Posted by gary g (208.133.221.166) on October 29, 1999 at 16:43:12:
In Reply to: narcotics posted by Angela on October 28, 1999 at 17:48:07:
DON'T ANYBODY READ ANY OF THIS AS ADDRESSED TO ANY INDIVIDUAL EXCEPT MY OWN COMMENTS ABOUT MY OWN CASE-
IF YOU FEEL THREATENED OR OFFENDED BY ANYTHING IN THIS - YOUR BEST BET IS TO ASK YOURSELF WHY - PROBABLY BECAUSE WHAT IS SAID APPLIES TO YOU
IN THAT CASE -SO IF THE SHOE FITS, DON'T EMBARASS YOURSELF BY POSTING AN OUTRAGED PROTEST, BECAUSE THAT IS VERY VERY TRANSPARENT
INSTEAD - LOOK IN THE MIRROR AND ASK YOURSELF IF THIS IS SOMETHING YOU REALLY BETTER THINK ABOUT
~~~~~~~~~~~~~~~
this is a VERY tricky subject because cause/effect/timing of both CH and narcotic painkillers can interact in so many ways, the conclusions can fall out all over the place
don't have any great theories on this, haven't seen enough WELL DOCUMENTED info to even start
BUT
there are a few GOOD reasons why a doc might refuse to prescribe strong painkillers to a particualr individual, but might not be completely honest about WHY they won't - it isn't always about the CH
my opinions, based on my personal case experience:
1. strong enough narcotics, taken early enough WILL "erase" even the nastiest attacks, but there are lots of ifs and maybes (have used percoset during several clusters, alternating a few days at a time with cafergot, to keep the ergot load down, and before the oxygen miracle reached me)
2. I rapidly develop a tolerance for narcs, and it takes more to achieve the same relief - that is definitely something to be avoided, and is VERY hard to get around when you have 4 - 8 attacks in 24 hrs, SO:
3. PROBLEM: to be effective, need to take at least 15-20 minutes before the serious pain manifests,but at "peak minus 20" I have no way of knowing if it's gonna be a 3, 7 or 9, so tricky to guess whether it is worth using perc for a particular attack - don't want to waste an "allowable" (see #2)dose on a 3 or a 5
4. personally believe that use of narcotics turning episodic into chronic is pure foolishness, and probably another lame excuse by an anti-pain med Doc - -
also some docs, (and some patients) aren't comfortable using something that has to be varied as you go along, they prefer a real cut & dried scrip instruction form - - and using narcs for CH is NOT a no-brainer !!!!!!!!!!!!
in my own case I started episodic, went chronic for a couple years, then returned to episodic -
all BEFORE ever using any of the strong painkillers; and have used percoset during 3 or 4 clusters in the last 15 years, and it has had NO negative effect on what is looking like a gradual IMPROVEMENT of my CH
(improvement= the running AVERAGE, over several years, is trending toward less time spent in cluster, and fewer 8 - 9 level attacks in each cluster that does occur, my scale goes to 10, but a 10 never happens - part of the mental therapy)
remember - EVERYTHING in our culture, including medical practices tends to swing from one extreme to another, as it cycles along - it just never gets settled down the middle-
we're now emerging from a period (20 - 30 years maybe ?)when the trend had been very ANTI pain med oriented among docs in general...(a case of the philosophy of "treat the disease, not the symptom" being carried to an extreme.....now we seem to be swinging back a little toward a more moderate approach, and some docs are beginning to "dare" to actually try to help people with the pain itself...
they ARE addictive, make no mistake about that !
when I DO use strong painkillers, even a 2 -3X a day for a very few days I ABSOLUTELY have withdrawal symptoms when I stop- mostly general headache & malaise -,
I then taper that down with ibuprofen for a week or so & end up OK
people who have had previous drug abuse problems, or who are "shaky" in recovery from alcoholism, should probably avoid narcotics, regardless of their CH, and some Docs may have this in mind with particular patients,even if they don't bring it up
also a doc may recognize substance abuse problems in a patient who hasn't come to the point of admitting or dealing with them yet, and try to "finess" his way around the subject to avoid a counterproductive confrontation with the patient
(that's all a WHOLE other realm of consideration, which we don't need to pursue on CHMB, but it is obvious to all that it might be a common dynamic)
and BOTH of those situations, especially the alcoholism, are FAR more common in the CH population than we as a group seem to be willing to admit, so until we do, we're just gonna have to make a bit slower progress