Aa
Pain medication tolerance ( it is not what you think, read on)
I learned something today from my PM doctor.
He said that as far as tolerance your body becomes tolerant to the meds after a couple months. Therefore the need for a raise in meds due to tolerance is simply bunk. Your body gets adjusted to the meds and the tolerance after two months and when the meds stop working as well as they used to it is because your body ( pain) has simply become worse.
Now I am like you and have always heard that after taking a medication for too long it becomes ineffective. But he says he has the research to back this up and is currently getting me copies to post here as I explained that no one would believe this because we have been told that tolerance is a huge issue when taking narcotics.
I had been explaining that I needed an adjustment because the dose I am on and have been on for years and years just isn't cutting it anymore. Well I had my annual MRI and he showed me on the scan results where indeed I am definitely worse off than when I had my last MRI last year. Anyone with degenerative disease knows it gets worse over time just as injuries to our back does.
So tolerance has to do with our bodies and injuries getting worse and the meds are effectively working just as they did we just got worse.
I will post the results and research when I get it. It does make sense to me and although it also makes sense that the meds lose its effectiveness after time. But My PM doctor is one of the best in the country, he actually got into pain management because he broke his neck and never got sufficient relief. He invented the blood transfusion machine years ago and is very up on anything to do with pain management. So I trust he knows what he is talking about. Something to think about in any case. We are not getting tolerant to our meds we are just getting worse. Not to scare anyone though:)
He said that as far as tolerance your body becomes tolerant to the meds after a couple months. Therefore the need for a raise in meds due to tolerance is simply bunk. Your body gets adjusted to the meds and the tolerance after two months and when the meds stop working as well as they used to it is because your body ( pain) has simply become worse.
Now I am like you and have always heard that after taking a medication for too long it becomes ineffective. But he says he has the research to back this up and is currently getting me copies to post here as I explained that no one would believe this because we have been told that tolerance is a huge issue when taking narcotics.
I had been explaining that I needed an adjustment because the dose I am on and have been on for years and years just isn't cutting it anymore. Well I had my annual MRI and he showed me on the scan results where indeed I am definitely worse off than when I had my last MRI last year. Anyone with degenerative disease knows it gets worse over time just as injuries to our back does.
So tolerance has to do with our bodies and injuries getting worse and the meds are effectively working just as they did we just got worse.
I will post the results and research when I get it. It does make sense to me and although it also makes sense that the meds lose its effectiveness after time. But My PM doctor is one of the best in the country, he actually got into pain management because he broke his neck and never got sufficient relief. He invented the blood transfusion machine years ago and is very up on anything to do with pain management. So I trust he knows what he is talking about. Something to think about in any case. We are not getting tolerant to our meds we are just getting worse. Not to scare anyone though:)
Hey Sandee! Well, I'm so excited and sad that I found your article. The past two years I told my husband that something had changed. My hips and back were hurting more than usual. I am on hydrocodone 10-325 2x a day and tramadol 2x a day 50 mg. Tramadol is for breakthrough pain. I too have degenerative disc disease, scoliosis, my coccyx bone is inside out and possibly has been broken off. sciatica and arthritis. lol... The sciatica has been so bad for several months I have wanted to cry!!!!! Anyway, I have thought my intolerance was because my liver wasn't filtering like it should. I am going to show this to my PM doctors. This is so great and please, when you go back tell him thank you for opening our eyes!!! I have many health problems even besides those. I am a Christian and have been praying that God would give me wisdom on how to do better with my health. I honestly believe he led me here. I have been putting off my MRI and x-rays because we have no insurance. However, God will make a way!!! Sorry, I'm just babbling because I'm so excited!!! Thank you for posting this!
Hi Jazmon,
I really wish you would have began a new thread (question). You will obtain better responses and visibility.
For those that don't know - Meloxicam (Mobic) is a nonsteroidal anti-inflammatory drug (NSAID). It works by reducing hormones that cause inflammation and pain in the body. - Meloxicam is used to treat pain or inflammation caused by osteoarthritis or rheumatoid arthritis in adults.
Maloxicam contains Naproxen sodium 220 mg (naproxen 200 mg) which is also a NSAID. It's probably better known as Aleve.
Given the fact that you have an inflammatory/degenerative disease processes going you probably require a NSAID - however it's obvious given your daily pain that you may benefit from an added opiate. There are more opiates than you listed. Yes many are in that same family but it doesn't mean you're allergic to all of them.
I'm very allergic to some forms of penicillin. Ampicillin almost killed me. My mouth and tongue swelled, I had difficultly breathing and I broke out in hives. There's a few other "cillins" I cannot take - however I can take plain old penicillin. An allergist cannot explain it other than I must be allergic to the additives in these high breed or changed "cillins".
My suggestion to you is to find a great - not good - a great PMP that is willing to work with you to find something that you do not react to - like plain morphine. Yes I know most pain meds are derivatives of the opium poppy - with morphine being the first manufactured and probably the "cleanest" - well Ampicillin is a derivative of Penicillin.
You'll probably have to have Benadryl close by and maybe an Epi-Pen but your physician can direct all that - but please keep trying. There are opiates out there that may help you.
Opiate describes any of the narcotic opioid alkaloids found in opium. These alkaloids come from the sap of the opium poppy. Active opiates that are found in the opium poppy are morphine, codeine, thebaine, and papaverine.
Thebaine is used to create semi-synthetic pain relievers, such as oxymorphone, oxycodone, OxyContin and Dilaudid. I am extremely allergic to Dilaudid but not to oxycodone or OxyContin. Do you see my point? Why am I allergic to Dilaudid and NOT either of the oxys? A chemist may be able to answer that questions but no physician has been able to - other than they are just a bit different in their chemical make up.
Just so we know, Papaverine, though from the opium poppy is used primarily in the treatment of visceral spasm or vasospasm medications.
You are your own best advocate. Be assertive and don't take "You'll have to learn to live with it" for an answer. In all things, including medicine - the squeaky wheel gets the oil.
Please begin a new thread next time, keep in touch and let us know how you are doing. I'll look forward to additional questions or comments. You can copy and past this onto a new "questions". If you need assistance please feel free to ask.
My Best,
~Tuck
I really wish you would have began a new thread (question). You will obtain better responses and visibility.
For those that don't know - Meloxicam (Mobic) is a nonsteroidal anti-inflammatory drug (NSAID). It works by reducing hormones that cause inflammation and pain in the body. - Meloxicam is used to treat pain or inflammation caused by osteoarthritis or rheumatoid arthritis in adults.
Maloxicam contains Naproxen sodium 220 mg (naproxen 200 mg) which is also a NSAID. It's probably better known as Aleve.
Given the fact that you have an inflammatory/degenerative disease processes going you probably require a NSAID - however it's obvious given your daily pain that you may benefit from an added opiate. There are more opiates than you listed. Yes many are in that same family but it doesn't mean you're allergic to all of them.
I'm very allergic to some forms of penicillin. Ampicillin almost killed me. My mouth and tongue swelled, I had difficultly breathing and I broke out in hives. There's a few other "cillins" I cannot take - however I can take plain old penicillin. An allergist cannot explain it other than I must be allergic to the additives in these high breed or changed "cillins".
My suggestion to you is to find a great - not good - a great PMP that is willing to work with you to find something that you do not react to - like plain morphine. Yes I know most pain meds are derivatives of the opium poppy - with morphine being the first manufactured and probably the "cleanest" - well Ampicillin is a derivative of Penicillin.
You'll probably have to have Benadryl close by and maybe an Epi-Pen but your physician can direct all that - but please keep trying. There are opiates out there that may help you.
Opiate describes any of the narcotic opioid alkaloids found in opium. These alkaloids come from the sap of the opium poppy. Active opiates that are found in the opium poppy are morphine, codeine, thebaine, and papaverine.
Thebaine is used to create semi-synthetic pain relievers, such as oxymorphone, oxycodone, OxyContin and Dilaudid. I am extremely allergic to Dilaudid but not to oxycodone or OxyContin. Do you see my point? Why am I allergic to Dilaudid and NOT either of the oxys? A chemist may be able to answer that questions but no physician has been able to - other than they are just a bit different in their chemical make up.
Just so we know, Papaverine, though from the opium poppy is used primarily in the treatment of visceral spasm or vasospasm medications.
You are your own best advocate. Be assertive and don't take "You'll have to learn to live with it" for an answer. In all things, including medicine - the squeaky wheel gets the oil.
Please begin a new thread next time, keep in touch and let us know how you are doing. I'll look forward to additional questions or comments. You can copy and past this onto a new "questions". If you need assistance please feel free to ask.
My Best,
~Tuck
Im 33 years old and was diagnosed in February with DJD and DDD in my lower half of my body , including my hips. Im allergic to tramadol,Hydrocodone and Hydrocodeins. Yeap pharmacy told me i was 1 in 100 that was allergic to both. Kinda ***** for me because i go day to day in pain, and cant hardly move anymore, and cant take anything for it that helps anymore because of the high tolerance i have to any pain meds anymore. After about a week of taking Maloxicam it stopped working as good. I am useing a menstrual Pain Relief called Menstridol now. Been useing it since All this flaired up on me all of a sudden. It also doesnt cut theough the pain. Can anyone give me any advice on how to deal with this better then im already doing ? I also take hot baths with 2 cups of epsom salt.
Sorry my last comment that was addressed to Molly should have been addressed to Pololove. Sandee1818 has been absent from this community since approximately 2009.
Sorry,
~Tuck
Sorry,
~Tuck
Madman,
Amen! I've encountered the same since I lost the best PMP in the world! I've been through a lot of medications and treatments. I've been had this demon called Chronic Pain for many years and I've been at this joke of a term called Pain Management for longer than I care to imagine! Some new PMP think they have all the answers, when you've been there, done that!
Molly,
As you know Sandee has been absent from this community for years. I believe this was posted shortly before she left. I too would have liked to see the research she was discussing.
Take Care,
~Tuck
Amen! I've encountered the same since I lost the best PMP in the world! I've been through a lot of medications and treatments. I've been had this demon called Chronic Pain for many years and I've been at this joke of a term called Pain Management for longer than I care to imagine! Some new PMP think they have all the answers, when you've been there, done that!
Molly,
As you know Sandee has been absent from this community for years. I believe this was posted shortly before she left. I too would have liked to see the research she was discussing.
Take Care,
~Tuck
Fantastic to read. Sometimes we can teach the doctor a thing or two IF THEY ARE WILLING TO LISTEN TO YOU! Therein lies the rub! My PC (who I am new to) seems to think she has all the answers with a smart a-- attitude. She writes when I refuse something SHE thinks is right for me. Now I have been trying to see a Neurologist to get a definitive diagnosis from a specialist and my Orthopedic doctor agrees, but the system is set up to let the PC make that decision. He can only advise her of his medical opinion but it does not mean she has to agree with it.
I am working on getting another PC doctor but I would love to stay with my orthopedic doctor. He listens and explains!
As pain specialists, we know what our bodies can tolerate and what and how we feel. Just getting someone to listen is the issue!
I am working on getting another PC doctor but I would love to stay with my orthopedic doctor. He listens and explains!
As pain specialists, we know what our bodies can tolerate and what and how we feel. Just getting someone to listen is the issue!
Hi. My 1st posting. I have Chronic Pain(CP) from multiple sites for multiple reasons.
As a former ER RN, I witnessed a lot of patients dealing w/CP. I was disgusted by some of my colleagues who assumed that 99% of ER patients w/CP, were drug seekers. We did have our share of "frequent fliers", who were actually addicted and were seekers and they were handled appropriately. But, their actions brought suspicion, to legitimate Cp'ers.
Advice- go to your PCP for a referral to a Pain Management group or individual. I'll get off of my soapbox now.
Question. Has anyone experienced increased "Rebound Pain" after increasing their pain med. due to tolerance?
In other words, does the pain increase due to more medication, in a snowball type reaction? I have heard of this and am reluctant to increase my pain med.dosage, only to create a higher degree of pain.
As a former ER RN, I witnessed a lot of patients dealing w/CP. I was disgusted by some of my colleagues who assumed that 99% of ER patients w/CP, were drug seekers. We did have our share of "frequent fliers", who were actually addicted and were seekers and they were handled appropriately. But, their actions brought suspicion, to legitimate Cp'ers.
Advice- go to your PCP for a referral to a Pain Management group or individual. I'll get off of my soapbox now.
Question. Has anyone experienced increased "Rebound Pain" after increasing their pain med. due to tolerance?
In other words, does the pain increase due to more medication, in a snowball type reaction? I have heard of this and am reluctant to increase my pain med.dosage, only to create a higher degree of pain.
Hi Kmart....This is a really old thread....why don't you start a new one with your information. You will get better results. Thanks,
Molly
Molly
I have been reading through a lot of older posts as I have found a lot of the discussions very informative & interesting. So I know this post is old but it piqued my interest & I was curious as to whether or not the research being discussed here was ever posted & if so could someone help me find it?
To add my two cents into the conversation...
I have been on a low dose of norco (5/325) & neurontin (100mg) for right at a year for SI nerve damage/low back pain/localized lipoma pain, a condition/conditions that has only been partially diagnosed (FRUSTRATING!) up to this point. I suffer on a daily basis with this mess always on a moderate to severe pain level.
Recently (and extremely warily I might add!) I asked my doctor to increase my doseage (1-2 tabs 4 times daily as needed of norco & 1 neurontin at bedtime nightly) to 2 more norco daily & 1 more neurontin daily.
He refused this stating that since I didn't have a definitive diagnosis for my back pain (MRI showed no abnormalities aside from lipoma in right side sacrum at L5 level) as well as my age being a factor (I'm 33) he felt that I was experiencing increased pain levels due to having developed a certain amount of tolerance to the meds.
What I also found interesting was that he said he didn't want me to be entirely pain free for fear of me overdoing it & engaging in activities that could further aggravate my condition. I don't know if it's just me but he sure seemed to contradict himself with these explanations. He was basically saying that I was too young to have anything seriously wrong (he doesn't really believe me is how I took that!) with me & that he wasn't yet able to find a diagnosis for the pain in my back (I took this as him saying it's all just in my head!) yet at the same time said that if I were to get complete pain relief (from a 'condition' that's 'all in my head' because I'm 'too young' to be experiencing pain!) I would be risking injuring myself further (yet he insinuates there is no injury to begin with?) & aggravating my condition (the 'condition' he hasn't yet diagnosed?).
I apologize everyone if it seems that I'm whining or overreacting to this; maybe I'm just reading into this too much? I just thought this an interesting experience of my treatment to add to this discussion.
I guess I could understand his reasoning if he had already increased my meds in the past & I was on a high daily intake of pain meds but I am on the same amount I was started on a year ago & yes it does help me to a certain extent but my daily life is still significantly impacted by my struggle with this pain. I feel like I should at the very least be able to hold my baby while standing up for longer than a few seconds & not have to have help putting him in his carseat, etc, etc. I'm not sure if my doc thinks that just because I don't have to go to a job everyday that I'm able to just lay on the heating pad on the couch all day & tend to myself but if he does he is so off base it isn't even funny.
I also have noticed (of course it may just be me being overly sensitive as I just had my 1st urinalysis) that lately my doc has been treating me differently. I feel as if he's distancing himself from me, a bit standoffish & as if he's not taking me seriously. I swear it seems he's asking me the same questions over & over & I'm recounting my different types/levels of pain over & over & he's acting as if he's never heard them before. I'm beginning to think that along with several other factors (including my age & the partial diagnosis)the fact that I asked for this increase has made him suspicious of me in some way. I just really hate thinking that my doc doesn't believe me & thinks I just see him for meds. I've done everything he's asked, from PT to injections and will continue to do so.
Anyhow I ended up getting way off in left field here, sorry about that everyone! I just wanted to mention the doc's concerns of 'masking' the pain too much & causing further injury. Anyone have any thoughts on this? And I'd love to read that article/research if anyone knows where it can be found.
Thanks to everyone so much for listening/letting me vent! It was much needed!
To add my two cents into the conversation...
I have been on a low dose of norco (5/325) & neurontin (100mg) for right at a year for SI nerve damage/low back pain/localized lipoma pain, a condition/conditions that has only been partially diagnosed (FRUSTRATING!) up to this point. I suffer on a daily basis with this mess always on a moderate to severe pain level.
Recently (and extremely warily I might add!) I asked my doctor to increase my doseage (1-2 tabs 4 times daily as needed of norco & 1 neurontin at bedtime nightly) to 2 more norco daily & 1 more neurontin daily.
He refused this stating that since I didn't have a definitive diagnosis for my back pain (MRI showed no abnormalities aside from lipoma in right side sacrum at L5 level) as well as my age being a factor (I'm 33) he felt that I was experiencing increased pain levels due to having developed a certain amount of tolerance to the meds.
What I also found interesting was that he said he didn't want me to be entirely pain free for fear of me overdoing it & engaging in activities that could further aggravate my condition. I don't know if it's just me but he sure seemed to contradict himself with these explanations. He was basically saying that I was too young to have anything seriously wrong (he doesn't really believe me is how I took that!) with me & that he wasn't yet able to find a diagnosis for the pain in my back (I took this as him saying it's all just in my head!) yet at the same time said that if I were to get complete pain relief (from a 'condition' that's 'all in my head' because I'm 'too young' to be experiencing pain!) I would be risking injuring myself further (yet he insinuates there is no injury to begin with?) & aggravating my condition (the 'condition' he hasn't yet diagnosed?).
I apologize everyone if it seems that I'm whining or overreacting to this; maybe I'm just reading into this too much? I just thought this an interesting experience of my treatment to add to this discussion.
I guess I could understand his reasoning if he had already increased my meds in the past & I was on a high daily intake of pain meds but I am on the same amount I was started on a year ago & yes it does help me to a certain extent but my daily life is still significantly impacted by my struggle with this pain. I feel like I should at the very least be able to hold my baby while standing up for longer than a few seconds & not have to have help putting him in his carseat, etc, etc. I'm not sure if my doc thinks that just because I don't have to go to a job everyday that I'm able to just lay on the heating pad on the couch all day & tend to myself but if he does he is so off base it isn't even funny.
I also have noticed (of course it may just be me being overly sensitive as I just had my 1st urinalysis) that lately my doc has been treating me differently. I feel as if he's distancing himself from me, a bit standoffish & as if he's not taking me seriously. I swear it seems he's asking me the same questions over & over & I'm recounting my different types/levels of pain over & over & he's acting as if he's never heard them before. I'm beginning to think that along with several other factors (including my age & the partial diagnosis)the fact that I asked for this increase has made him suspicious of me in some way. I just really hate thinking that my doc doesn't believe me & thinks I just see him for meds. I've done everything he's asked, from PT to injections and will continue to do so.
Anyhow I ended up getting way off in left field here, sorry about that everyone! I just wanted to mention the doc's concerns of 'masking' the pain too much & causing further injury. Anyone have any thoughts on this? And I'd love to read that article/research if anyone knows where it can be found.
Thanks to everyone so much for listening/letting me vent! It was much needed!
Hi Tigerlily yes it is very interesting and I just found this the a couple days ago as well.
I PM'd Sandee and she is still working on getting this research out there for us...so keep posted there will be something, although she did say she would be off site of awhile..
I PM'd Sandee and she is still working on getting this research out there for us...so keep posted there will be something, although she did say she would be off site of awhile..
Sorry I just noticed that this wasn't a new thing, where can I find the info?
Lily
Lily
Wow, I just can't wrap my head around this. I would have never imagined something like this and it is raising so many questions in me that I never would have thought of as I'm sure it is in everyone. I look forward to reading more about this.
Lily
Lily
hi everyone I just found this discussion in the archives...very interesting, Sandee, is there somewhere I can find the research that was done on this tolerance vs. condition..I would be very interested in reading it.
It was explained to me that the body 'remembers' the pain whether it still exists or not re: neuropathic pain...and apparently the most difficult to treat!
the remembered pain is most apparent in 'phantom pain' after an amputation.
It was explained to me that the body 'remembers' the pain whether it still exists or not re: neuropathic pain...and apparently the most difficult to treat!
the remembered pain is most apparent in 'phantom pain' after an amputation.
Hi again, everybody. What an amazing high level discussion this is. I, too, am looking forward to reading the promised research...fpainestam
Welcome to our forum. You have offered additional good information on the topic of tolerance. I beleive we all know that we need pain. It is our bodies way of signalling us that something is not right. It is a challenging and difficult task to juggle medications that effectively treat chronic pain and still allow our bodies to interpret "good" pain signals. And yes I agree there is "good" pain. That pain that signals, hello, something is going on here, something is not functioning correctly, look at me. The good pain must be differentiated from the chronic pain and it is often a challenging task.
Chronic Pain is a very complex issue and varies with each of us. The definition of Neural Plasticity is the ability of the brain and/or certain parts of the nervous system to adapt to new conditions, such as an injury. The research by various medical facilities and medical research groups is even more complex. Results and focus of these research studies vary. This is a very exciting time in the area of Chronic Pain Research.
The classification spectrum regarding "chronic pain" is immense. Terminal cancer pain is considered chronic pain, yet the patient certainly has great reason for pain. Fibromyalgia is also considered chronic pain and no one here would disagree with the statement that it is real pain. In my opinion chronic pain has become a catch all term for all causes of pain that last longer than thirty days. Again, in my opinion there are degrees and variances of pain principles and causation that need to be addressed on an individual basis.
I am hopeful that advancements and concrete results in CP research will be forthcoming. Our quest will be to get the slow-to-accept-change medical community on boards with any new conclusive approaches. Currently ideas, opinions, treatments and approaches to CP vary widely from state to state, city to city and often clinic to clinic.
I am sorry that your search for a restful night of sleep has not ended. Many of us face that issue and understand your plight. I wish you a good nights sleep and welcome you to our community. I am hopeful you will continue to join in our discussions and add your comments to our threads.
Peace, Tuck
Chronic Pain is a very complex issue and varies with each of us. The definition of Neural Plasticity is the ability of the brain and/or certain parts of the nervous system to adapt to new conditions, such as an injury. The research by various medical facilities and medical research groups is even more complex. Results and focus of these research studies vary. This is a very exciting time in the area of Chronic Pain Research.
The classification spectrum regarding "chronic pain" is immense. Terminal cancer pain is considered chronic pain, yet the patient certainly has great reason for pain. Fibromyalgia is also considered chronic pain and no one here would disagree with the statement that it is real pain. In my opinion chronic pain has become a catch all term for all causes of pain that last longer than thirty days. Again, in my opinion there are degrees and variances of pain principles and causation that need to be addressed on an individual basis.
I am hopeful that advancements and concrete results in CP research will be forthcoming. Our quest will be to get the slow-to-accept-change medical community on boards with any new conclusive approaches. Currently ideas, opinions, treatments and approaches to CP vary widely from state to state, city to city and often clinic to clinic.
I am sorry that your search for a restful night of sleep has not ended. Many of us face that issue and understand your plight. I wish you a good nights sleep and welcome you to our community. I am hopeful you will continue to join in our discussions and add your comments to our threads.
Peace, Tuck
Hi folks,
I just joined and am enjoying the thoughtful discussion. I believe I am having tolerance issues, so I am trying to stay calm and inform myself. I have to say I believe both things can be true, - that we can develop tolerance to pain meds + much of our change in medication needs may be due to worsening of physical damage. Pain is a complex phenomenon, and is caused by different amounts of tissue injury and signalling function, depending on who you are neurologically, and what has befallen your body, injury or illness-wise. Also, I don't think that 2 months is a magic number. There is probably a variance based on individuals responses. Anyway, here are some things I am thinking about.
First, the scary thing is that people NEED pain. It helps prevent us from doing further injury to ourselves. People who are congenitally unable to feel pain risk a lot of bad stuff, because they can't tell when they are seriously injuring themselves. I know the idea of pain being necessary sounds cruel for people who have long-term pain from debilitating conditions like arthritis or some of the things you have mentioned. But in a sense, pain is like the warning track in a baseball stadium. It's trying to prevent us from crashing into the wall at full speed. It's adaptive in general, even though it's such a bear when you have chronic injury and damage.
Anything that gets in the way of feeling pain can be perceived by our bodies as an infringement on the warning system. That is, our bodies will try to restore "normal" perception of pain so that we will be properly advised as to what is going on with our skin, joints, muscles, tendon, ligaments, bones, etc. We can't afford to suppress pain very much or for very long; our bodies will respond by resetting the pain mechanism to report even more forcefully on smaller pain experiences.
What this is all a demonstration of is something called neural plasticity. The message of neural plasticity is that tolerance is an almost unavoidable response to the use of pain medications. Our central nervous system is trying desperately to keep us in touch with reality, and will continually renew and in most cases, "upregulate", the way sensory experiences are processed. If your doctor doesn't talk about this, then perhaps its because this is all being researched more thoroughly now, and medicine is a conservative profession that doesn't go jumping on bandwagons. This is all part of a larger field of study called epigenetics that deals with the way that environmental causes interact with genetic endowment to change expression of genes involved in everyday function and behavior.
The only place where tolerance doesn't seem to be inevitable is something called central sensitization, which is what causes pain in a susceptible group of people. It has been implicated in some cases of fibromyalgia, pain from shingles, pain from diabetic neurpathy, and some types of back pain that linger after damage has been repaired. (But not all types...) Central sensitization is a hypersensitivity that is caused only by a neurological change (changes in neurochemical signalling), and is not caused by ongoing damage in the skin, joints, muscles, tendons, ligaments, bones, etc. That is why some people get almost miraculous pain relief from some of the newer drugs (such as gabapentin and pregabalin) and often don't even have any recurrence. It's because they were having pain for no good reason, and this type of pain can be eliminated by "down-regulating" the pain system.
I am not sure if this helps anyone, but I just wanted to add this to the discussion. As I said, I just realized I am having tolerance issues. I thought meds were going to solve my long-standing sleep disruption issues. After a few blessed nights of restful sleep, I am back to my usual state of exhaustion (and it took a lot less than 2 months!). I was SO hopeful. Like all of you, all I want is a normal life. The really nice thing is that researching all these medications and research has helped me see how hard scientists and practitioners are working to get us help. Here's to medical science! Good luck to you all in having comfortable, productive and fulfilling lives.
I just joined and am enjoying the thoughtful discussion. I believe I am having tolerance issues, so I am trying to stay calm and inform myself. I have to say I believe both things can be true, - that we can develop tolerance to pain meds + much of our change in medication needs may be due to worsening of physical damage. Pain is a complex phenomenon, and is caused by different amounts of tissue injury and signalling function, depending on who you are neurologically, and what has befallen your body, injury or illness-wise. Also, I don't think that 2 months is a magic number. There is probably a variance based on individuals responses. Anyway, here are some things I am thinking about.
First, the scary thing is that people NEED pain. It helps prevent us from doing further injury to ourselves. People who are congenitally unable to feel pain risk a lot of bad stuff, because they can't tell when they are seriously injuring themselves. I know the idea of pain being necessary sounds cruel for people who have long-term pain from debilitating conditions like arthritis or some of the things you have mentioned. But in a sense, pain is like the warning track in a baseball stadium. It's trying to prevent us from crashing into the wall at full speed. It's adaptive in general, even though it's such a bear when you have chronic injury and damage.
Anything that gets in the way of feeling pain can be perceived by our bodies as an infringement on the warning system. That is, our bodies will try to restore "normal" perception of pain so that we will be properly advised as to what is going on with our skin, joints, muscles, tendon, ligaments, bones, etc. We can't afford to suppress pain very much or for very long; our bodies will respond by resetting the pain mechanism to report even more forcefully on smaller pain experiences.
What this is all a demonstration of is something called neural plasticity. The message of neural plasticity is that tolerance is an almost unavoidable response to the use of pain medications. Our central nervous system is trying desperately to keep us in touch with reality, and will continually renew and in most cases, "upregulate", the way sensory experiences are processed. If your doctor doesn't talk about this, then perhaps its because this is all being researched more thoroughly now, and medicine is a conservative profession that doesn't go jumping on bandwagons. This is all part of a larger field of study called epigenetics that deals with the way that environmental causes interact with genetic endowment to change expression of genes involved in everyday function and behavior.
The only place where tolerance doesn't seem to be inevitable is something called central sensitization, which is what causes pain in a susceptible group of people. It has been implicated in some cases of fibromyalgia, pain from shingles, pain from diabetic neurpathy, and some types of back pain that linger after damage has been repaired. (But not all types...) Central sensitization is a hypersensitivity that is caused only by a neurological change (changes in neurochemical signalling), and is not caused by ongoing damage in the skin, joints, muscles, tendons, ligaments, bones, etc. That is why some people get almost miraculous pain relief from some of the newer drugs (such as gabapentin and pregabalin) and often don't even have any recurrence. It's because they were having pain for no good reason, and this type of pain can be eliminated by "down-regulating" the pain system.
I am not sure if this helps anyone, but I just wanted to add this to the discussion. As I said, I just realized I am having tolerance issues. I thought meds were going to solve my long-standing sleep disruption issues. After a few blessed nights of restful sleep, I am back to my usual state of exhaustion (and it took a lot less than 2 months!). I was SO hopeful. Like all of you, all I want is a normal life. The really nice thing is that researching all these medications and research has helped me see how hard scientists and practitioners are working to get us help. Here's to medical science! Good luck to you all in having comfortable, productive and fulfilling lives.
I can agree with that....That both our tolorance and increased pain levels play a role in the need for an increase. When thinking about it, I guess it has to be a combination of both playing it's own roll in the course of things.
Thank's for the information, it's been helpful.
Take care.
Molly
Thank's for the information, it's been helpful.
Take care.
Molly
The doc said after two months your body has become tolerant of the pain medication. Now I like you was a little taken back because this is not what I have always thought. I asked if someone took say hydrocodone for a year then what exactly will happen. He said they will become tolerant to the medication in two months and if the medication starts losing its effectiveness then it is because the persons injuries are becoming worse.
If you were taking say one tablet then your body kept becoming tolerant over time as you raise your dose then of course you would have to take more to get the same relief. I look at it like this, we still have tolerance issues but we just become tolerant after a couple months instead of over many months or years. We become tolerant after two months our body does and even if we get worse the tolerance has reached its high point if you will after two months and will not go beyond that. I hope I am making sense. I know how it is explained and how I conceive it in my brain but my brain isn't quite working with my voice this afternoon:)
I do get what your saying Mollyrae and you have a valid point but if if you think about it and we become tolerant to our current dose after two months then both tolerance and our condition worsening plays in the sceanerio.
If you were taking say one tablet then your body kept becoming tolerant over time as you raise your dose then of course you would have to take more to get the same relief. I look at it like this, we still have tolerance issues but we just become tolerant after a couple months instead of over many months or years. We become tolerant after two months our body does and even if we get worse the tolerance has reached its high point if you will after two months and will not go beyond that. I hope I am making sense. I know how it is explained and how I conceive it in my brain but my brain isn't quite working with my voice this afternoon:)
I do get what your saying Mollyrae and you have a valid point but if if you think about it and we become tolerant to our current dose after two months then both tolerance and our condition worsening plays in the sceanerio.
Maybe I am not understanding correctly but 3yrs ago when I first started taking pain meds I could take one 5/325 percocet and get hot flashes and sick feeling and now I can take like 6 percocets with hardly any effect what so ever other than feeling normal? I am not doubting anybody just wondering if that is what the tolerence after a few months is what you are talking about?
I forgot to mention that the amount of meds I took back in the day that I first was introduced to pain meds which was 1/4 of what I take today was enough to make me comfortable. Today it would be like taking an asprin because of my tolorance not my pain. Take care....
Sandee:
You give some great information and I agree but disagree at the same time. While I do understand that our bodys become worst over time..I also suffer from a degenerative disc disease..and the need for an increase is warranted but the tolorance in regards to pain meds is real and this also warrants an increase. I remember a time when I was first introduced to narcotics and I had pain that ravished my body. If I took the amount of meds back then that I take today, I would have overdosed. the degeneration that I suffer with hasn't changed much in the last 6 months or so but the need for an increase has changed alot as the meds are not as effective. I have also talked recently with my Doc and he agreed that my tolorance is definitly an issue with my added pain, therefor he increased the dose. He has stated that our bodys can become worst over time and the dose might not be high enough but he has also stated that the body builds a tolorance to the meds and doesn't allow the pain meds to work as effectivly as they should. So this is why I agree and disagree with your new information.
You give some great information and I agree but disagree at the same time. While I do understand that our bodys become worst over time..I also suffer from a degenerative disc disease..and the need for an increase is warranted but the tolorance in regards to pain meds is real and this also warrants an increase. I remember a time when I was first introduced to narcotics and I had pain that ravished my body. If I took the amount of meds back then that I take today, I would have overdosed. the degeneration that I suffer with hasn't changed much in the last 6 months or so but the need for an increase has changed alot as the meds are not as effective. I have also talked recently with my Doc and he agreed that my tolorance is definitly an issue with my added pain, therefor he increased the dose. He has stated that our bodys can become worst over time and the dose might not be high enough but he has also stated that the body builds a tolorance to the meds and doesn't allow the pain meds to work as effectivly as they should. So this is why I agree and disagree with your new information.
Sandee brings up a good point. Attitude is everything. Statistics say cancer and other grave illnesses have higher survival rates and faster healing in those that laugh and are optimistic. Healing is enhanced when one is positive and again....laughs a lot.
We all know it is difficult some days to be positive. But we need to find things that make us smile and bring joy into out lives everyday. Laughter release endorphins and speeds the bodies healing process. So I think we all should add that to our list of New Years resolutions, a laugh a day. Let's not lose sight of the joy in life.
We all know it is difficult some days to be positive. But we need to find things that make us smile and bring joy into out lives everyday. Laughter release endorphins and speeds the bodies healing process. So I think we all should add that to our list of New Years resolutions, a laugh a day. Let's not lose sight of the joy in life.
your right but i will be 48 this year and my body feels 78....lol..if i didnt laugh i would probably cry..lol
Have an Answer?
You are reading content posted in the Pain Management Community
Find out how beta-blocker eye drops show promising results for acute migraine relief.
Could it be something you ate? Lack of sleep? Here are 11 migraine triggers to look out for.
Find out if PRP therapy right for you.
Tips for preventing one of the most common types of knee injury.
Here are 10 ways to stop headaches before they start.
Tips and moves to ease backaches
