Big guns for chronic pain

[BusyGrl]

Sorry if this has been asked before; I couldn't find it in the archives. My question is, what's anyone's experience been with methodone, Fentanyl patch, or morphine MS (extended release capsules) for chronic pain? I finally got to a pain manager who seems to be a good fit, and she wants me to reduce my use of Klonopin before starting me on one of these drugs. They all sound so heavy-duty I'm a little nervous about it. I tired of the roller coaster of leg on 200mg of Tramadol, 600 mg of Neurontin, 1500 mg Robaxin, and 118mg of Effexor XR (trying to get to 150mg) a day. I'm also nervous because my regular doctor had me quit my 15mg oxycodone cold turkey and I went through withdrawals and he wouldn't give me xanax or anything to ease the hideous symptoms. What a traumatic nightmare that was, and I was only taking 15 mg a day! I read about people taking 40 pills a day and I can't imagine. Withdrawal is something I fear greatly because of that experience, especially when I hear of medicines like morphine and methodone.

Any comments would be appreciated. I guess if I had my choice, I'd go with the Morphine MS. My husband says oh great, now you're going to be addicted to morphine. (See other recent posts about family members and chronic pain. I can so relate.) That is not helping my comfort level.

[Tuckamore]

Hey Busygrl,

There is Oxycontin but because it has a high rate of abuse and a high street price therefore many physicians are not comfortable prescribing it. It is slow release oxycodone.

And yes it sounds like you are going through the normal stages of CP acceptance. I did it too and sometimes I "slip" back to the denial and I think I will get better. That doesn't happen very often anymore. You will experience stages a grief like process. Some breeze through it or have very little issues with it; others struggle with it for some time. I am the later. We all accept it at our own time. Actually we have little choice.

You may want to or have to try several meds before you find the one that works the best for you. And sometimes we don't have a choice, we must take the one that works the best for us, even though we may not want to take that med.

Best of luck in your decision process. Tuck

[BusyGrl]

The only reason my PM mentioned these drugs is because they are continuous release so I don't have the ups and downs and pain breakthrough. Are these the only options that you know of? I sometimes feel like my pain isn't that bad, but if I wait to take the Ultram, it starts to ramp up pretty quickly. I guess part of having chronic pain is acceptance. I keep thinking it's going to get better.

I don't have herniated discs and all that; just had lumbar fusion about 6 months ago. But I surely have muscle spasms and bone spurs and that sort of thing. I also have inflamed nerve roots, which I suppose will get better over time.

Thanks Tuck (and everyone) for caring.

[Tuckamore]

Hello again Busygrl,

Yes for most ppl the meth and morphine both help with sleep for two reasons. One it eases your pain allowing you to rest better. And two they have a sedative effect.

You have to be v-e-r-y careful when taking a muscle relaxant with Methadone, Morphine or any other major opiate. Indeed I would not take them together. I know there are ppl that do. My physician says if I take one of the "Big Digs" I cannot take my muscle relaxant with it. So I rarely take the "Big Dog" because I need muscle relaxants fairly regularly. I have horrid muscle spams.

You will find other opinions. This is just mine. And I am very cautious with medications because I don't want to be a statistic. I am a bit of a drug wuss.

Take care, Tuck

[Tiger39]

I take 60mg of MS Contin Extended Release twice daily for Chronic pain due to 3 bulging and 1 torn disk.  I can say that, although it does not take the pain away completely, it does seem to help.    I can also say that I actually do NOT have bad w/d when coming off of it - again, this is based on different people, but I had BAD w/d when coming off the Fentanyl patches so maybe thats why it didn't seem to be too bad.

Morphine is considered to be the "gold standard" in pain relief, I wish you luck.

[BusyGrl]

P.S. I'm really functional on all the drugs I'm taking, so I hope to "maintain" on Morphine.

Also, the Robaxin does not seem to be a very helpful muscle relaxer. Last night I slept really poorly on 1500mg of that plus 5mg Ambien. Has anyone had good success with a muscle relaxer that can be used with extended release morphine or methodone? And do these drugs help with sleep issues as well?

[BusyGrl]

Thanks so much for your posts. I had a sense that the Morphine MS was the best option, and I would hope that doctors are sensitive to withdrawal issues, but sadly, some aren't. The patch sounds really restrictive, so I will decline that one. I'm afraid of methodone, too, because I've read so many negative comments about it in the PM community.

Special thanks to Tuck for noting important questions to ask. I tend to forget and be too trusting. Silly! I only know that I don't want to be knocked out like Adam was.

Thanks again everyone. This group is the best.

[Billy__B]

I've been on Morphine ER for bout 2 years now and i take 100mgs daily although i'm prescribed 200mgs daily. because i have been in withdraw and it does scare me to death. But, the morphine does control my pain quite well. (I suffer from Degenerative Disk Disease and other back/spinal problems).  But i'm not recommending anything as i am NOT a doc or in the medical profession.  But i've HEARD that methadone is a beast. and i've never taken Oxy but i've heard and read that its perhaps a step up from morphine sulfate.  but not sure.  all i can say is that the morphine works well for me. I also took effexor 150mgs twice daily and it wasn't cutting my depression at all, so my pain management moved me to zoloft 200mgs daily (100mgs twice daily) and this is working for me.  But i would definetly speak to your pain management doc. The morphine makes you sleepy also, so be careful at first if u chose that path. Best of luck!

Billy B

[HawktheSlayer]

Hi,

  I just read the post and wanted to let you know what I went through with the Fentanyl patch. I was on the patch for about 3 months and at first I could not do anything at all, it really hit me hard, but after about 2 weeks it got better I could get up and move around with out too many problems. Then after about 1 month I was back at work still using the patch. Then at the end ( I ended it myself , I should have talked to my Dr but I was just tired of the mental effects it was giving me ) well after i stopped using the patch so that I could take a hot shower and sleep with my heating blanket I went through the worst withdraw I have ever had. For 3 days I would be laying down and would get cold then i would just take a very thin blanket and put it on and after 3 min I was sweating like a rosted pig, I finally called my Dr and told him what i did he told me to take 4 750mg Vicodin then in 4 hrs take 2 more then take 1 every 4 hrs for 2 days just to get over the Fentanyl patch. I have to say that it did help with the pain but I myself will never take it again it was just not worth it. I have has a SCS implanted for my back problems and I still take  Vic, or Perk, 4-6 times a day and Lyrica 2 times a day. I hate having to take the pills but i know that without them there  is just no way that I could work. I hope that you are able to find something that can help you with you pain and make it so that oyu can do some of the things you would like to do.

R/
Adam

[Tuckamore]

Hi again,

Jollyman offers great advice. Often Morphine MS is the first choice for many ppl. I am not sure of the rationale behind that but maybe because it seems the most familiar.

I am posting again because I forgot to add that the one has the least side effects(while taking it) is the Methadone.

Again best of luck, Tuck

[jollyman069]

well i can tell you about the morphine MS i take 30 mg a day along with pers for breakthrough pain, i have 3 herniated disc and they dont kill the pain completely but it controls the pain ok.. i have been told by many to saty away from methdone at all cost and i hear the patch is nasty too so i go to a pain dr and i am haopy with the meds i am on i hope this has helped a little

[Tuckamore]

Hello BusyGrl,
You have asked some very good questions. I am glad you posted them. All the drugs you named have withdrawal symptoms, every one of them. There is no way to get around this. We all wish there was. When my physician talked me into taking one of the "Big Dogs" as I call them, I brought up this very concern. My physician promised me she would not let me down. She said I would need a "Big Dog" for the rest of my life. There would be no withdrawal for me to face. So I tried several before I settled on one that seems to be the best for me. I do not take it as often as it is ordered. I use it more fthe pain when everything (Warm baths, etc) I have tried, including my muscle relaxant and regular pain medication will not touch it. I do every thing to avoid it but the simply truth is I can't. My pain won't let me.

And which has the very worse withdrawal symptoms? It absolutely depends on who you talk to, everyone thinks there withdrawal from their "Big Dog" is the worst. It's pretty subjective. I do beleive they are all have severe withdrawal symptoms.

I would ask the questions of your physicain that I have asked of my physician. What will happen if I don't need it anymore? (I always will.) What happens if you relocate? (She'll see to it that another physican (one of her partners) takes over my care as she has.)  And make sure you are comfortable with the answers.

Taking a medication that is long lasting and eases your CP better than short term narcotics simply makes sense. I wish you well. Please keep in touch and let us know how you are doing. We learn from one another. And as always, please take care, Tuck