Addiction: Substance Abuse Community
Pain Killer Alternative
About This Community:

This community is a place to share information and support with others who are trying to stop using drugs, prescription drugs, alcohol, tobacco or other addictive substances. Discuss with others, the symptoms of addiction, addiction recovery, ways to quit like tapering and cold turkey, and withdrawal symptoms. If you are interested in general "chat", please visit our Addiction Social Community.

Font Size:
A
A
A
Background:
Blank
Blank
Blank
Blank Blank

Pain Killer Alternative

I have been asked by my boss to find a non-addictive pain killer(s) sufficient for severe chronic non-malignant pain.  

After reading through a few forums, especially helpful one from 2001 --http://www.medhelp.org/forums/addiction/messages/30733.html --

it appears that there are really no viable alternatives to narcotics for effective severe chronic pain control.  Ultram was discussed in the 2001 forum as the best alternative (which I know was a while ago ... many new medications may now be available).  NSAIDS were portrayed as leading to stomach problems.

I am not a doctor or nurse (nor expected to be), but my boss wanted some alternatives to present to the doctor this week.  

The background:  Her daughter has had two surgeries in the past two years, which have resulted in severe open wounds from the surgeries that have had a hard time healing (I don't really want to get hung up on why these wounds are not healing).  So Percocet and Vicoden have been presribed in pretty high strengths (I don't have those numbers to share).  The daughter is 21 years old.  She becomes mean on the Vicoden and doesn't like the Perocet, because she is also a student at college, and cannot function too well on the Percocet.  The mother is concerned that the daughter now has a physical dependence on the Vicoden (maybe Percocet too), as the daughter has been using both now for 1-1/2 years; the mother is unsure if actual addiction (emotional, taking the drug for a "high") has resulted; but physical dependence is pretty much a given now.  Other pain-management tools are being considered, as well as options to heal the open wound.  But for now, my question is strictly narrowed to:  are there any viable alternative(s) to narcotics for effective pain control for moderate to severe pain?  If not, what are better alternatives to the Vicoden and Percocet?  We know that we will have to deal with withdrawal issues, too.  Really appreciate your responses.  I have a great respect for the people in this forum, as I have spent the last 2 hours reading through various discussions.  Thanks!
Related Discussions
47 Comments Post a Comment
Blank
271792_tn?1334983257
Hello! Glad to see you posted.

I suffer with chronic pain, as you will see many people in here do. I took pain meds for nine years and became addicted to them. I recently stopped. I have been prescribed a medication called "Naproxen" 500mg tablets, to be taken twice a day. It is non-narcotic. From what I have read, it takes several weeks to get into the system and begin to work. Since I just started it on Friday, I am not there yet. However, I am hopeful. I am also contacting a woman in my area who is a "nutritionalist". She uses herbal supplements and specific exercies for pain management. Again, I have not talked with her as of yet.

I don't know that I have been much help, but others will post and tell you what they are doing for pain relief.

Also, when, and if, addiction from the pain meds becomes an issue, please come back and post about that. You will find several treatment options as well.

Good Luck and keep posting.

Hugs....
Blank
Avatar_n_tn
Thank you so much for taking the time to respond.  I have added Naproxen to my list of alternatives to be researched.  In the 2001 post discussing pain killer alternatives, Naproxen was discussed and dismissed by some who were concerned about stomach issues.  But again, that may just be a potential side effect (like all medications have side effects).  

Would you mind me asking what pain medications you were on?  I'm just wondering if Naproxen is sufficient for severe pain.  As stated, the daughter has an open wound.  From what I heard, someone who was a doctor (not the prescribing doctor) looked at the strength of the prescription and was awed by how high it was, but then also commented they had never performed the type of surgery that the daughter experienced (thus inferring the strength may be appropriate for the need).  The  wound is very deep and in a place that can tear open easily.  So the mother is caught in a catch 22 ... concerned about physical dependence and possible addiction but knowing that the daughter has to have something to deal with the very real pain she experiences.  
Blank
Avatar_n_tn
I didn't mention that the daughter has been diagnosed with ADHD, and is under treatment for that as well.  The below states that some preparations of Naproxen are not recommended for use in patients with hypertension:  http://en.wikipedia.org/wiki/Naproxen

Naproxen – Also like other NSAIDs, naproxen can inhibit the excretion of sodium and lithium. Extreme care must be taken by those who use this drug along with lithium supplements. Naproxen is also not recommended for use with NSAIDs of the salicylate family (drugs may reduce each other's effects), nor with anticoagulants (may increase risk of bleeding). Certain preparations of naproxen are not recommended for use in patients with hypertension, as they contain sodium, potentially worsening the effects of hypertension, in the very small subset of people who exhibit sodium-sensitive hypertension.
Blank
Avatar_f_tn
I believe Naproxen is an anti-inflamatory - that's how it helps with pain.  But I would double check this (i.e. google.)  :)

Every med is different.  Personally, I could not take Naproxen, it made me sick.  

And I know you didn't ask me this, but if you want any additional info, I tried Cymbalta, Neurontin (not very long tho,) Naproxen, Fleveril (muscle relaxant,) Aleve/Advil, and Norco - which is what I ultimately got addicted to.  And - btw - was the only thing that worked when the pain was SEVERE.
Blank
271792_tn?1334983257
Thank you for your post on Naproxen. As you mentioned, it have side effects, as most medications do.

I was taking Vicoden, Percocet and Oxycotin toward the end. I hade surgery, every therapy you can think of, epidural injections, steroid injections, and accupuncture. Some of these treatments worked for a realtively short period of time. The pain meds worked earlier on, but after years of use they stopped working as my tolerance built.

I also take "Soma", which is a muscle relaxer. Also non-narcotic. I wish I could be of more help, unfortunately, it has only been a short time that I am seeking non-narcotic alternative medications, so I am not well versed. There is a young lady who frequents this forum "FLaddict". She would be a good person to speak with. She is very helpful and does a lot of research. Keep an eye out for her.

Again, thank you. Hope you find the help you are looking for.
Blank
256169_tn?1191688915
With the type of injuries you describe she should feel NO shame nor any guilt, nor should her mother worry more about a "possible" problem with pills than the pain her daughter is now suffering......There are NO OTC meds that can really help the pain from such open wounds.  Good luck.

To get the details straight, you mean your boss has asked you to research alternatives for her/his daughter.....I have never heard of anyone getting "mean" on Vicoden, but ....I don't know everything.  Perhaps the daughter does have a physical dependance but that is not necesarily evil...She darn sure needs something for her pain......Perhaps your boss is a bit judgemental, based on incomplete information and predjudices.

Your boss perhaps needs to open her mind to the possibilities that these meds are "helping" and not necessarily hurting the daughter....She may be physically addicted but not necessarily psychologically.....Ask your boss, if the daughter is taking more than the prescribed dosage.....It would be hard to do this with your boss, but it might help if the boss "lightened up" on the guilt and shame thing and concentrated on helping the daughter with the pain......
Blank
256169_tn?1191688915
Personally I have found Naproxen to be quite worthless and VERY hard on the stomach.....After reading the ADHD thing of course care has to be taken with how whatever pain med chosen interacts with that medication.....I can't overemphasize how important it is to deal with the daughter's "pain"...It's good to be concerned about possible addiction, but your boss does not need to let predjudices against meds rule the decision.......Again, does the daughter take more than the prescribed dosage, more often than prescribed, or not......

Maybe a duragesic patch of some kind might work... I hear good things from folks about these things.
Blank
256169_tn?1191688915
Sometimes, Diabetes stops wounds from healing quickly, but hopefully they have already checked for that.... I would certainly think after 2 surgeries that those tests have been done.  I have a bruise on my hip that's been there for 12 months, as a Type II diabetic.
Blank
Avatar_n_tn
Thank you for your post.  No one feels any shame nor guilt.  There may be some possibility of abuse.  Also, other people have commented on the personality change the daughter has when on Vicoden, not just the mother ... in fact, the daughter has also commented on it.  From almost a decade of working with my boss, slideshow, I can assure you she is not judgemental and loves her daughter so very much.  I am not a young woman and a mother myself, and can tell you, there is absolutely no question of the mother's love and commitment.  I have oftentimes been amazed by how much this mother DOES for and LOVES her daughter.  It is out of love that she is looking for other alternatives.  But no one feels shame or guilt ... that's not even part of this.

In my research and taking the time to read through this forum, it is out of the respect I have for the people here that I posted my question.  

My question is simple and may have no answer ... is there a better (i.e. less addictive) pain killer for severe pain than Vicoden and Percocet?  It seems that if there is, it would fall into the categories of NSAID or Opiate Agonists (e.g., Ultram, which is not yet a controlled substance.  I know Vicoden is an Opiate Agonist ... but there may be some others in this drug class that are as effective but less addictive).

Again, thank you for taking the time to post.
Blank
Avatar_n_tn
The daughter is being taken to one of the best hospitals in the world and is receiving the best medical care for her condition.  I don't want to reveal too much.  It is a rare condition that has had complications.  They are scheduled to go to the Pain Management Clinic at this hospital where alternative approaches to pain will be explored.  That whole piece of this is outside the scope of what I've been asked to do ... that is why I'm not focusing on that.  The mother has that handled.  I'm just focusing on the prescription piece of this.  But, certainly, slideshow, there is a lot of other things going in with healing the wound and a comprehensive approach to pain management.  
Blank
214255_tn?1205639236
I have been taking pain meds for 4 5 yrs just to get high and well i'm off now, but I do know that when on some like vic's perks or oxy certian things would set me off little things that would have never if I was sober and I would have a major attitude so it is very possible that it can make her moody...Not sure what exactly, but my b/f would call it oxitude as in attitude....As for alternatives i'm not the one to know anything, but i'm sure someone will....Good luck!
Blank
Avatar_n_tn
Thank you.  Yes, there is no question that the daughter gets an attitude when on Vicoden.  Even the daughter has acknowledged that.  appreciate the post.
Blank
214255_tn?1205639236
I see you wrote ultram was not an addictive, but I think it is look up tramadol I think that is the generic name for ultram and I have seen post on here for tramadol addiction.
Blank
Avatar_n_tn
Yes, Ultram is addictive.  The question is, is it less addictive than Vicoden or Percocet?  The jury is mixed on that point.  Ultram is an Opioid Agonist (the same drug class as Vicoden), but some literature and testimonies suggest that it less addictive.

"Ultram is prescribed to control moderate to moderately severe pain.  Used as an intermediary step between over-the-counter pain relievers such as Tylenol or ibuprofen and narcotic pain killers.  While technically is a narcotic or opioid pain medication, it is different from typical narcotics in that patients do not build up a tolerance with extended usage and there is a very low incidence of addiction. With other narcotics there is a general tendency to escalate the dosage of the medicine with time and a chance of addiction. The narcotic effect of Ultram is not as strong as the narcotic agents in other common pain medications, such as Vicodin (hydrocodone) and Oxycontin and Percocet (Oxycodone)."  http://www.spine-health.com/topics/conserv/overview/med/med042.html


I have read through the post, http://www.medhelp.org/posts/show/44446, which discusses this specifically.  

Thanks, for the guidance.
Blank
Avatar_n_tn
When I'm done researching this, would anyone be interested in the final report?  I'm not a doctor, but I could offer some 8 hours worth of digging into this.  Maybe it would be worth something to someone, even if just providing a start in the walk of considering alternative pain relievers.  If no one is interested, that's okay ... just thought since I was doing this, I'd offer.

Look forward to your comments ... I know from reading through these posts, there are some people who have some really deep knowledge into this subject.  http://www.medhelp.org/forums/addiction/messages/30733.html
Blank
271792_tn?1334983257
I would be most interested in a final report, and I thank you for that offer.
I hope you found some help here today. Please post when you can.

Take care and GOD Bless!
Blank
256169_tn?1191688915
Thank you for taking the time to answer.   Often folks have that predjudice against people that use pain meds for pain....I just wanted to be that line of defense if the daughter needed.  It sounds like the arent has it covered.....I did not mean to be rough, only to have that avenue considered......Thank you for responding so nicely.....Good luck....

I would however consider a duragesic patch of some kind.  I hear that there are some out there that handle pain nicely with less addictive properties.........Tell boss to ask the doc.
Blank
Avatar_n_tn
From reading what is going on with your boss' daughter, I'm shocked that they have not addressed the problem and are treating symptoms for over 1.5 years.  An opening in the skin, the largest organ of the body, especailly an organ of elimination and protection from germs/organisms/etc., is a serious medical condition.  She should go to another doctor, such as a dermatologist, to address the original problem.  After that, it would be possible to address any dependency or addiction issues.  It's interesting that your boss is passing this onto you to research.  hmmmmm...  Best of luck to all involved and I would love to read how it comes out. Warmest wishes for healing.  G.
Blank
228686_tn?1211558307
Have you considered acupuncture? It does work. I'd look into it.

Regardless, she does have an addiction to deal with. But who can tell with the physical problems what she should or shouldn't take? You're right, there really aren't alternatives when it comes to pain relief.
Generally you have to choose between being in pain and being an addict.
Blank
Avatar_f_tn
There are some innovative postoperative pain control techniques - depending on where on her body the wound is located they range from epidurl pain control to putting the narcotic directly into the operative are thru a small pump.
Wha't is crucial is not to try to cure her addiction or worry about withdrawal's until after the surgery.You simply won't be able to cure the addiction until she's well into her post op phase.  What type of surgery is she having and how long has she been using?
Blank
256169_tn?1191688915
Again, DURAGESIC PATCH is at least worth a bit of research.   I know some foks that truly suffer that do like this option.....
Blank
Avatar_n_tn
Just thought I would add something to this debate. Here in England all hangun ownership is completely outlawed yet gun crime (especially black on black gun crime has never been higher). I myself held a hangun licence about 10-12 years ago (just for target shooting you weren't allowed to carry them outside) but after the Dunblane massacre in 1996 were a guy killed 16 primary school kids and their teacher (with a LEGALLY held gun) the government banned all hangun possession. I think the government felt they had to do something after the massacre but it meant people like me couldn't shhot for target practice (sport if you like) but as a result, guns havr never been easier to get a hold of and gun crime never higher. Go Figure.
God bless all,
Graeme
Blank
Avatar_n_tn
Oops sorry, I meant to post this under the "Thoughts on legitimate oc and recent crackdowns" thread. I'll move it.
Graeme
Blank
256169_tn?1191688915
Your points are "well taken"..  I agree that not all folks should have guns but some are responsible enough....At least as responsible as some police officers that I have met..The hard part is weeding through the administrative **** to decide who may own one.  My particular life experience "required" the use of a handgun...I am not so proud of it, but I am not so ashamed either.  I know if a terrorist opened up with an AK in a crowd that I am in, part of the crowd has at least a fighting chance.....
Blank
Avatar_n_tn
Thank you for your comments.  I'm wrapping this up today.
Rockport 12 - I do not want to get sidetracked about the open wound; that is why I'm not going to comment about why it still exists or the complications involved in healing it ... that is simply outside the scope of what I'm trying to do.  If you do not know the details, it is confusing (on the surface) why the open wound is having trouble healing.  The wound experts and doctors are focusing on this; not me.  My focus is simply what is the most non-addictive pain reliever sufficient for moderate to severe chronic non-malignant pain.  

Savas - Thank you.  In exploring pain management from a comprehensive approach, acpuncture is on the table and will be explored when the mother and daughter go to the Pain Management Clinic, which offer just about every alternative to pain management you can think of.  The clinic has already commented that the daughter has more than likely developed a physical addiction to the Vicoden and Percocet that she has been taking for 1-1/2 years.

I'm simply coming up with questions (ie alternative pain medications to Vicoden and Percocet) for my boss to ask the doctor when she next sees him.  If there are none, then there are none, but at least we know.

Thanks again to everyone who has taken the time to type and post.  I really do feel glad when I see people care enough to respond.
Blank
256169_tn?1191688915
Don't forget the patch......I've never used it, but I've had some really sick friends that swear by it.  There are many different ones, with different drugs in them, some more or less addicting than others.
Blank
Avatar_n_tn
The results of the 11 hours on this topic.  If you have anything to add ... please let me know.  I'm sure there is a lot more, but I've run out of time.  However, I will be checking back for the next few days to see if anyone has anything to add.  Again, thank you all!  Had to post in multiple posts because of 8000 character limit.

Objective:
To find non-addictive pain killer(s) sufficient to treat moderate to severe nonmalignant long-term pain (verses mild intermittent pain).  If none exist, to find the best alternative to Vicoden and Percocet that is less addictive but sufficient enough to treat moderate to severe nonmalignant long-term pain.  Note: initially thought “chronic” was the pain type, but don’t want to assume, since elements from both "chronic" and "acute" fit.  http://www.theacpa.org/documents/ACPA%20Meds%202007%20Final.pdf

Pain Types & Chronic Pain Classification
Acute pain is distinguished as being of recent onset, transient, and usually from an identifiable cause.

Chronic pain can be described as persistent or recurrent pain, lasting beyond the usual course of acute illness or injury or more than 3 to 6 months, and which adversely affects the individual’s well-being. A simpler definition for chronic pain is pain that continues when it should not. It is usually treated with medicine that you take at specific times every day (rather than as needed) so that you get pain relief throughout the day.

Chronic pain is classified by pathophysiology (the functional changes associated with or resulting from disease or injury) as nociceptive (due to ongoing tissue injury) or neuropathic (resulting from damage to the brain, spinal cord, or peripheral nerves), with mixed or undetermined causes as well. Pain relievers or analgesics are generally effective for nociceptive pain but less effective for neuropathic pain.  http://www.theacpa.org/documents/ACPA%20Meds%202007%20Final.pdf, page 8

________________________________________________________________________
Preliminary
I would read through these first before proceeding:

* ACPA (American Chronic Pain Association) Medication & Chronic Pain, Supplement 2007, http://www.theacpa.org/documents/ACPA%20Meds%202007%20Final.pdf

* “Treatment of Nonmalignant Chronic Pain” – Dawn A. Marcus, MD, http://www.aafp.org/afp/20000301/1331.html
Blank
Avatar_n_tn
Treatment Medications:
DRUG CLASS:  NSAID

Nonsteroidal anti-inflammatory drug used to relieve mild to moderate pain
http://arthritis.webmd.com/features/making-decision-on-nsaids

Although NSAIDs and short-acting opioids may be helpful with pain flares, they should not be used chronically on a daily basis in most cases. Chronic use of NSAIDs may be associated with significant side effects,23 including end-stage renal disease in two out of every 1,000 patients who use them daily for five or more years. The use of analgesic combination products is associated with the greatest risk of renal disease.24 Chronic use of NSAIDs, aspirin, or acetaminophen is also associated with hepatotoxicity or coagulopathy. Ulcer formation occurs in 2 to 4 percent of chronic NSAID users every year. NSAIDs have also been associated with reducing the effectiveness of some antihypertensives (beta blockers, angiotensin-converting enzyme inhibitors and diuretics)25 and increasing the effect of sulfonylureas when used in conjunction with these drugs. These effects are generally prostaglandin-mediated, and therefore not seen with tramadol or opioids. - http://www.aafp.org/afp/20000301/1331.html

Nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen are the most widely used medications for most pain conditions. But these drugs are not without risk. NSAIDs can cause gastric distress with ulceration and bleeding while acetaminophen can cause liver toxicity.  Fortunately, they do not produce physical or psychological dependence. Aspirin and acetaminophen are available over-the-counter while most NSAIDs are available both by prescription and by non-prescription over-the-counter purchase. The NSAIDs are indicated for pain that involves inflammation; acetaminophen does not have anti-inflammatory activity. Some of these medications are more effective than others in some individuals, which indicate that it makes sense to try several different ones to determine which medication works best for you. The cyclooxygenase (COX)-2 inhibitors are NSAIDs that have less gastrointestinal side effects with short term use. Currently available is celecoxib (Celebrex®); however, serious stomach ulceration can still occur without warning with this drug. As with other NSAIDs, patients should be monitored during long-term use. There is no evidence that meloxicam (Mobic®) or other somewhat COX-2 selective NSAIDs are gastroprotective. These medications additionally have potential kidney effects and heart (cardiovascular) complications, especially when taken for prolonged periods. - American Chronic Pain Association, Copyright 2007

______________________________________________________________________

Brand Name: Celebrex
Generic Name: Celecoxib
Drug Class: NSAID / Specific Cox-2 Inhibitors.
Rx Report: http://www.rxlist.com/cgi/generic/coxib_ad.htm

Comment1: “Celebrex was worthless.  As a pain killer, it is less effective than tylenol.  This is based on both personal experience, family experience (my brother is in a lot more pain than me, and had the worst year of his life on Celebrex), and finally, via a Celebrex sales slime.  This person is related via marraige to me, and told us that she was aware of the almost valueless pain management equation concerning Celebrex, but it was her job to push it to Doctors.” – Blog name, Broom, http://www.medhelp.org/forums/addiction/messages/30733.html

Comment2: The COX-2 inhibitor celecoxib (Celebrex) is more expensive than some other NSAIDs and does not provide any better pain relief, but it does seem to be less risky for developing an ulcer when taken for less than 6 months.  The COX-2 inhibitors rofecoxib (Vioxx) and valdecoxib (Bextra) were withdrawn from the market due to potential cardiovascular side effects. - http://www.theacpa.org/documents/ACPA%20Meds%202007%20Final.pdf

Use/No Use: http://www.worstpills.org/results.cfm?drug_id=702.  Celecoxib (CELEBREX); meloxicam (MOBIC); rofecoxib (VIOXX); valdecoxib (BEXTRA).  We list these drugs as Do Not Use drugs because they are no more effective than related drugs, most have not been shown to have a lower rate of ulcers than related drugs and some have been shown to cause heart disease.
________________________________________________________________________

Brand Name: Dolobid
Generic Name: Diflunisal
Drug Class: NSAID
Rx Report: http://www.rxlist.com/cgi/generic/diflunisal_ad.htm

Use/No Use: http://www.worstpills.org/results.cfm?drug_id=199.  We list these drugs as Do Not Use drugs because they have no advantage over ordinary generic aspirin in safety or effectiveness.

Additional Information:  http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a684037.htmlBrand
_______________________________________________________________________________

Name: Naprosyn
Generic Name: Naproxen
Drug Class: NSAID
Rx Report: http://www.rxlist.com/cgi/generic/naprosyn.htm

Comment1:  Used to treat headache, muscle ache, fever, menstrual cramps, backache, arthritis pain and inflammation. http://www.theacpa.org/documents/ACPA%20Meds%202007%20Final.pdf

Comment 2: Also like other NSAIDs, naproxen can inhibit the excretion of sodium and lithium. Extreme care must be taken by those who use this drug along with lithium supplements. Naproxen is also not recommended for use with NSAIDs of the salicylate family (drugs may reduce each other's effects), nor with anticoagulants (may increase risk of bleeding). Certain preparations of naproxen are not recommended for use in patients with hypertension, as they contain sodium, potentially worsening the effects of hypertension, in the very small subset of people who exhibit sodium-sensitive hypertension. http://en.wikipedia.org/wiki/NSAID

Use/No Use: http://www.worstpills.org/results.cfm?drug_id=444

Additional Information: http://www.healthsquare.com/newrx/ana1021.htm

Other NSAIDs include the following:
• Diclofenac (Cataflam®, Voltaren®, others)
•• Etodolac (Lodine®, Lodine® XL)
• Fenoprofen (Nalfon®)
• Flurbiprofen (Ansaid®)
• Indomethacin (Indocin®, Indocin® SR)
• Ketorolac (Toradol®, others) – only U.S. NSAID in injectable formulation
• Mefenamic acid (Ponstel®)
• Nabumetone (Relafen®)
• Oxaprozin (Daypro®)
• Piroxicam (Feldene®)
• Sulindac (Clinoril®)
• Tolmetin (Tolectin®)
* Brand names are the trademarked property of the medications’ manufacturers.

http://www.theacpa.org/documents/ACPA%20Meds%202007%20Final.pdf, see page 12 for a chart that summarizes the uses and cautions that apply to many of the non-opioid analgesic medication now on the market (NSAIDS).
Blank
Avatar_n_tn
DRUG CLASS:  OPIATE AGONISTS

Opioids are morphine-like substances and have been available for centuries to relieve pain. The term opioid is derived from opium, which is an extract from the poppy plant. There are both naturally occurring and synthetic opioids. There are a number of opioid receptors in the body that mediate analgesia. In 1975, it was discovered that the body generates internal or endogenous opioids called endorphins, enkephalins, and dynorphins.

There are numerous opioids available by prescription. The potency, speed of onset, and duration are unique to each drug. All of the opioids have similar clinical effects that vary in degree from one drug to another.  Opioids are formulated as both short- and long-acting. Some opioids are used around-the-clock, while others are used as needed for breakthrough pain.

Most opioids are agonists, a drug that binds to a receptor of a cell and triggers a response by the cell. An agonist produces an action. It is the opposite of an antagonist, which acts against and blocks an action.  Agonist - A drug that binds to a receptor of a cell and triggers a response by the cell. An agonist often mimics the action of a naturally occurring substance.

There are a number of opioid analgesics (pain relievers) that are partial agonists and mixed agonists/antagonists, which can simultaneously produce analgesia and precipitate withdrawal. These agents include buprenorphine (Buprenex®, Subutex®), butorphanol (Stadol®), nalbuphine (Nubain®), and pentazocine (Talwin®). They can be used for pain before surgery, pain during labor and delivery, migraine headache pain, and various other types of moderate to severe pain.  Some are also used for the treatment of opioid dependence.

http://www.theacpa.org/documents/ACPA%20Meds%202007%20Final.pdf
_______________________________________________________________________
Brand Name: Buprenex
Generic Name: Buprenorphine (Subxone, Subutex)
Drug Class: Opiate Partial Agonist
Rx Report: http://www.rxlist.com/cgi/generic/buprenorphine_ad.htm
Comments1:  The most frequent side effect in clinical studies involving 1,133 patients was sedation which occurred in approximately two-thirds of the patients. Although sedated, these patients could easily be aroused to an alert state.  Buprenorphine hydrochloride is a partial agonist of the morphine type: i.e., it has certain opioid properties which may lead to psychic dependence of the morphine type due to an opiate-like euphoric component of the drug. Direct dependence studies have shown little physical dependence upon withdrawal of the drug. However, caution should be used in prescribing to individuals who are known to be drug abusers or ex-narcotic addicts. The drug may not substitute in acutely dependent narcotic addicts due to its antagonist component and may induce withdrawal symptoms.

Use/No Use: http://www.worstpills.org/results.cfm?drug_id=1027

Blog(s): http://www.medhelp.org/posts/show/43416 (control “F” and type in Talwin)

_______________________________________________________________________

Brand Name: Duragesic
Generic Name: Fentanyl Transdermal  
Drug Class: Opiate Agonist
Rx Report: http://www.rxlist.com/cgi/generic/fentanyl_ad.htm

Controlled Substance: DURAGESIC® contains a high concentration of fentanyl, a potent Schedule II opioid agonist. Schedule II opioid substances, which include hydromorphone, methadone, morphine, oxycodone, and oxymorphone, have the highest potential for abuse and risk of fatal overdose due to respiratory depression.

Comments1: In July 2005, the FDA issued a public health advisory to alert people of reports of death and other serious side effects from overdoses while on fentanyl transdermal patches. Deaths and overdoses have occurred in patients using both the brand name Duragesic® and the generic product. Some patients and health care providers may not be fully aware of the dangers of this drug. The directions for using the fentanyl skin patch must be followed exactly to prevent death or other serious side effects from overdose.  Page 16, http://www.theacpa.org/documents/ACPA%20Meds%202007%20Final.pdf

Use/No Use: http://www.worstpills.org/results.cfm?drug_id=257

Additional Information: http://www.drugs.com/cdi/duragesic-patch.html

Blog(s): http://www.medhelp.org/posts/show/43664 - “Chronic pain from Hydrocodone to Duragesic patch”
______________________________________________________________________

Brand Name: Darvon
Generic Name: Propoxyphene
Drug Class: Opiate Agonist
Rx Report: http://www.rxlist.com/cgi/generic/propox_ad.htm

Use/No Use: http://www.worstpills.org/results.cfm?drug_id=542. We list this drug as a Do Not Use drug because it is no more effective than aspirin and is addictive.
_________________________________________________________________________

Brand Name: Talwin Nx
Generic Name: Pentazocine and Naloxone
Drug Class: Opiate Partial Agonist
Rx Report: http://www.rxlist.com/cgi/generic/pentazocine_ad.htm
Controlled Substance: Schedule IV

Comments1: There are a number of opioid analgesics (pain relievers) that are partial agonists and mixed agonists/antagonists, which can simultaneously produce analgesia and precipitate withdrawal. These agents include pentazocine (Talwin®). They can be used for pain before surgery, pain during labor and delivery, migraine headache pain, and various other types of moderate to severe pain. Some are also used for the treatment of opioid dependence. Page 14, http://www.theacpa.org/documents/ACPA%20Meds%202007%20Final.pdf

Use/No Use: http://www.worstpills.org/results.cfm?drug_id=495#drugprofile lists this drug as a Do Not Use drug because it causes more confusion and hallucinations than related drugs.

Additional Information: http://www.drugs.com/cdi/talwin-nx.html

Blog(s): http://www.medhelp.org/posts/show/43416 (control “F” and type in Talwin)
Blank
Avatar_n_tn
___________________________________________________________________________

Brand Name: Ultram
Generic Name: Tramadol HCL  
Drug Class: Opiate Agonist
Rx Report: http://www.rxlist.com/cgi/generic/tramadol_ad.htm

Comments1:  This drug is prescribed to control moderate to moderately severe pain.  Used as an intermediary step between over-the-counter pain relievers such as Tylenol or ibuprofen and narcotic pain killers.  While technically is a narcotic or opioid pain medication, it is different from typical narcotics in that patients do not build up a tolerance with extended usage and there is a very low incidence of addiction. With other narcotics there is a general tendency to escalate the dosage of the medicine with time and a chance of addiction. The narcotic effect of Ultram is not as strong as the narcotic agents in other common pain medications, such as Vicodin (hydrocodone) and Oxycontin and Percocet (Oxycodone).
http://www.spine-health.com/topics/conserv/overview/med/med042.html

Use/No Use: http://www.worstpills.org/results.cfm?drug_id=638.  We list these drugs as Do Not Use drugs because they are no more effective than similar drugs, are addictive and cause seizures.

Additional Information 1: Unlike most other opioids, Tramadol is not considered a controlled substance in many countries (U.S. and Canada, among others), and is available with a normal prescription. Tramadol is available over-the-counter without prescription in a few countries.  http://en.wikipedia.org/wiki/Ultram

* See pages 21 and 22 for detailed discussion http://www.theacpa.org/documents/ACPA%20Meds%202007%20Final.pdf

Blog(s): http://www.medhelp.org/posts/show/44446 - discusses Tramadol and
http://www.medhelp.org/posts/show/43416 - (control “F” and type in Ultram)

__________________________________________________________________________

These are examples of medical opioids: (http://www.theacpa.org/documents/ACPA%20Meds%202007%20Final.pdf, page 15)

o        Hydrocodone (with acetaminophen – Anexsia®, Lorcet®, Lortab®, Norco®, Vicodin®, Xodol, Zydone®; with ibuprofen –ReprexainTM, icoprofen®; with aspirin—Azdone, Lortab ASA, Panasal)

o        Oxycodone (OxyContin®, OxyIR®, RoxicodoneTM; with acetaminophen - Endocet®, Percocet®, Perloxx, RoxicetTM, Tylox®; with aspirin – Endodan®, Percodan®, with ibuprofen - CombunoxTM)

o        Codeine (with acetaminophen -Tylenol® with codeine No. 2, No. 3, No. 4)

o        Levorphanol (Levo-Dromoran®)

o        Dihydrocodeine bitartrate, Aspirin, Caffeine (Synalgos-DC®)

o        Methadone (Dolophine®, Methadose®, Westadone)

o        Hydromorphone (Dilaudid®)

o        Fentanyl (Actiq® lozenge, Fentora® buccal tablet, Duragesic® patch) – FDA warning

o        Morphine (AvinzaTM, Duramorph®, Kadian®, MS Contin®, MSIR®, Oramorph SR®, RoxanolTM)

o        Butorphanol (Stadol®)

o        Meperidine (Demerol®)

o        Oxymorphone (Numorphan®, Opana®)

o        Pentazocine (Talwin®; with acetaminophen-Talacen®; with aspirin- Talwin Compound)

o        Buprenorphine (Buprenex®, Subutex®) and Buprenorphine and Naloxone (Suboxone®)

____________________________________________________________________________

ANTIDEPRESSANTS COMMONLY USED FOR CHRONIC PAIN TRICYCLIC ANTIDEPRESSANTS (TCAS)
The tricyclic antidepressants have been used to treat depression for a long time. They include amitriptyline (Elavil®), desipramine (Norpramin®), imipramine (Tofranil®), and nortriptyline (Aventyl®, Pamelor®).  These antidepressants have been proven to have pain-relieving effects. Desipramine is considered to have the lowest side effects profile of the TCAs.  See pages 27 and 28 from ACPA Medications & Chronic Pain, Supplement 2007, http://www.theacpa.org/documents/ACPA%20Meds%202007%20Final.pdf

__________________________________________________________________________

ANTICONVULSANTS OR ANTIEPILEPTIC DRUGS
Several drugs that were developed for prevention of epileptic seizures have been found to help certain pain conditions.  http://www.theacpa.org/documents/ACPA%20Meds%202007%20Final.pdf

_________________________________________________________________________

MISCELLANEOUS

Most of the time when someone is able to swallow, they should first try a nonnarcotic drug such as aspirin taken by mouth. If aspirin alone is not effective, it can be combined with a narcotic, such as codeine. These two drugs work in different ways, and when they are used together, they generally relieve pain that would otherwise require a higher dose of narcotic, while causing fewer adverse effects.  http://www.worstpills.org/results.cfm?drug_id=495#drugprofile

_________________________________________________________________________

Miscellaneous Resources:

o        AAPM, The Use of Opioids for the Treatment of Chronic Pain, http://www.painmed.org/productpub/statements/pdfs/opioids.pdf

o        American Pain Society, http://www.ampainsoc.org/pub/principles.htm

o        American Academy of Pain Medicine, www.painmed.org

Blogs:

o        Blog on Medhelp, “Pain Killer Alternatives.”  This blog specifically discusses alternative non-narcotic pain medications for those with moderate or severe pain.  This forum has some very intelligent, well-informed discussions.  It is obvious these people have sought long and hard on this subject.  Reading through the posts will inform you of many alternatives, and their downsides.  Even though this is a 2001 discussion, it is worth reading.  http://www.medhelp.org/forums/addiction/messages/30733.html (my question is under SheMike)

o        Some newer posts here.  http://www.medhelp.org/posts/show/43664

o        A thread I started, http://www.medhelp.org/posts/show/302466 (I am SheMike)

___________________________Concluding Post_________________________________
Blank
256169_tn?1191688915
Wow--Excellent work.....Thanks for sharing.   I see you did reserach the patch.........Truly good work.  Good luck with the daughter.

Curious though, did anyone come to any concluson about which one/ones to use.  I notice some of those listed won't do much for the type of pain she is suffering.......
Blank
228686_tn?1211558307
One comment; the only time I had a good acupuncturist, it was a little old Chinese fellow down in china town. Needles and all, acupressure doesn't seem to work as well.

And most (all?) of the medications offered by western medicine have serious mental and physical side effects, including addiction. The anti depressants...*shudder* well, most are just...terrible.

Good luck with all this!
Blank
256169_tn?1191688915
I agree that NO antidepressants are good for pain....My wife however did take one that seemed to help with her Migraines, not so much as an immediate reaction thing, but an over time, affect.
Blank
Avatar_n_tn
The doctor will be asked.  We'll see what she says.  Doctor appointment next week.  I did research on anti-depressants and ADH.  I agree; scary.  If you're interested, this is a very interesting website:   http://www.cchr.org/
Blank
Avatar_m_tn
I was prescribed ultram for a while and it was one of the worst hells ive had detoxing....

Neurontin worked for a guy who had broken his back in several places years back....I didnt like it, it made me way too dopey and lethargic.
Blank
Avatar_n_tn
I was also prescribed Ultram and I agree that it was hell getting off of it.  If you read the package insert it tells you that the symptoms expected if you stop taking it suddenly include such severe things as hallucinations.  Ewwww.  I took Neurontin though for some time and for the first few days I was dopey and lethargic, but then those things went away and my nerve pain decreased.  Of course these things work differently for everybody.
Blank
Avatar_f_tn
most of what has been mentioned here are traditional "Western" medical approaches.  I think it's worth your while to check out "alternative" therapies as well.. chiropractic (some are doing amazing things these days;) acupuncture - i got some relief for my back through this for a little while; as well as homeopathic and Chinese medicines.

hey... it's worth a shot.

btw - i went to my acupuncturist today.  he said "stick out your tongue."  i did.. he then went on to tell me EXACTLY what was going on with me the last couple of days: bloating? (he hadn't seen my gut yet - lol,) sinus (HORRIBLE lately,) he even described what my b.m.'s looked like - all by looking at my tongue.  he was spot on.  then after my acupuncture my sinus's were improved.

it's worth at leat a visit...  
Blank
Avatar_f_tn
also - try Cymbalta and Neurontin.  I didn't have much success, but i heard some who have.

they both work on the nerves... which carry the pain.  you'd have to look them up to get the real skinny on them tho... but they are also options.
Blank
Avatar_f_tn
... there is also an item my pain mgmnt doctor used on me (honey - i've tried 'em all!) that is the newest version of the T.E.N.S. unit.  it's a little bix with little electrodes that attach to your skin and disrupt the pain signals being sent.

again, it's the latest version of the TENS unit, and I don't know it's name, so you'll need to do a little research... again, for me it didn't work, but my pain mgmt's wife had the same back  issues i have and it was REALLY working for her.

all of these things are at least checking out.  they're helping people somewhere, that's for sure.

i'd defnitely, again, try the acupuncture too, as a few of us have mentioned...

good luck!
Blank
256169_tn?1191688915
I've used Cymbalta for several months, and it ended up going the way of the rest of the ADs, the garbage, just didn't do it.  Cymbalta is "supposed" to work on seratonin balance and adrenaline, but it just didn't work for me......That does not mean that it would not work for others.  Neuronin I found to simply make me dizzy and nauses.  I think its designed for some particular nerve pain and just too specific for my injuries.
Blank
256169_tn?1191688915
Sorry about my spelling.   I know how to spell but I type too fast and just don't "review" these posts.
Blank
Avatar_f_tn
good morning slideshow,  how are you?  i hope feeling a little better than yesturday, i noticed you seemed a little down...hope all is well and you are back to yourself...i havent been to bed yet...its going to be a llooonnngg day... chat soon...
Blank
Avatar_n_tn
Thank you for your new comments ... I'll look up the new prescription medication ideas brought up!  The acupuncture and other non-medication approaches will all be considered when the mom and daughter go to the pain management clinic.  I think I have heard of the TENS unit ... I'll look that up too.
Amazonangel - thanks for mentioning Neurontin ... have not heard of that one.  I'll post this evening what I find out.
Blank
256169_tn?1191688915
You are going read better things about the Neurontin than the reality will be.  I believe though that it may well work for the specific nerve pain that it is prescribed for, bu it is NOT a "cover all bases" stop you from hurting kind of pill.

Acupuncture, I know nothing about, but I think Savas is a genius so he probably knows what he is talking about.

Blank
Avatar_m_tn
Personally as far as narcotic alternatives to percs and vicoden,I take MS Contin which releases the med over the course of 12hrs and I personally don't think it's as bad as oxycontin,as far as the whole agitated mood and getting high,but that's just my opinion.And it controls my pain and again personally I don't find it has as rapid a tolerance issue.
Blank
Avatar_f_tn
My pain doc put me on Suboxone after I yelled UNCLE on fentanyl.  I have long history of shot discs and bone/nerve pain. My body started rejecting, or going thru withdrawal on, the Duragesic (fentanyl) within  hours of a new patch. I fear the downspin of drugs and the damage they can do, themselves, to nerve endings, so tend to be leary.  Suboxone is used off-label for pain. Down side is that it is an antagonist... and won't let other pain meds work in your system.  Next, only a few doctors per state are licensed to prescribe. Since one has to get a new RX each  month, you have to stay close to home.  I felt like a hostage.  Next, I had that emergency one fears.  I got a case of viral meningitis. Not one doctor in the ER knew how to handle suboxone and so were giving me extreme doses of iv dilauded (sp wrong on most of this) until the subx was out of system. What a nightmare and a lot of agony.  I still am suffering from the after affects, 3 months later.  My doc wasn't returning their calls....  how toxic was that?  and the ER team was scouring the internet themselves to find a way to help me. So... before stepping into the world of suboxone, think carefully about the ramifications. Yes... it can help pain without leaving one feeling stoned. But, I was not ready to be a hostage... and since my condition may call for yet another fusion, though I'll put off as long as able...  I can't use that medication.   My new doc put my on Levorphanol, but the vote's not in yet. still sick w/meningitis , so it's hard to tell which part of feeling awful is which.
Blank
Avatar_f_tn
I understand this situation completely as I am also a 21 year old female who was given hydro- meth as a pain killer and have now been addicted to it for 3 yrs I am also looking for ways to get off of it as I would like to put my life back together but it seems doctors cannot care less to listen to us "junkies" as they reffer us too. They seem to have no problem giving us these addictive pills but when we sit down to talk to them about other alternative measures to get off them, such as methadone and benzo's as well as gabapentinal which helps with nerve pain and is unaddictive they seem to not have the time to be bothered or care. I don't understand how they can pump out all these highly addictive pain meds but cannot help in desperate measures of addiction and strong dependancies to these drugs by giving us the proper temperary medications to kill the craving and addiction. I know it would take maybe a week of methadone and 2 weeks of benzo's and gabapentinal to cure me completely so I could live a happy normal life like I used to but finding someone who cares enough to actually help is very difficult it seems. But like I stated Gabapentinal is for nerve pain and not addictive... Not sure if that's any help... Best of luck to you all!
Blank
Avatar_f_tn
hi im addicted to tramadol that the doc gave me now she treats me like a junkie any ideas how to come off it??
Blank
Avatar_f_tn
ultram generic name (tramadol) is very addictive. i know i was perscribed this med for a herniated disk was told it was not addictive was on it for seven years took it everyday it did help but after taking it for a few years i had to up the dosages myself just to get rid of the pain. i had my whole prescription bottle stolen and had to go without them a couple of days i thought i would die bad withdraws bad. i knew there was something wrong so i asked my doctor about it and told him i wanted help getting off of them because i felt that i was addicted to them and asked him to please help me get off so i was told he would call me something in to help my feeling of restlessness,shaking,body aches,pain,cold chills ect.. so i kept calling the pharmacy and nothing was ever called in a few days later after calling his nurse and begging them to help me i got a letter in the mail discharging me from his clinic so my mom stayed with me for a week as suffered with this cold turkey until i got into another clinic and told the doctor what all was going on and he told me that they ARE VERY ADDICTIVE and he prescribed a few meds to help me with the withdraws and i have been off now for a year with my mom and his help, so please NEVER NEVER take these......
Blank
Avatar_f_tn
ultram generic name (tramadol) is very addictive. i know i was perscribed this med for a herniated disk was told it was not addictive was on it for seven years took it everyday it did help but after taking it for a few years i had to up the dosages myself just to get rid of the pain. i had my whole prescription bottle stolen and had to go without them a couple of days i thought i would die bad withdraws bad. i knew there was something wrong so i asked my doctor about it and told him i wanted help getting off of them because i felt that i was addicted to them and asked him to please help me get off so i was told he would call me something in to help my feeling of restlessness,shaking,body aches,pain,cold chills ect.. so i kept calling the pharmacy and nothing was ever called in a few days later after calling his nurse and begging them to help me i got a letter in the mail discharging me from his clinic so my mom stayed with me for a week as suffered with this cold turkey until i got into another clinic and told the doctor what all was going on and he told me that they ARE VERY ADDICTIVE and he prescribed a few meds to help me with the withdraws and i have been off now for a year with my mom and his help, so please NEVER NEVER take these......
Blank
Post a Comment
To
Blank
Weight Tracker
Weight Tracker
Start Tracking Now
Addiction: Substance Abuse Community Resources
RSS Expert Activity
469720_tn?1388149949
Blank
Abdominal Aortic Aneurysm-treatable... Blank
Oct 04 by Lee Kirksey, MDBlank
242532_tn?1269553979
Blank
The 3 Essentials to Ending Emotiona...
Sep 18 by Roger Gould, M.D.Blank
242532_tn?1269553979
Blank
Control Emotional Eating with this ...
Sep 04 by Roger Gould, M.D.Blank
Top Addiction Answerers
6942344_tn?1417222347
Blank
Amandag78
Perth, Australia
4810126_tn?1415169246
Blank
EvolverU
Boston, MA
2083449_tn?1381358308
Blank
Sonrissa
NV
Avatar_m_tn
Blank
gnarly_1
phoenix, AZ
4522800_tn?1405696702
Blank
VICourageous
ID
495284_tn?1333897642
Blank
dominosarah
City of Dominatrix, MN