Posted by pinksharkmark (126.96.36.199) on June 27, 2000 at 15:16:42:
In Reply to: Tylox knocks the pain keeps me from using Imitrex @$17 per posted by bob on June 27, 2000 at 09:49:32:
Many doctors over-react to the various US govt restrictions on medications that contain narcotics, and are hesitant to "over-prescribe" for fear of retaliation by govt agencies or by malpractice suits from ungrateful patients who claim to have become addicted.
The narcotic ingredient in Tylox (and in Fiorinal C, which I use a lot) is codeine. Codeine is not a particularly effective opioid. It is probably actually the least effective of the whole hierarchy, with heroin at the top, followed my methadone, morphine, dilaudid, opium, demerol, and finally, at the bottom, codeine. There's probably a few others in there I forgot.
There is a new inexpensive synthetic opioid available in the US called Ultram. It has been available in Europe for years. The generic name is tramadol hydrochloride. It is roughly equivalent to demerol on the pain-relieving scale. Since many a clusterhead's trips to emergency rooms end up with demerol injections, I figured I'd try the tramadol. It comes either as a liquid, or as an orange-flavored pill that you dissolve in water and drink.
The beauty of tramadol is that, unlike codeine and all the others, it does NOT appear on the US govt's "Schedule of Narcotics", so doctors can prescribe as much of it as they feel the patient requires without fearing a midnight visit from DEA inspectors.
I find that it is MUCH more effective than codeine, and does not constipate me as badly, although it does make me a little itchy as it wears off. Like all of the opioids, it doesn't really reduce the pain of the cluster attack... it just makes it more distant... makes it seem less important, somehow. The pain is still there, it just is not such an all-consuming issue anymore.
I use it and Fiorinal the same way that you do; to lessen the expense of Imitrex. I have no medical insurance and must pay full price for all my meds, and, like you, at the peak of my cycles I can go through four Imitrex pills per day for weeks at a time. It gets extremely expensive. I find that by using the "narcotic" pain meds, I can often get by on half of a 100 mg Imitrex, sometimes even do without one entirely.
When my cycle is over, I stop using the opioids. Period. I use them ONLY during my cycles (at a rate that astonishes my doc), I stop them cold turkey with no tapering off period, and I've never experienced the slightest hint of withdrawal symptoms. The medical literature is very familiar with this seeming paradox: those who use narcotics recreationally have nightmarish withdrawal symptoms, and are truly addicted in the clinical sense of the word, while those who use them for pain management can almost always quit cold turkey with no desire to ever use narcotics again, even though their dosage levels are often staggeringly high compared to those of the "recreational" user.
I know that some who post here claim that if your headache is helped by narcotic pain meds, then what you have is not a cluster headache. They are wrong. I don't say that the narcs will STOP the headache: they won't. But, just as meditation, yoga, and concentration techniques ease the distress for some, opoioids ease the distress for others.
I think your doctor is being overly paranoid about possible codeine addiction. Hell, 45 doses over the course of a year is a trivial amount.
Talk to him about Ultram. He may be more willing to give you as much as you need, since, in the eyes of the law, it is not a narcotic. It's worth a shot, in my humble opinion.
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