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Why does CDC say no narcotics for pain?

Discussion in 'General Treatment' started by CJB, Aug 10, 2012.

  1. heapsreal

    heapsreal iherb 10% discount code OPA989,

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    I just think these posts help people to see there are other options and stratagies to use these types of meds long term while trying to avoid problems with them. Most doctors dont give a rats but if the patient is informed most of the time the doctors are happy for u to try other things to avoid tolerance etc etc
    CJB and WillowJ like this.
  2. alex3619

    alex3619 Senior Member

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    Hope on the horizon - breakthrough in understanding opioid addiction mechanisms. A very old drug can prevent and reverse addiction to opioids:

    http://www.prohealth.com/library/showarticle.cfm?UTM_SOURCE=feedburner&UTM_CAMPAIGN=Feed: Prohealth_me-cfs (ProHealth's ME/CFS Research and News)&LIBID=17159&UTM_MEDIUM=feed

    I found the link here: http://mecfsblogroll.blogspot.com.au/

    Even though this is an old drug, it opens the way for "new" drugs based on combinations of old drugs - and those can be patented so research funding might be forthcoming. So far the study is on mice and rats:

    http://www.jneurosci.org/content/32/33/11187.abstract

    Bye, Alex
  3. taniaaust1

    taniaaust1 Senior Member

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    I'd like to point out that there can be the same issue with tollerence of antihistamines as there are for benzos and Z drugs. Ive twice developed tollerance to an antihistamine I was taking for sleep and hence had to raise its dose... hence I now if im on those have to alternative my drugs so not to gain more tollerence.
  4. taniaaust1

    taniaaust1 Senior Member

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    I too think a big part of why ME/CFS patients dont get the individual good drug care they need from doctors, is due to the illness not being taken seriously enough.
    CJB likes this.
  5. peggy-sue

    peggy-sue

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    Naltrexone blocks opiate receptors, it can shove other opiates off them. I don't see how this equates to preventing or reversing addiction, Alex.
    It stops the drug of choice working if they take it - but the person is still an addict, they still crave the effects. That's not prevention or reversal of addiction.
  6. alex3619

    alex3619 Senior Member

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    Hi peggy-sue, the article was not on naltrexone. In fact it said do not confuse it with naltrexone. The chemical is naloxone. It acts on toll like receptors (TLR4). I believe it allows normal pain killing but blocks the dopamine rush from opiates - the reward mechanism is gone. Of course its just on rodents for now.

    I am on low dose naltrexone for treating ME.

    Bye, Alex
  7. peggy-sue

    peggy-sue

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    :oops: Doh, I read the "not to be confused with naltrexone" and the naltrexone word was what stuck in my brain - shoving the naloxone out!
    I can even remember when it came out.

    But again, it simply prevents the high the addicts crave, it does NOT fix/prevent/cure or reverse addiction, or remove the craving.
  8. Hope123

    Hope123 Senior Member

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    Yes, I agree, especially with your second paragraph and also WillowJ's point about how ME/CFS is not taken to be a serious chronic illness that requires a serious chronic treatment. After all, it wasn't that long ago that medical textbooks were saying 50% of patients would recover within 6 months to 2 years -- based on very shaky evidence. That's what my old textbook says.

    For an analogy, albeit imperfect, let's look at blood pressure and diabetes treatment. In both conditions, people require treatment for long periods of time, daily, with medications. Sometimes, the doses of those medicines need to be increased and other times, more than one medication is needed. [In fact, the stats are now that more than 50% of people will need more than 1 med to get blood pressure under control.] Off of those meds, many people will have "rebound" high blood pressure and high blood sugars that are bad for them. The meds have potential side effects also like any med. However, these conditions are viewed as primarily biological and not necessarily controllable 100% by the patient's thoughts or actions; some people just have bad "protoplasm" (medical slang, don't take it literally!) and have bad disease regardless of how much they try to control their diet and increase activity for these conditions. Most good docs do not place blame on their patients if they require more treatment for their disease. The language of dependence, addiction, tolerance, etc. is not applied to these conditions.

    As WillowJ alluded to, not treating pain and sleep does have long-term consequences that science does not yet fully understand. It is known in my field (and I'm not in pain management even) that undertreated pain can lead to delirium in the elderly but that fact is underrecognized by non-specialists. In terms of dosage, in regards to opioids, neither clinicians experienced with pain nor the World Health Organization has a set dosage that is deemed "dangerously high." It is acknowledged that people have widely varying degrees of pain and reactions to pain and that a "high dosage" for one person may be a "low dosage" for another and inadequate for relief of pain. (The good thing for opioids is that they don't have a peak level beyond which people don't respond.) Rather dosage needs to be tailored individually taking into account side effects, patient preferences, physician experience, etc. etc. If a patient chooses to have inadequately treated pain because they have ideas about dependence/ addiction that are not supported by the scientific literature after they've been educated by their physician, that is fine but it should be an individual choice and not healthcare policy.

    There is a lot of misinformation out there about pain management, even among nurses, pharmacists, and physicians, so finding an authoritative resource is important. In fact, there is so much misinformation that my state took the very rare initiative of requiring all physicians (save pathologists, etc.) to take a course on pain treatment or not have their license renewed.
    [ A quick google site that might be good: http://www.theacpa.org/default.aspx]

    I am somewhat passionate about this topic because I had a patient with sickle cell disease (a painful condition) whom many of my professors viewed as a drug seeker. I was taught to deny him "too high" a dose of opiods; it wasn't until a new professor showed up and advancements came about in the treatment of this illness that I learned what a difference a different attitude and treatment regimen made.
    August59 likes this.
  9. Hope123

    Hope123 Senior Member

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    Forgot the most important part!

    Inadequately treated pain is a recognized risk factor for suicide in other illnesses and I suspect also in ME.
  10. alex3619

    alex3619 Senior Member

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    Hi Hope123, if you use some of the suicide figures out there for us, including Lenny Jasons, we have a suicide rate much worse than major depression, yet I do not think we have depression anywhere near as bad as major depression. Many of us are not even depressed a lot (most?) of the time, despite our symptoms and issues. Of course some studies say that our suicide rate is normal, but I am suspicious of those. One of the reasons is there are unpublished studies (as in peer reviewed) as well - such as the finding that one in six long term CFS patients in Australia (or was it Victoria, a state in Australia) have attempted suicide.

    Pain and distress are two of the issues we have to face that is different to what people with major depression typically have to face.

    Bye, Alex
  11. alex3619

    alex3619 Senior Member

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    Hi peggy-sue, that could be right, its why we need human trials. The evidence from human trials will tell us. Bye, Alex
  12. August59

    August59 Daughters High School Graduation

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    I have been in Pain Management for about 10 years. Of course I went through all the physical therapies, constant barrage of various types of injections. None of which had a lasting effect. About 4 or 5 years ago I was going through the worst pain that i had ever been in and it was 24/7/365 and it wouldn't seem to break. I was all the way up to 125mcg of Fentanyl patches changed every 2 days and 4 - 30mg oxycodone pills a day and it still would not stop all of it. I had to weather a storm, but it slowly started subsiding and I can't think of one thing I done to make it do this, as it just had to run it's course.

    I'm now only taking Exalgo 12mg a day and only 2 - 30mg oxycodone a day which is roughly equivalant to a 1/3rd of what I was on. I have always been upfront and honest with my PM doctor and he would not hesitsate take me to that higher dose if I needed it, but why take it if you don't need it. Chronic Pain Management does not mean an ever lasting eventual increase in dosages. If you are being dosed properly and you pain subsides over time, you will not have any problem whatsoever in decreasing your dose over time. It just has to be done slowly of course.

    If someone is in chronic pain management and for whatever reason their pain subsides, but they can't slowly decrease their medication they have more than likely been taking too much to start with, so that the medicine had gone beyond stopping the pain and had gone on to creating euphoria and that where addiction really starts to show itself. If you are taking the right amount of meds for the amount of pain you have then you should never have any feelings of euphoria at all.

    I also know some patients that are not at the pain level that they used to be, but they don't tell the doctor that and they keep getting the same amount every month. They take what they need and sell the rest, but it almost always comes back to bite them. There is always that month that they go in and have to take the Pee Test and they get terminated and no other clinic will take them. They have a long road ahead of them then, but it is their own fault.

    I know some patients that are on the same dosage they were on after the first 3 months in Pain Management and that was 8 years ago. They have had their meds rotated but they always stay at the same equivilancy that they started at.

    There are always some that eventually have to get increases in meds and they probably need it. Low back patients are a big part of this group as they have been told that surgery would not do them any good or they have had "Failed Back Surgery" and as life goes on the mechanics in their backs wear out even more. Most of these end in wheel chairs or some other assistance device.

    I however do feel lucky that I have a doctor and staff that i have a good relationship with, but it took a long time and I would not jeopardize it in anyway.
    heapsreal likes this.
  13. peggy-sue

    peggy-sue

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    I'm afraid I cannot agree with this statement!
    "If you are taking the right amount of meds for the amount of pain you have then you should never have any feelings of euphoria at all."
    I've just been at my beloved Mother-out-law's deathbed. She was in so much pain that the morphine pump she was given had her completely out of it for the last few days - thankfully - as water and food had been removed.
    Her pain WAS so great that the eupohria was required.
    alex3619 likes this.
  14. heapsreal

    heapsreal iherb 10% discount code OPA989,

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    I think august59 shows its not all gloom and doom, and your mother inlaw shows the other end of the scale. I guess its showing its not black and white. As august59 has done, he has taken control of his own health care, maybe your mother inlaw wasnt in a position to do the same. It shows we need to always try to be informed and not just go with the flow of doctors, they dont know what we are feeling i guess.

    cheers!!!
  15. peggy-sue

    peggy-sue

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    My Mother-out-law had terminal bowel cancer, she was being "put down", the legal way. (dehydration)
    But what is so "wrong" with experiencing a wee bit of euphoria anyway?
  16. alex3619

    alex3619 Senior Member

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    Hi August59, not all pain conditions decrease with time, or not consistently. Many increase with time. This makes dosage issues, and eventual tolerance, very problematic. The problem with extremely long term pain conditions is that treating the pain might bring temporary benefit, but can cause long term harm if dosage is high and if tolerance results. Its a tough call however - treating the pain may be the only thing that makes life worth living.

    I know several people with severe chronic pain, and at least one with extreme chronic pain. Finding pain relief from extreme long term pain is still a major problem. I can easily see patients getting into trouble because they cannot get sufficient pain meds and so resort to large quantities of alcohol or street drugs. Suicide may then be the next option they consider.

    Bye, Alex
    peggy-sue likes this.
  17. CJB

    CJB Senior Member

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    I can't speak to anyone else's experience with pain meds, but in my experience, with extreme pain, there is no euphoria from the medication. None.

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