Years of pain on opiates, opiates now gone

[emjai]

After years of taking opiates for back pain due to two lumbar fusions, exacerbated by years of lupus, I was finally able to get clean of the opiates but the remaining pain is quite bad.  My doctor suggested I try Lyrica, and I started on one 50 mg dose at night and am now taking one dose in the morning and the other still at night.  The pain is so far not being handled at this dose.  My concerns are becoming dependent on the Lyrica if the dose is increased, and also that my body's own chemicals to fight pain, which have been dormant for so many years due to the opiates, will NOT reappear to naturally fight my pain because of the Lyrica.  Can someone tell me what is best to do?

[emjai]

vox,

Both you and ggreg were extremely helpful in your suggestions as to how best to handle this whole situation, which at times makes me feel very helpless.  Thank you.

emjai

[emjai]

Thank you gg for taking the time to talk to me through this forum.  You weren't longwinded.  You were helpful.  I'll try to put into practice what you've suggested.  Thank you again!

MJ

[ggreg]

Dear Emjai,
I would like to add a comment about Lyrica.  The dose you took is probably nowhere near enough.  I had sharp pain in lumbar spine, wrecked up my whole back in a car wreck, and opiates didn't touch it, but Lyrica at 75mg bedtime stopped the pain overnight.  But the way that drug works is, it has to be increased about four-fold in the first several months, your doc should already know this, until you reach a plateau of comfort in your dose and schedule.  So, my suggestion, before you drop the medication, is to ask the doc to increase your Lyrica dose.  He might want to, say, prescribe 75mg at bedtime, and another 75mg at lunch.  See how you do with that.  Then over the next few months, he might up that, to more times per day and at a higher dose, for example.

As to your questions on whether the opiate usage took away your body's natural ways of killing pain, which is by endorphins being released in the brain, the opiates will not affect the way that works (illegal drugs like Ecstacy DO do that).  To confirm how endorphins help kill pain, even tho this may be uncomfortable, start to do some simple exercises at home for about a week, and then increase it to longer and longer walks out in the neighborhood.  When you reach a certain threshold with exercise, endorphins will really start flowing in the brain, and you'll feel worlds better.  People who run in 10K distances talk about this zone they get into after a couple miles, where the endorphins take over, and as a result, they feel really good and want to stay in that zone.

Also, if you do some of this long walking eventually, you can get a back support wrap from the pharmacy, or if you want to, you could simply get your exercise with some physical therapists and they'll prescribe a brace for you, to keep the movement of your lumbar spine to a minimum, so you won't cause more pain by doing exercises.  I know, all I have to do is bend just a little bit when washing dishes, and gosh my back goes to pieces.  So, I keep my back brace handy whenever I'm going to do something stupid that will strain it.  But actually, easy exercise has not bothered my back, altho walking for any length of time DOES bother it, so I wear my back support when I do that.

I might add that if you up the Lyrica and it still isn't helping as much as you'd like, your physician could also prescribe a mild tranquilizer (I take Klonopin, relaxes muscles) to take with the Lyrica, it increases the effectiveness of Lyrica, you won't need much tranquilizer to get the effect, and you can stay on the same dose long-term of the tranquilizer.  Both drugs do indeed create a sort of dependency, but they're not as hard to get off as opiates, plus since you are already on the alert about that kind of situation, you do not have to worry about how it might take over.

I would also like to thank the previous poster, Vox, about her advice with the professional massage therapist and also acupuncture treatments.  No matter whether medicine works or not, massage or acupuncture feel REALLY good and will provide not only pretty substantial pain relief, but also will increase flexibility so you can move around better.  In closing (finally), I'm sorry I've been so long-winded, but I'm real familiar with the troubles you have, Emjai, and I wanted to tell you everything I knew, in hopes it might help you a little bit more than where you're at now.
GG

[vox_weps]

Ahh, I didn't see the part about lupus. That would be why the doctor would turn to lyrica. It's interaction with your lumbar problems is irrelevant. It is systemic, not localized, so it wouldn't focus anymore on that than anything else. The only thing is that since it is inflammatory it would make the injury seem worse seeing as the nerves are inflamed anyway. I would possibly seek alerternative methods such as massage and accupunture. If you are lucky enough to have good insurance these might be covered, if not there are sliding fee clinics that do wonderful work.

[vox_weps]

I wouldn't be concerned about lyrica. It is not as addicitve as barbiturates or opiates. It is commonly prescribed for problems such as yours and has proven effective. It works on a different level than opiates so I doubt it has to do with a deficiency caused by addicition. Lyrica works on neropathic pain, meaning the nerves themselves are damaged and sending incorrect signals, working on the nervous system itself as opposed to triggering or adding pain blocking chemicals. So, the doctor is trying to stop the pain caused by the nerves in your back that are damaged as opposed to treating the nerves being simulated by the damage from the injury. If lyrica isn't working, that could mean the nerves aren't the problem. That would mean a blocker would be better, and problem is most if not all are biologically addicitive.