primary says - you have chronic pain - what to do?

[GordonCook]

the thing that you need to do is  find and keep the lowest dose of fentanyl that will keep the pain at bay.  So next Wednesday I move to only 50 µg from 62.5.  Nervous!   the weird question now is I'm not absolutely sure exactly where the source of my pain is?   I know one source has been in the S I joint on the right side but with physical therapy and strenuous exercise I can put weight on my right leg and stress the sacroiliac joint without it hurting!  Horaay.

At night when I am immobile everything from my knees to chest arms and thighs etc. hurts but the hurt is a soreness rather than screaming pain. I have learned now that if it's waking me up I must get up and move and exercise a little bit that doing this will alleviate the problem.   So I do it to cope with it.   it's not what I had last may thank God. May was in nine and 10 and maybe 11. This is five or six,

now one question is with the abscess and infection  of the psoas major on my right side "gone" is the horrible pain from last May gone or is it still there lurking and masked by the fentanyl?
i think I hope its gone.

now the question is  I still have severe stenosis and multiple places according to two different MRIs and one CAT scan  done after the surgery of November 2013.  How much pain is not causing? Hopefully not that much.   in theory the fusion at 45 and S1 should not be causing pain. I do have scoliosis which with the remaining desks at L1  L2 and L3 being generally desiccated may be a source of problems.  if not now in the future.

One can speculate but in my case I think I have three or four or five possible sources of pain once the fentanyl is further decreased
.
So my question is at least whether there is anything that can replace it.   I must admit that while at the moment I can pay the price I find the  co-pay of either $85.00 hundred and $70 every month in effect 13 months a year because we are talking a 30 day supply not 31 is outrageous.

I am very leery of methadone although the other docs said it's "dirt cheap"

is there anything else?

how would I know whether the continuous delivery of the pain that it comes from fentanyl is really that important.

I'm getting zero support from my wife who seems to be quite pain tolerant and declares methadone is what you take to get off of heroine you do not take it to relieve pain of course she's wrong but you can't tell her that.

I am confident that if I can show my primary that I've done my research and backup my request with evidence that he would have no problem putting me on something other than fentanyl.   so what to do?   So damn discouraging.

[GordonCook]

thank you very much Tuck
you response will demand time i can't give it right now
but I will - promise
I have something related to bring up

[Tuckamore]

I understand your wife's concern. Seniors have to be especially cautious when taking opiates - or most any medication. That's another long subject that I will avoid at this time - but it is a fact.

There are multiple sources on Methadone in pain management. There are also good and and not so good outcomes in using Methadone for pain management. I'll be honest with you - it scares me - especially in seniors. About ten years ago my PMP ordered it for me on a trial bases. I wasn't impressed with it's pain management effects. I was on a small dose but feared going to a higher one.

Some ppl swear by Methadone's pain reducing effects - others say just the opposite. There is a lot of stigma attached to Methadone - some is just not justified. It depends on what you are comfortable with - and how effective the drug for you - and how competent, educated and skilled the prescribing physician.  

Methadone is not a preferred initial treatment in Pain Management because of its long half-life, which makes it difficult to titrate.

Here's a few links on Methadone in Pain Management.

http://www.practicalpainmanagement.com/treatments/pharmacological/opioids/methadone-pain-management

Here's a link to several discussions in MedHelp about the same. These discuss the pros and cons of Methadone Pain Therapy in our Senior population:

http://healthquestions.medhelp.org/methadone-in-elderly

In late 1999 a trusted web-site carried an article over the concern of the increase use of Methadone in Pain Management. Remember that was about the time opiate RXs were on the rise. Deaths from ODs and misuse of all opiates were also on the rise - and continued for approximately ten years. Here's what that web-site has to say (in part):

Begin Quote:
"The Problem With Methadone"

"The increase in methadone deaths corresponds to the drug’s increased use for pain relief, which began abruptly in 1999, says Nicholas Reuter, a public health analyst who has been tracking methadone use and deaths for the Substance Abuse and Mental Health Services Administration.

Increased concerns about the abuse potential of the pain reliever OxyContin and the desire for a relatively inexpensive long-acting opioid painkiller led to the shift in methadone use.

Last year, 750,000 methadone prescriptions were written for pain relief, but only 250,000 people were treated with the drug for addiction to heroin and other opioids, Reuter tells XXXXX.

Methadone can suppress drug withdrawal symptoms as an addiction treatment for 24 hours; the drug’s ability to suppress pain lasts just four to eight hours.

But methadone stays in the system as long as 59 hours. Patients may feel they need more pain relief before the drug is cleared from the body, and if taken too often or at doses that are too high, toxic levels can build up, which can lead to life-threatening changes in breathing and heart function."
End Quote.

If you place the words, "Methadone for Pain Management" in your search engine you'll find even more information.

I hope this has been helpful. I am not recommending Methadone - or any opiate. It would be irresponsible of me to do so.

What I do recommend is to educate yourself on any medication/opiate suggested by your medical provider. Knowing the pros and cons and the risks and benefits - will assist you in making an educated decision. What's right for you may not be right for me, Joe or Sally and vise versa.  

I encourage you to research all LA opiates - once you've done that and are educated maybe you can make suggestions to your PMP.  Be sure to ask if your PMP has the additional training suggested - maybe even required today -  before prescribing Methadone.

If you need assistance in searching please ask. There's a lot to learn and consider. Good luck my friend in pain.

~Tuck

[GordonCook]

I was in   hurry 6 hours ago... just read this carefully makes much sense.  Thank you. Fortunately dizzyness is NOT a symptom for me.  Michael dash  my primary is NOT trained in pain management but he *IS* open to documented research that i bring him.

[GordonCook]

is there a single resource regrading methadone as pain  reliever your recommend. wife claims its NOT a pain reliever got to pedel the to see how long i can sleep before waking

[Tuckamore]

Hi Mr. Cook,

It's good to hear from you again. You are facing one of the many challenges of Chronic Pain. We've all been there to one degree or another - and my heart goes out to you. We get it! It can become discouraging! Hang tough, you'll get through this too.

What is fortunate in your situation is that you have a physician that is willing to work with you. Many of us don't have that in this opiate-phobic climate. So chalk that up as one for the good guys. It's a big one!

Am I missing a rescue SA opiate in addition to the Fentanyl? I'm not reading anything that says you do have a SA opiate. Did I miss it?

There are options to the expense of a Fentanyl Patch. However it depends on what is effective for you - how your body metabolizes each opiate. Obviously you won't know that without a trial and error process - unless your Physician does the new DNA check swabs to determine what opiates you best metabolize.

The least expensive LA opiates include MS Contin which is a long acting Morphine. Methadone is also used effectively in Pain Management. Do your research on both - but especially Methadone. It scares me a bit and not because of it's reputation in rehab. If you move - or your physician relocates you may have a lot of difficultly finding another PMP that will be comfortable in writing you an RX for Methadone. I hear that issue here.

There's a newer LA form of Hydrocodone. I haven't heard a lot of good things about it. Obviously being new it has a patent and it's not in the inexpensive category. LA Oxycodone called OxyContin. Is a bit less expensive than the Fentanyl Patch - but it was highly abused and PMP are concerned about prescribing it. I found it to be very effective in managing my pain.

Those are the LA Opiates that I am aware of - maybe our members have other suggestions.

I know the pain of SIJD (Sacroiliac Joint Dysfunction). It was the DX that initially disabled me and finally brought my life to a screeching halt. It's difficult to keep the SIJ healthy. Don't ignore it. Mine will never be right - or good again.

I hope you'll be able to reduce the Fentanyl - and find a good, less expensive substitute.  

I'm sorry to hear that your wife is not as supportive as she could be. Ppl that have never experienced Chronic Pain have a lot of difficultly understanding it. Try providing her with information on the disease - yes it is considered a disease! You'll find some information on Chronic Pain in my journals. If you need help locating them please let me know. I also suggest taking her to your appointments. If you have a knowledgeable PMP they will often help in the education process. Like anyone would want to be a dependent upon pain management and the stigma that accompanies it! We'd do about anything to be free of the crippling conditions that make up Chronic Pain. Most ppl don't understand our plight! I'm blessed to have an understanding and supportive spouse!

I hope something I have offered will be of help. I'm  hoping our members will stop by and offer their suggestions also. I'll look forward to hearing more from you! Take Care!

Regards,
~Tuck