. Ibuprofen and Tylenol sucks. Norco helps, but I don't take it every day.

In the Winter it's heating Pads in the recliner, in Summer it's icepacks.

Acupuncture WAS GREAT. But when Governor Scharzenegger left office He signed a bill that GUTTED Worker's Comp. We now have 10% of what we did have. No Acupuncture, Physical Therapy everY 2-3 years, an epidural about 18 months. Synvisc injections for the knees about once every 2-3 years. NO KNEE REPLACEMENTS, NO SHOULDER REPLACEMENT.

Can't take Norco at night to sleep, it keeps me awake. So I sometimes take them at dinner, not every day. But just to dull the edge of the knives that are always in my back.

If they take that away, I'll never do anything again.

[MaryB]

9 surgeries on joints since 2006, one low back, one neck to do a 2 level fusion, right rotator cuff twice, right wrist carpal tunnel twice, right thumb detach the tendon and shorten it then reattach, right knee scraped out, left hip nerve tumor removed... on top of osteoarthritis all up and down my spine and in both shoulders and hips, spine is slowly self fusing(very painful condition...)

I take on oxycontin and a percocet when I get up to get moving and get something done during the day, a percocet at 8pm, and repeat the morning oxy/perc right before bed. I have tried all the injections, all the PT, all the massage... I actually cut my dose in half on my own with no input form the doc, only take enough to be able to function... if you take enough pain meds to be pain free you are an addict! No signs of addiction, no tolerance build up... my daily pain level with the meds would have the average person screaming for morphine! I just deal with it and live life as I see fit.

These attempts to remove access to meds that make life livable for millions of people is outright stupidity. 99.9% of legal pain med users are not the addicts and are not the problem. The problem flows across the southern border!

[DougGuy]

These attempts to remove access to meds that make life livable for millions of people is outright stupidity. 99.9% of legal pain med users are not the addicts and are not the problem.

Hmmm kinda sounds like another constant argument we all have to face as gun owners!