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Title: Long-Term Prescribed Narcotic Use for Chronic Pain Post by CHTom on Sep 5th, 2005, 3:32am There continues to be a number of posts concerning CH suffers becoming addicted to narcotic analgesic medication, even after being used for only a very short time. I am publishing the following statement to try to allieve concerns that CH sufferers, who may be or have been prescribed such medications, are in great danger of becoming drug addicts. I am not endorsing the use or non-use of these medications but just hope to put some sufferers' minds at ease and also to clarify, which I think that the statement does an excellent job of doing, the difference between dependence and addiction. This statement was updated in Feb. 2004. PFDANs. Prescribing Controlled Substances for Pain A statement by the Medical Board of California, 1997 On May 6 the Medical Board formally adopted the following statement on "Prescribing For Pain Management.". It is the first formal statement of its kind in the nation made by a licensing board. This statement was adopted after a year of testimony at hearings held by the Board's Task Force on Appropriate Prescribing and a day-long "Summit," sponsored by Governor Wilson, involving scores of experts from around the country. The Appropriate Role Of Opioid Analgesics There are numerous drug and non-drug treatments that are used for the management of pain and other symptoms. The proper treatment of any patient's pain depends upon a careful diagnosis of the etiology of the pain, selection of appropriate and cost effective treatments, and ongoing evaluation of the results of treatment. Opioid analgesics and other controlled substances arc useful for the treatment of pain, and are considered the cornerstone of treatment of acute pain due to trauma, surgery and chronic pain due to progressive diseases such as cancer. Large doses may be necessary to control pain if it is severe. Extended therapy may be necessary if the pain is chronic. The Board recognizes that opioid analgesics can also be useful in the treatment of patients with intractable non-malignant pain especially where efforts to remove the cause of pain or to treat it with other modalities have failed. The pain of such patients may have a number of different etiologies and may require several treatment modalities. In addition, the extent to which pain is associated with physical and psychosocial impairment varies greatly. Therefore, the selection of a patient for a trial of opioid therapy should be based upon a careful assessment of the pain as well as the disability experienced by the patient Continuation of opioid therapy should be based on the physician's evaluation of the results of treatment, including the degree of pain relief, changes in physical and psychological functioning, and appropriate utilization of health care resources. Physicians should not hesitate to obtain consultation from legitimate practitioners who specialize in pain management. The Board recommends that physicians pay particular attention to those patients who misuse their prescriptions, particularly when the patient or family have a history of substance abuse that could complicate pain management The management of pain in such patients requires extra care and monitoring, as well as consultation with medical specialists whose area of expertise is substance abuse or pain management. The Board believes that addiction should be placed into proper perspective. Physical dependence and tolerance are normal physiologic consequences of extended opioid therapy and are not the same as addiction. Addiction is a behavioral syndrome characterized by psychological dependence and aberrant drug related behaviors. Addicts compulsively use drugs for nonmedical purposes despite harmful effects; a person who is addicted may also be physically dependent or tolerant. Patients with chronic pain should not be considered addicts or habitues merely because they are being treated with opioids. (Edited to fit the alowed space; bold face and underlining done by me for emphasis) |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by LeLimey on Sep 5th, 2005, 3:36am Hmm.. John used to advocate narcotics as pain relief wheras everyone else including Professor Goadsby says they have no place in the management of clusters. Your veil is slipping Mata Hari. |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by pubgirl on Sep 5th, 2005, 3:39am [smiley=laugh.gif] [smiley=laugh.gif] [smiley=laugh.gif] [smiley=laugh.gif] [smiley=laugh.gif] Helen, that cracked me up! Ground control to Major Tom, your circuit's dead, there's something wrong ;;D W the B |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by E-Double on Sep 5th, 2005, 8:36am There are definitely a few that do not respond to typical meds and are in need of narcotics to survive. I can name a few here but will let them pop up and advocate for themselves. I'm honestly for whatever works! The problem that I see is with the medical community and the improper treatment and inappropriate diagnosis'... If people are given hard core narcotics prior to conventional CH meds and then find themselves screwed because they are dependent. The problem wiht dependence is the increase in need for the med. When one habituates because and starts to get rebound they will take more & more. Now you not only have CH but an additional headache type which could be extremely excrutiating(trust me!!) If narcotics are used, I think we are talking more along the lines of Fentynl or acqtic lollipops as opposed to popping mass amounts of percs or vicadins. Whatever helps BUT one does need a good Dr. E |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by pubgirl on Sep 5th, 2005, 12:02pm Oh don't encourage him E! We'll never hear the last of it ::) W |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by Karla on Sep 5th, 2005, 12:31pm All I can say is I think what he wrote is well said. Last year after taking the duragesic (fetanyl) patch for over a year I quit taking it cold turkey and had virtually no problem at all with stopping it. However, I had tried over 35 different meds to prevent my ch from occurring and nothing worked and I was chronic getting hit 8x/day for 1 1/2 ea. That was 16 hr mostly at kip 10's. I couldn't work at home or else where and I had no life at all. Eventually I needed to go back on the patch because the ha came back. This medicine has given me a quality of life with my family and just life and living in general that I would never have had otherwise. I have 0 ch occurr that is 0 pain. I may be dependent on it but I am not addicted and I thank God for a compationate dr I have who isn't affraid to perscribe to me and we have a good patient /dr relationship where he trusts me. However I do believe it should be a last resort and only after you have tried everything else under the sun because there are alot of other meds out there that work for people. |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by CHTom on Sep 5th, 2005, 10:12pm Fentanyl patches and Actiq (fast acting fentanyl "lollipops") have shown the most promise for chronic, intractable CH pain-the patches as a preventive and the "lollipops" as an abortive for breakthrough pains. I agree, E-Double, that a good doc is essential and will add that a good pain clinic is best, along with a neurologist who knows how to diagnose and treat CH. Karla, I'm glad that the patches have given you back a normal life and agree that such medications should be used as a last resort if everything else fails. Perhaps the article could be shown to ignorant people who think that you (or other users) are not "drug addicts"; being dependent is not a problem and when the time comes to stop using the drugs please do so under medical supervision. PFDANs. |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by gore2424 on Sep 5th, 2005, 11:50pm I do agree with you Karla i too wear the pain patch its the 75ug/h been my life saver been chronic since Nov 1999 and for many years tried 67 different meds in all combos even went as far as have brain surgry cut nerve i have no feeling on whole right side of face so after all that finally been getting relief with the patch i get mine supplied thur the VA and twice they were late first time 8 days without and second 7 days without should of been in hospital cause i had nasty days and nights laying in bed toss and turning couldnt sleep when my Neuro found out he now supplies me with 30 mg of morphine pills 14 a month for the really bad days and if am late with them again he will put me in hospital so i dont withdraw ok i rambled enough Terry |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by hdbngr on Sep 14th, 2005, 4:42pm I'm really glad that someone posted on the difference between depend vs. addiction. I used to use the Duragesic patch. I used them for a year and a half, and when the worst had passed, I weaned off of them. It wasn't fun, but it was doable. Like Karla, I honestly think it saved my life and I'm deadly serious when I say that. The patch is sometimes used when they are worried about addiction. You get exactly enough to last one month. Each patch last three days. When it's gone, it's gone, so that inhibits anyone using them when they aren't needed. If you feel a narcotic would improve your life, offer to have voluntary bloodwork each month. That way the Doc knows the amount in your system. It also red flags folks who are taking them inappropriately. Narcotics do have a place in treatment of chronic CH. |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by nani on Sep 14th, 2005, 6:56pm I'm glad they work for some folks. They have never touched my CH. The last time I was in the ER, I got 2 morphine/phenergan shot within 3 hours and it didn't do a thing. I never even fell asleep or felt drowsy. Come to think of it, I drove (with no "under the influence" effects) within 2 hours of the last shot. I'm a freak. :-/ |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by madprof on Oct 16th, 2005, 1:38am Is treatment with narcotics really a problem for CH patients? I'm a great admirer of PJ Goadsby's and was surprised at his assertion that narcotics have no place in the treatment of CH. Clusterheads know better than most that nothing works for everyone. I typically get 5-7 attacks a day, most 120-140 minutes, relatively slow onset. Unfortunately, with the exception of Imitrex, none of the standard treatments work reliably. 02 is good, can't live without it, but often it is not enough. So I save Imitrex for work, take PKs at night, and await Verapamil salvation. Thirty four years of PK use, no problem ever getting off. One would think that we would have fewer problems than other chronic pain patients, given that the consequences of permitting tolerance to increase are so severe and the association of the high with the pain so unpleasant. New to this excellent board, been cluster-free for ten years (after a last cycle that lasted 14 months), brushing up on my long-neglected mycology, will let you know how it goes. |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by burnt-toast on Oct 16th, 2005, 7:57am I have often posted concerns about using narcotics for treating CH. but maybe I wasn't being objective. Not being a doctor I can only provide my point of view, about my situation. Blood serum levels of narcotics would have to be maintained at sufficient levels for relief 24X7/365. I don't believe that those experiencing Chronic or Lengthy On-Cycles are good candidates for narcotics treatment. The word zombie comes to mind. But I believe the best point made is that everyone is different - narcotics may be just the ticket for sufferers with short or infrequent On-cycles. This group probably has the least amount of risk for addiction as a result of treatment. As long as there is a reasonable certainty of not causing more problems - Whatever it takes to get relief is a good motto. Tom |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by CHTom on Oct 16th, 2005, 8:24am Amen Brother! |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by Sean_C on Oct 16th, 2005, 8:48am on 10/16/05 at 07:57:18, burnt-toast wrote:
The phrase "not a cluster sufferer" comes to my mind. Opioids will not abort a cluster and thats fact. Don't spread rumors to all these newbies that Oxcy's make it go away because it won't. Any doc that gives you pain pills for CH shouldn't be treating a patient IMHO. There is no relief in Opioids. Sean............................. BTW google Oxy and read the facts for yourself. I've lost 3 friends to that crap :'( Dependence is addiction. READ |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by E-Double on Oct 16th, 2005, 11:44am Sean, The only problem is that there are some who do not respond at all to the traditional meds/can't use them and can not or will not try the alternatives that we are learning about. Those like Karla & Terry who are like the above don't have a choice if they want to live functional lives. Like I mentioned there are certain narcotics like fentynl that has helped. In fact I have that listed on my emergency card as a med to be given if I have run out of options and have to go to the ER. That is a different case than taking regularly but it is a necessary evil sometimes if a break is needed like many of us encounter. I personally think the nature of our disorder shows that narcotics overall do not have much of a place when used the way they are for other types of pain or disorders that cause extreme pain yet if used properly and strategically along with the aid of a CH knowledgable doctor than it can not be ruled out as a last resort. E |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by Kevin_M on Oct 16th, 2005, 12:04pm Quote:
It says, an addict is characterized by psychological dependence and aberrant drug related behaviors, a person who is addicted may also be physically dependent or tolerant. A lot in common with psychological/physical dependancy and addiction. The dependence exclusions as defined here are tolerance and "aberrant" drug related behaviors. Quote:
I would change the word "or" to "and" as the third from last word in the above quote for the reason I highlighted, also within the quote. Where applicable and for the right reasons, although I would not be an advocate of it for clusterheadaches and would agree with Dr. Goalsby for personal reasons. |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by toolong on Oct 16th, 2005, 12:23pm Ok I've read just about all who contributed to this post,and all I have to add is this.When I feel a ball busting CH on it's way,and believe me I always know,and a Vicodin is all I have available I'll damn sure use it.It doesn't make the CH vanish into the air but it does somewhat deaden the pain.Wish I new a magic pill that would make it disapear.My doc said no more triptans because of a heart attack,so if O2 is not available I'll do whatever it takes. :PDavid Been a little while since my last post,hope everybodies doing great! |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by Sean_C on Oct 16th, 2005, 12:31pm on 10/16/05 at 11:44:06, E-Double wrote:
But they choose a medication not intended for short term pain. Am I correct? Pain medication does work bud, if I had my hips replaced this morning. Not if I had a CH. I've tried to scratch myself to relief many times my friend ;;D It doesn't work ;;D Cheers [smiley=me&mb.gif] Sean.................................... |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by CHTom on Oct 16th, 2005, 1:58pm There are narcotics that are slow release which are intended for chronic pain (i.e., Fentanyl patches) and then there are those that are fast acting (i.e., Dilaudid) for use when pain becomes so severe that it breaks through the slow release medications. Sometimes a combination of both is required. A pain clinic is the best and safest place to get either or both types as their use is strictly monitored and the physicians there are specially trained regarding the use of these medications. For certain chronic CH patients, where nothing else has worked to control the pain, a pain clinic is the appropriate place to be evaluated for and obtain, if the doctor deems it necessary, these medications. They have very strict controls regarding a patient's use of these medications. While not for everyone, for some chronic CH patients, narcotics are the only option to relieve the severe pain. In a good pain clinic, an extensive work up is done, including a neurological consultation by a neurologist who specializes in chronic CH, before a decision is made to place one on these medications and can enable a person with severe, chronic CH to live a productive and as near to normal as possible life. Whether or not someone chooses to use these medications is a personal decision, just as it is a personal decision to use any other medication, be it conventional or mushrooms. "Judge not lest ye be judged" and "Walk a mile in my shoes." PFDANs to all. |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by Sean_C on Oct 16th, 2005, 2:07pm OK help me here. For all practical purposes its 1am and I wake up with an attack, its a kip 8 and growing. What do I do now opioid speaking? How long will it take to abort my CH? Sean..................................... |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by CHTom on Oct 16th, 2005, 2:13pm It depends upon the drug, but something like hydromorphone hydorochloride will start decreasing the pain withing 15 minutes or so and at the proper dose, decided upon by the prescribing physician, the pain should be gone or very significantly reduced (so that you can sleep) within an hour at the longest. What you take and what doseage is something to be worked out by you and your physician. I hope this helps. |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by Jonny on Oct 16th, 2005, 2:31pm on 10/16/05 at 14:13:59, CHTom wrote:
Sounds like youve tried them all....LMAO ;;D TROLL!!!! |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by LeLimey on Oct 16th, 2005, 2:42pm You got that right Jonny.. thats why in a previous incarnation he was dissing the diamond headache clinic. They had the temerity to insist he had to try other stuff than cocaine nasal sprays so he checked out.. Some of us here have good memories in spite of CH eh?! ::) |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by Kevin_M on Oct 16th, 2005, 3:51pm Posted by: CHTom Posted on: Sep 5th, 2005, 4:32am Quote:
Posted by: LeLimey Posted on: Today at 3:42pm Quote:
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by theoldboiler on Oct 16th, 2005, 8:37pm on 10/16/05 at 14:13:59, CHTom wrote:
Can I be very dim here? Why would you take something so strong and potentially habit forming ( morphine derivative, dilaudid??) if it may take longer to work than it would take for the attack to stop on its own? |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by CHTom on Oct 16th, 2005, 9:52pm With some chronic CH sufferers, the length of each attack can last several hours and they can hit one after another all day long (see post by Madprof, among others). When one suffers like this, to get relief within less than an hour is a blessing. |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by burnt-toast on Oct 17th, 2005, 6:27am on 10/16/05 at 08:48:32, Sean_C wrote:
Not even attempting to say narcotics of any type abort clusters. Only admitting that folks with short or infrequent attacks could possibly get relief from pain under a doctors care. But extreme caution is necessary. I believe narcotics are extremely dangerous and in most cases the risk outweights the potential for relief if sufferers need to take them frequently enough to become dependent and/or risk addiction. What's the difference - call it dependent or addicted - someone has reached a point where a foreign substance is needed and that risk is real for most CH sufferers when an addictive substance becomes a frequent treatment. Tom |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by CHTom on Oct 17th, 2005, 7:35am For "The Old Boiler" : With many people who suffer from severe, chronic CH, the attacks can last for several hours and one can get hit several times successively, without much, if any, of a break in between (i.e., the pain may decrease from a 9 or 10 after a couple of hours to a 7 and then another 9 or 10 comes along; this pattern can go on all day and all night, sometimes for weeks. With the proper narcotic medication, the pain level can drop considerably once the attack has started and so can future attacks. If you have experienced this, especially for years on end, the benefits can give you the chance to lead a semi-normal life. Once again, I stress that the use of narcotics should be supervised by a reputable pain clinic. |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by BMoneeTheMoneeMan on Oct 17th, 2005, 11:49pm Well, i am not an expert in some of the drugs you guys are mentioning, but i have certainly been through my fair share of vicodin and percocet. Wash them down with about 20 OTC pills a day, only to get my ass kicked hard by the beast. The more I took, the worse the beast kicked my ass. Since i got on here and people mentioned rebounds, i have taken less than 10 pain pills in 10 months. Definately, (those) pain pills did nothing for me except make it worse. Some of those other really hardcore drugs, morphine, oxycontin, methadone...... they might be so powerful they would numb it....i have no idea, never taken them. But, yeah, if my only choice was taking an oxycontin and maybe getting relief in an hour, or just banging my head on the sink and getting relief in about an hour, Id stick to the sink. PF wishes BMonee |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by Origin on Oct 18th, 2005, 12:39pm on 09/14/05 at 16:42:03, hdbngr wrote:
I unfortunately get the wonderful dynamic duo of headaches: chronic migraines and seasonal clusters. I have used the duragesic/actiq combo for close to three years, and so far have yet to have to increase the dose. I also went off it cold turkey at one point for what turned out to be a very masochistic test, but didn't suffer any withdrawal whatsoever. (FYI 25mcg patch - 200/400mcg actiqs). It took me from becoming completely non-functional to being the guy who never misses a day of work whom everyone can count on...am I nervous about dependence? Yes, although quitting after two years for a few months eased some of my fearts. Am I nervous about addiction? Not in the slightest, because the ONLY time I ever take the meds is when I'm in pain. Using them for anxiety or stress is what will really cause addiction. Unfortunately, everyone is different. The high risk cases are those who have high levels of anxiety and/or depression. I was fortune to be one of the rare cases who has chronic pain but does not suffer from anxiety or depression (I know...they sound mutually inclusive...heh). Best wishes to all of you out there...keep the faith. |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by CHTom on Oct 18th, 2005, 2:45pm Origin: I stopped using the Duragesic patch as well-200mcq-on my own (between that and the Dilaudid I was always too tired to do much of anything). I just didn't put on a new patch one day and didn't have any withdrawal symptoms and my pain was controlled just as well with the Dilaudid, taken as needed. I too was able to return to work and even had a one year spontaneous remission several months later that lasted for a year. I now use Dilaudid and Actiq (and after a DBS operation, the amount used is 1/10th of what I was using prior to the surgey). I never developed a craving for any of the drugs that I used and am once again able to lead a "normal life". Very few people who take narcotics for chronic pain (something like 1%) become addicted in the classic sense of the word and I have found that I-they use as little as possible, just enough to prevent the pain from ruling/ruining my life. I hope, with the DBS operation that I had a month ago to be able to not have to use any medications within the next 3-4 months. Continued PFDANs to you! |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by don on Oct 18th, 2005, 9:50pm Quote:
Where did you dig up that little gem of inaccurate info? Show me that documentation. |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by LeLimey on Oct 19th, 2005, 3:31am Oh BTW CHTom, John, Hdido, PCMCKK, John Skorohod, NYC John, Gegory P. Skorohod, DBS... and all the rest of your little handles - you've been busted on the main board. I'm sick of you trying to take people here for a ride and I will never stop busting you. |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by marty on Oct 19th, 2005, 6:53am I just had to do the quote like Don ;;D [quote I just didn't put on a new patch one day and didn't have any withdrawal symptoms and my pain was controlled just as well with the Dilaudid, taken as needed. Very few people who take narcotics for chronic pain (something like 1%) become addicted in the classic sense of the word and I have found that I-they use as little as possible, just enough to prevent the pain from ruling/ruining my life. [/quote] Of course you did not suffer any withdrawel symptoms - the dilaudid is a lot stronger than the patch - do you inject or take the pill? Please, if you take Dilaudid "as needed" you are, or will become addicted - or if you prefer, "dependent". Same thing as with methadone that is commonly used for chronic pain. As to addicted "in the classical sense of the word"..? does that mean that we now have two categories: 1. addicted in the classical sense of the word. 2. Dependent upon a substance. I would love to see the criterias that seperate these categories.. There ain't no difference dude. It only makes it easier for someone who is addicted (or in danger of becoming addicted) to reason, read "hide behind" the term dependent instead of addiction. There are times when narcotics can be used for CH but in almost all cases (I would guess) does the narcotic given at an ER turn out to be a "quick fix", leading the CH'r to do almost anything to get this quick fix instead of fighting. Next thing you know, the combination of severe pain and quick pain relief in the form of a shot may lead to the big "A". Marty |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by don on Oct 19th, 2005, 7:10am The defining differance between dependance and addiction is that addiction includes the phenomenon of craving. Characteristics of addictiion include rationalizing and justifying. Much like CHTom does in this thread. |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by marty on Oct 19th, 2005, 7:41am I stand corrected Don. But it is a pretty thin line, wouldn't you agree? Marty |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by don on Oct 19th, 2005, 7:58am An extremely thin line and no one knows where it is until well after you've crossed it. I would like to know what our learned CHTom's credentials are for researching addiction. Reading this thread I will wager he has none as he talking out of his ass and putting a lot of people in danger by promoting narcotic usage without a clue to the variables that lead to addiction. Find yourself a street corner CHTom. |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by Pinkfloyd on Oct 19th, 2005, 8:42am on 10/18/05 at 21:50:43, don wrote:
Yeah, it's actually closer to 2% ::) Bobw |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by Kevin_M on Oct 19th, 2005, 11:00am on 10/19/05 at 07:10:54, don wrote:
As Hdido and CHTom, he finds and prints ONLY the articles to rationalize and justify his use. As Hdido, two by the same author. US Govt Declares War on Doctors! « on: Jul 23rd, 2005, 3:07pm » on 07/23/05 at 14:07:27, hdido wrote:
State of Pain! « on: Jul 19th, 2005, 1:25pm » on 07/19/05 at 12:25:49, hdido wrote:
Posted by: CHTom Posted on: Sep 5th, 2005, 4:32am Quote:
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by don on Oct 19th, 2005, 12:24pm Quote:
Show me the documentation and I certainly dont mean clusterbuster research. Show me that evidence form someone who has the credentials to make that statement. |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by Pinkfloyd on Oct 19th, 2005, 2:39pm on 10/19/05 at 12:24:49, don wrote:
Trust me or ignore me. I couldn't care less. Show me the evidence that its higher than 2% (and I don't mean based upon your circle of friends) Bobw |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by don on Oct 19th, 2005, 3:43pm Quote:
I dont need to . I'm not making claims, you are. Back em up. I've been working in the addiction field for the last 10 years and I dont know what the % is largely because it differs from population to population, geographic regions, population dynamics, etc. etc. But I can guarantee you that you can multiply your baseless % claims by at least 40. Thats not from contrived research, thats from first hand experiance. When people come on here and throw out whatever baseless facts suit them, especially when the subject is use of narcotics, it sets a dangerous precedant for anyone seeking treatment. So again I ask you and CHTom to back up your claims. I dont think you can. Quote:
My circle of friends include only those with successful recovery or those that have not, nor likely will, need it. If you think being a shroom head is all the experiance you need then you are sadly mistaken. |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by Pinkfloyd on Oct 19th, 2005, 4:18pm on 10/19/05 at 15:43:34, don wrote:
Oh bull. We're talking national averages of chronic pain patients, not the number of crack addicts on the south side of Boston vs. heroin addicts in Jersey. Population dynamics..... [smiley=laugh.gif] on 10/19/05 at 15:43:34, don wrote:
ROTFFL....so, you say 80% of chronic pain patients that use opiods to treat their pain, become addicted. We finally found the author or Reefer Madness!!! on 10/19/05 at 15:43:34, don wrote:
It's not baseless. You just don't know the basis. That's not my fault. You don't know the percentages but you KNOW mine are wrong. [smiley=laugh.gif] |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by kimmeesue on Oct 19th, 2005, 4:37pm on 10/19/05 at 16:18:25, Pinkfloyd wrote:
I remember having to watch that in high school. I was high as a kite and thought it was hysterical. As far as statistics go, I majored in sociology and have a history working peripherally in the field of chemical dependency. You learn early on that numbers can be manipulated. You can get them to say whatever you want. As far as this board is concerned we shouldn't be so concerned with who is right "statistically". According to statistics I should "be" a statistic, but I'm not. We are individuals and should treat each other with respect even when we disagree. With clusters there are no absolutes. If there were they could find a way for all of us to cope. JMHO Kim |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by Pinkfloyd on Oct 19th, 2005, 5:39pm on 10/19/05 at 16:37:50, kimmeesue wrote:
Very true Kim. I would hope that everyone would do their own research and apply it to their own situation before taking the advice of anyone on the internet. I could cite 100 documents that would back my point of view. My point of view and all I use to support those views, still come from a guy that goes by the name of Pinkfloyd. Bobw |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by Kevin_M on Oct 19th, 2005, 6:45pm a little education Click on this link for a comprehensive seminar about pain management. http://www.stoppain.org/for_professionals/compendium/index.asp Click in the light blue box on Pain and Chemical Dependency. A click-a-pic slideshow will appear, but read the writing underneath and use the up/down bar to read everything under each slide. It looks objective. Here is an excerpt: The existing literature suggests that the risk of abuse, addiction and diversion is relatively low overall, but becomes significant among the patients referred to pain management programs. This literature should remind all clinicians that the risk of abuse, addiction and diversion cannot be eliminated. If a clinician prescribes opioids or other potentially abusable drugs, he or she will encounter the phenomenology of chemical dependency. This justifies the view that all clinicians should have some working knowledge and skills in addiction medicine, particularly as it applies to the population receiving treatment for pain. |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by Pinkfloyd on Oct 19th, 2005, 11:25pm on 10/19/05 at 18:45:27, Kevin_M wrote:
Thanks for posting this Kevin. Dr. Portenoy is certainly one of the most respected Dr's in this area. Bobw |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by phydeaux on Oct 20th, 2005, 1:16am I have chronic CH, and so far my doc hasn't found the key preventative/abortative. So when the pain is extreme, I have Actiq lollipops. And when those don't cut it, I go t the ER for morphine. They prefer to give me diaudid (spelling?), but it makes me really sleepy for a few days. I don't feel the need to pop an actiq all the time, and don't FEEL addicted. And I know that they are not the answer for my problems. Believe me, I'd rather not take them at all. It's certainly an issue when it's a bad week, like recently when I was at the ER three nights in a row. The same Dr. was there, and I get the looks like I'm a doper trying to score. Is there a point to my rambling here? Maybe not, other than I take what I need, when I need it. Those I know who suffer the same ailment are the same. None of us take any meds we don't need, and if we could get away with it, wouldn't take any at all. |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by MJ on Oct 20th, 2005, 2:19am I am one who falls into the nothing works category. Some years back Narcotics were a tried treatment for me. I dont remember the dosage but it was high. I remember my wife (a nurse) saying that what I was given over time would have killed some of her patients. The doc at that time was so convinced he could stop the pain that he kept increasing the dosage. Narcotics did nothing for my CH. That was not a happy time in my life due to the narcotics. Not only was I stoned all the time but the higher the dosages the worse my CH felt. The only time I felt clear headed was when I had a good K-10 going on. Following a 2 hr attack I would go back to my stupor. My personal experience says that narcotics are the wrong treatment. In the nothing works category the only option for me is to treat the non attack side for a quick and positive recovery from pain. Narcotics do not allow this to happen. I believe we must remain "alert" for the battles we fight. Its all about leaving an attack behind and resuming life as quickly as possible. It doesnt matter if its only an hours break I prefer it to be a good quality hour. (easier said than done) MJ |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by Jimmy B. on Oct 20th, 2005, 6:28am First off...not advocating the use of Narcotics for Cluster Headaches...although I have seen chronic use of narcotics help other types of chronic pain...cluster headaches are a different type of pain altogether. The fast rise from no pain to excruciating makes taking any pills a probable failure. But for those who believe there is not a difference between dependence and addiction, read the below site(s). http://www.pain.com/sections/pain_resources/library/abstract.cfm?ID=5512&next_page=1&startrec=1&RecordDisplays=20&Search_phrase=addiction Gives you a basic definition of Addiction, Dependence, & tolerance. also http://www.pain.com/sections/pain_resources/library/abstract.cfm?ID=795&next_page=1&startrec=1&RecordDisplays=20&Search_phrase=addiction%20to%20opioids http://www.nationalpainfoundation.org/MyTreatment/MyTreatment_Addiction_and_Chronic_Pain.asp http://www.painandthelaw.org/aslme_content/24-4c/24.4g.html "In addition, while studies report drug abuse/dependence/addiction in 3 to 19 percent of chronic pain patients,28 true addiction (psychologic dependency) is uncommon with the use of long-acting opioids for chronic pain. Tolerance is also less common with the use of long-acting opioids. The most common side effect is constipation, which is best managed with a combination of laxatives and stool softeners (e.g., senna products), exercise, high-water/high-fiber diet, and avoidance of additional constipating medications (such as tricyclic antidepressants)." 28Fishbain DA, Rosomoff HL, Rosomoff RS. Drug abuse, dependence, and addiction in chronic pain patients. Clin J Pain 1992;8:77-85. They're long reads..but give a good understanding of the differences between addiction, dependence, & tolerance. It's definitely better to become informed before using any drug for an extended period of time. Every person is different and should make up their own mind as to what helps or doesn't help their pain... |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by thomas on Oct 20th, 2005, 11:28am Chronic CH does not equal chronic pain. I don't see the relevance of the initial post. Chronic pain never goes away, even chronic CH sufferers have some pf times in their days. Chronic pain patients don't have that. |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by Lizzie2 on Oct 20th, 2005, 11:37pm on 10/20/05 at 11:28:03, thomas wrote:
Like me :( But...the strongest pain killer I take daily is Arthrotec, which is just an anti=inflammatory. I do take ultracet as needed at most twice a week for the severe migraine. I never take pain meds for CH, but then that's me. On that pain statistic, I'll dig it up if nobody else did yet - but Bobw is right. Just don't have the energy to go searching right now. I've got it in several textbooks from nursing school. My neuro won't even prescribe pain management therapies for me unless I stop working. On the other hand, my orthopedic wants me to do pain management, but I just don't think that's the direction I want to head at the moment. The pain helps us know we're still alive, which, I suppose, is much better than the alternative. L2 |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by phydeaux on Oct 20th, 2005, 11:51pm on 10/20/05 at 23:37:21, Lizzie2 wrote:
HA!! A little pain, perhaps, but this searing, life changing, more than pain (really, more of an event of in itself) more than lets me know I'm alive, it's makes me wish I were dead. I have thought of killing myself. Not in the sense of I need attention, of I need help, but I would do ANYTHING to stop the pain. So when my doc offers Actiq or Demerol, hell YES! With both hands out! Because when nothing else works, sometime, those alleviate the issue. And let me assure you, quite often, not even that happens sometimes. Damn, this disease can be too much to take sometimes. |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by Lizzie2 on Oct 20th, 2005, 11:55pm I'm not saying I don't wish I could use it, but I don't see the point for me personally. Get hit at least 5 times a day lately and pain meds have never touched it...not at all. I'd have to have enough pain meds to snow myself into zone out. And frankly for most people, life between the hits is able to go on without pain as Thomas said. That's not the case for me, but I still try to live life to the fullest. |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by Mr. Happy on Oct 21st, 2005, 12:17am Patch/lollipop when all else fails. Next step is one of the surgical procedures. I'm doing my best to understand the reason for this thread....other than Trolling. RJ |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by Lastdaddy on Nov 3rd, 2005, 1:22pm :o Hi All, Well this post certinly has me whipped up !! 1st Let me address Sean, Please don't tell me I'm not a cluster sufferer, not after 33 years of dancing with the Demon !!! Any one who's read my original hello post knows how much Narcotics I take. Now keep in mind That they were not originaly prescribed for my Clusters but rather a severe Back problem which started out as hearniated Disc's and has turned into a degenertive disc desease starting in 1993, 21 years after my Clusters began. In May of 2000 I had a Spinal Fusion which failed to make matters worse. I have been on these Pain Meds for about 12 years. After an 8 year remission , I'm 4 weeks into a new cycle. Last night I finally got to see the Dr. and as I was waiting I got bit hard by the beast in the Dr's office. the last dose I hhad taken was about 9:30 am now it was 5PM long since my next dose was due, so I took 1 Oxy and two Percocets, within ten Mintes of dancing around the office the Beast crawled back into his hole. So Plese Don't tell me There is no room for Narcotics in Clusters!! I'll tell you something else for the longest time the only real relirf I've gotten is from DEMEROL Injections, The pills don't work at all Some Doc's even wonder why they make them.The fact of the matter is there has long been this debate, Addicition VS. Dependence, and I am here to tell you there is a difference , a big one and any one who denies that is very closed minded, Dr's Included !!! It's a stigma that I have lived with for a very long time. However now that I have come to terms with it I really don't care what people say or think about me. I say This: do what you need to do to get rid of that dreded pain !! Folks read about some kids in the Midwest who got their hands on some oxy's crushed them snorted and died, next thing Congress and the FDA are talking about Banning this medication . I'm truely sorry for the pains those families went through but where does that leave me ?? What? don't ya think my Pain Mgnt Doc tested me to see if I just wanted to get " HIGH "??and this was after a Battery of tests , MRI's, Discographys and the like. I went through this for 7 years before I was cleard for chronic Narcotic Maintenence.We all know what works for one of us does not work for all of us, so again I'll say , you do what you have to to get rid of that pain only ya can't be telling people it doesn't work.. you can say it didn't work for you if you've tried it.I've had Imatrex IV injections and it did not work for me. Bottom line is this friends, No one knows you're body the way you do , Not even the Doc's. So no one knows what works best for you, except you. I read on this site about using the O2, and I'm getting mine today, However my Dr Thinks 9-12Ltrs is way too much. So ya see what I mean every one has their own opinion, But what I'm saying to everyone is you can state your opinion Because that's all it is especially if you haven't tried it!! But Please don;t state it as fact!!BTW Sean, I am Truly sorry to hear about your 3 friends. To Tom , I want to thank you for opening this post and for everyone who contributed. I also want to Thank JD for starting tis site, there is a wealth of info here and I thank you for that also. One more thing I want to mention, I go to a pain Mgnt. Dr. for my Back problems I have scar tissue the size of a footbal;l back there so the conventional epidurals cannot be done any more . They do something called a RACZ procedre where they thread a catherer through the hole in my coxyox Bone up into my L-4 L-5 L-5 S-1 area under x-ray and I've been getting good relief from that , During those times I cut way back on all my Pain meds because I don't need them. That is MY proof about Addiction VS Dependence. If that were not the case I'd be taking the same amount of meds all the time !!! Thanks again. Wishing everyone PFD&N's Gratefully Yours, Nico |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by cootie on Nov 3rd, 2005, 10:36pm I take pain meds for a nasty fucked up spine and all that degenerated this, arthritis that......bone spurs and all that crooked stuff with one area haveing a huge hard LUMP...........I monitor myself VERY CLOSELY.....I don't take large amounts.......and won't take em less'n I have to. ( I like the fact they do work sumwhat and don't wanna mess that up) But when I take a bad step (uneven ground is a killer to walk on) or I bend over wrong or sit too long or gotta do alot of lifting even tho not heavy stuff "I STILL FEEL IT LIKE FREAKIN HELL" when those nerves get pinched off harder or jammed or inflamed. I just DO NOT see HOW pain meds can help ch !!! (demoral maybe but I don't take that) Not a dope Pam Just my opinion and not neccisarily one of this station........but if it does work for you I am of course GLAD !! |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by Lastdaddy on Nov 3rd, 2005, 11:12pm :o Oh Cootie, You hit the nail on the head, when it comes to uneven ground!! I live in the country, a lotta ruts and stuff like that around here, If I step in one without seeing it first, I'm done for the day!! Anyway the whole point of my post was, no one can tell another person what will and will not work for them.You can only say what works for you. Like I said with all the pain meds I take it amazes me that the Demon can still sneak in there, However if it's been a while since my last dose and I take a couple off pills at the 1st twinge I can shorten it by about 20 minutes and in my book 20 minutes of CH pain is like 20 days and I'll take that any day. If anyone noticed I did not say anyone should try the oxys or anything else, what I said was They work for me and I'm like Ripley: Believe it or Not !!! ;;D Nico BTW I have had rebound HA from the percocets long ago, before I got a handle on this Back Problem , and they are definitely a horse of a different color!!! |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by StressFree on Nov 5th, 2005, 4:31pm Only one question from me on all this, Where do you find a doc that prescribes Dilaudid and Morphine? Oh yeah - the pain center. Sounds great - if you have one and can afford it. I'm with the group thinking "if you must get relief, try it for a short time". I was fortunate to use Stadol nasal spray on several cycles. This is one of the strongest pain meds, chemically related to morphine. I have mixed feelings about it. It helped most of the time if taken immediately at the beginning of an attack. A most unpleasant drug for the most part, and likely has a high danger of overdose (death) if not used as directed. I made a point of alternating it with one of the expensive abortives - Maxalt in my case. Fortunately I was down to only one bad attack per day while doing this alternating of the abortive and pain med last round. With multiple daily attacks during previous cycles, tollerance built up quickly and then none of it helped at all. This is very bad, as you then have nowhere to turn - unless you haven't tried God yet :). At some point, being a "zombie" or sleeping for several days from some strong drugs may be what a person needs. I know this wouldn't make a lot of sense for you chronics, but my attacks seem to peak toward the end of a cycle. "Peak" meaning regular KIP 10's, sometimes for hours or many times a day and night. A few days with even a partial break does wonders toward making it to the end of the cycle. Sorry if I've offended any chronics with my rambling. Hoping all won't need any meds someday soon, Rich |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by gore2424 on Nov 11th, 2005, 12:39am of all the pain meds I have tried "stadol" was the only one I myself told the neuro I didnt want anymore I would first fill 1/2 the bottle with water so I could use it more I used it way way too much i lied i cried and i cheated everyone inculding my self so I could get more I would use 1 bottle in 10 days when at work I took it just for the rush and when couldnt get refill without paying full price i did i took my self off it after only 4 months i knew it was wrong what i did and corrected myself so the pain meds where used the way and what they were to be used for in the first place to controll the beast as good as i could to live and work and have a life |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by CHTom on Nov 11th, 2005, 1:00am Congratualtions to you, Gore, for realizing that you were developing a problem with Stadol and got yourself off of it. I think that most of us chronics who use opiates will tell you that they are not fun to use-try being constipated for 3 days-owww! It is important to be honest with your doc about your use or over-use of the prescribed meds; it could be that a person is not abusing the medication but was not prescribed the correct dose or needs something else. I have limited myself to how much is prescribed for me and my doc goes along-it won't usually kill the pain, but makes it tolerable enough so that I can work. Honesty with your doc is the real key for the use of opiates and their derivatives. My use has drastically decreased since my DBS surgery, but I will probably need to take some for the rest of my life due to the severity of my condition. To go to a pain clinic and to use or not use opiates is a personal decision; I decided to go because the alternative was suicide; now with the DBS operation I'll die of something nature throws my way rather than a 9mm. PFDANs to all and to all a good night! |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by Dave_Emond on Nov 12th, 2005, 5:40am I'm actually on Stadol NS right now, have been for about 6 months. I hate this crap, but so far it's the only thing that will temper down a high level CH attack ... never aborts one. Side effects suck big time. The bottle would last only 5 days if you used it everyday. I won't refill for at least 10 days and have gotten better at making it last for 2 weeks plus. I'll save the "empty bottles" and add a touch of water, or instead of wasting those first few pumps to prime it, I prime into my last bottle, then add a little water. Also add water when the bottle gets down to about a third left. I absolutely hate putting this crap in my system, and I know I'm not addicted, but like to have it on hand for those real headbangers. Takes about 20 minutes to kick in and does not abort. I'd say it's just like many other diversion tactics. I really think my next bottle will be my last, I can see it would be easy to get addicted to, even with the nasty side effects. My two cents, Dave |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by purpleydog on Nov 12th, 2005, 11:30am I used Stadol for years. I started using it for my migraines, which it worked for, then when the CH started, I kept using it. It never did anything for my CH, and I was prescribed two sprays, the max, so when I used it, within about 5 to 7 minutes, I was on my ass, actually, I'd head to bed, and be zoned. I could never sleep while using it, and with CH, I would lie there with the beast poking away at my eye, and not able to move. I suppose it did make me care a little less, but I couldn't get up to pace. I never had a problem with it, never needed to have it. I finally stopped it after using it for 9 years. It is nasty stuff. It would make me irritated as hell, and I couldn't think straight. If I used one spray, I was ok at work, and to drive. It can be very dangerous, it definitely slows down your breathing, and I always had to make sure my neck was straight, and not have my head too high on a pillow. I came to one time and realized I had almost stopped breathing. That was a weird feeling. Scared the shit out of me. But if it works for you, then that's great. It did great at killing all pain except CH for me. |
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Title: Re: Long-Term Prescribed Narcotic Use for Chronic Post by Dave_Emond on Nov 12th, 2005, 4:38pm A lot of truth there purplydog! If I take two full shots of Stadol (which I tend to do on each new bottle :-[) I'm quite a mess. I'll roll around on the floor, climb chairs and couches ... fall back to the floor. :P I'll only do that when Annette is around to keep an eye on me though. To keep my sanity, she'll ask me trivia questions or better yet try to get me to guess names in the game "Nameburst". I already have trouble remembering to breath during Kip 8's or above, and on the Stadol, Annette will often tell me to "Breath Dave ... Breath!" Always feel like I need to vomit ... but can't. Have to strain like hell just to piss. And just generally get that "careless" attitude. Much better to use less or add water. Anyway it goes, it does stop other pains, but does not abort a CH attack. Very distracting though :-/ Dave |
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