Join Date: Jun 2003
Re: What is better
Hi Selena, I dont know why morphine would scare you any more than oxycodone. Morphine doesn't have any additional risk that Oxy has and Oxy is stronger mg to mg., The pharmcist simply disn't slap all the labeles he could have easily slapped on oxycodone as far as warnings like, may cause dizzyness, don't mixc with alcohol, may be habbit forming etc etc etc. Narcotics are narcotics, Although pure narcotics don't cause organ damage the way tylenol or ibuprophen can cause if used excessively. When opiates are used excessively or patients take it upon temself to take extra, they put themself at much greater risk than the patient that takes a little more tylonol than they should. It's just so simple to take one fact about opiates being safer on organs and ignore every other aspect regarding the risks involved and consequences of opiate use. The meds themself can become more impairing than someones condition.
Personaly I know three people that have died in the last 15years from the opiates and med combos PM doc prescribed. It was the way they abused those meds trying to get more and more relief. That thinking that if one will help, then 3 would be better that gets folks in trouble. One of those deaths was my brother who also abused his meds in the sense he simply took more than what the doc prescribed. They would give him a month supply of Soma and he would take it a week. I doubt he could remeber a thing from that week but then had to go the rest of the month without the soma and experience withdrawal each month from the way he took it.
I have never personally met or inderectly heard of a friend of someone that that has died or had internal organ damage from Tylenol or Ibuprofen. Yes you can read the stats that 17000 people die every year from tylenol, But that's a drop in the bucket compared to the millions that suffer from addiction when PM turns from management to abuse.
I took 4000 mgs of tylenol and 2400 mgs of Ibuprophen a day for over 7 years and developed no internal organ issues. There are many PM docs that use alternative therapies. Or alternative therapies combined with pain meds. They may not provide the imediate relief like oxycodone did, But some people manage just fine without opiates or can reduce their dose by adding another med, therpay or treatment. My wife is also a CP patient, her problems are entirely different from mine, she was born with a gentic disorder that causes the muscle, tendons and nerve to die in her extremeties. She was able to decrease her dose of morphine when they started using Botox and doing nerve blocks and adding a med called Nemanda. It's a med used for alzheimers but is one of the most potent NMDA receptor blockers available. Blocking that receptor decreaees rapid tolerance to opiates, increases ones pain theshold and has absolutely no impairing side effects, It's FDA approved use is to improve memory.
Untill you have exhausted and tried every single method of pain ,their is no reason to think your pain can't be managed with a combination of therapies.They may never make you pain free, but that's not a goal of pain management. It's not called pain oblitiration, it's management. Before I was given opiates I went through 3 month long 8 hour a day PM clinics where they did everything including self hypnosis, bio feedback, guided imagry and breathing techniques, Pt twice a day, art therapy, counseling individual and group, Nutrition is also a factor, some foods actually can make things worse, so every clinic also had a nutrionist involved in patient care. They can try lidoderm patches, Lidocaine infusions, nerve blocks, Antidepressants to help with pain, not by simply reducing depression but they reducing a chemical that is seen in CP patients called substance P. They can actually test for this in your spinal fluid and anti D's do reduce this substance that is part of the neuro chemical process involved in pain transmision. Other therapies I tried were Chiropractic, trigger point injections, accupuncture, TENS, TINS,nerve blocks and ablation, Drugs in the anticunvulsant class work on another part of neuro chemical process of pain transmission. You should find that combing therapies works better than using one single therapy alone wether it's opiates or antidepressants.
Even if they only reduce your level of opiates, they are doing something as far as treating pain. As far as PT, not all PT is the same, There are many different methods and techniques each PT may be more famliar with and its use. Some focus on strengthening, some focus on myofacial release, some focus on scar management, So 8 weeks with one PT doesn't mean that 8 weeks with another PT that uses a different techniques wouldn't benefit you in some way.
Satisfactory pain management is also about expectations. If you expect to be pain free, that simply may not be realistic whcih means you will never be satisfied. After 8 years and 3 failed fusions I was eventually given opiates and then had a pump implanted that delivers dilaudid and clonidine directly to my spine. Adding clonidine works on an entirely different part of the neuro chemical process involved in pain and when they added it it it felt just like an increase without the negative side efects of additional constipation, urinary retention and cognative imapirment and hormonal changes. Their are meds that can increase ones pain threshold in the NMDA receptor blocking class.
I was told a succesful pump is one that relives 50% of the pain, so anything I can add even if it's 10 other things that only give me an extra 1% relief each, I would do it to get to 60 % relief. In my case it's all the other things that are part of my treatment plan that get me to 50% on a good day rather than living with just 40 % relief the pump provides.
The pyschological aspects of pain management should also be addressed by a psychologist or Psychiatrist that specializes in pain in addition to your PM doc. Fortunately I can recieve all the therapis I have ever tried or spoke of at the one clinic I have gone to for the last 10 years. They have a psychologist on staff, One of the docs is an anesthesiologist who does the interventional procedures, whether it's nerve blocks, steroid injections, ESI's. He also does the nerve blocks and RFA ablation proedures. They have an Osteopath on staff that can do chiropractic manipulations and also looks at the condition as a whole, diet, excercise, joint manipulation etc etc. My main doc is a Neuro Psychologist. that's a neurologist thathas specialized in the chemical reactions of the brain that deal with pain and emotion.
I stilll use some of the other methods I learned In the PM boot camps that did help. PM is trial and error, If something provides any relief at all, you make it part of your treatment plan reagardless of how little or how rediclous it may seem. We aren't the docs, we don't have to understand how antidepressant effect substance P, or how clonidone effects the production of GABBA or how nemanda or DXM blcok NMDA receptors. I feel like if I have to tell a doc how to treat me, I'm seeing the wrong doc. I shouldn't have to tell my doc I'm concerned about my tylenol intake, he is aware of every med I take and if my liver function test or any other tersting he does sudenly change I have connfidence he will know what to do.
I see people ask what they should ask their doc for. If you have to ask you doc for something , your seeing the wrong doc. Your job is to report your symptoms and the results of each therapy, drug or modailty and let them make the adjustments and choices in meds.
The one thing I found to be worse for pain than anything is being sedentary and homebound cut off from the outside world. Anything that can distract you at all from your pain is a good thing. If you can get lost in an art project, a book or stay buisy doing anything that stops you from sittting home alone with nothing to think about aside from your pain is a good thing. Do something that makes you feel good about yourslef and distracts you from the pain, even if just for a few hours a week readig to the blind.
Excercise cause endorphins to be released. My wife thinks Im crazy when I come home from a 10 hour day and can barely walk but get on the elyptical for 10 minutes. It distracts, causes an endorphin release like a runners high and makes me feel like I'm doing something positive rather than being sedenary and siting around getting fat and lazy.
No matter what the condition, their isn't one therapy that works for everyone, It's like trying to hammer all these square pegs through the round hole that one doc thinks is the answer.You also have to keep in mind that their isn't a single drug out their aside from placebos that doesn't have some type of side effect or consequence to taking. True, opiates don't cause organ damage, but it's a huge leap from no organ damage to being absolutely safe in every regard.
I personally feel guilyt when I dont ecercise because I dont feel I'm doing my part to maintain my health, I had my first heart attack at 36 from constant high BP from pain, no other factors, just pain and living with BP of 210/140 for almost a decade takes it's toll. Being sedentary is the absolute worst thing for ones overall health and no doc will disagree with that.
SO even if it's getting out and reading to the blind once a week for an hour, if it makes you feel better physcially or emotionally just for that hour, make it part of you treatment plan. I've certainly learned over the years that no matter how bad things are, their is always someone in worse condition than me or you. Yes it used to make me mad when people said things could be worse, you could be paralyzed, but they were right. The very first PM doc I went to told me all I needed to do was excercise 3 times a week. It made me mad, sounded absurd and I never went back to him, But now it's part of my treatment plan because it helps, even if only for a few hours after, anything that helps and doesn't have negative consequences is a good thing.It keeps my weight in check, My core strong, helps with my heart and distracts me from the pain even if only for those 20 minutes ad a half hour afterwards.
Alot of people give simple answer like just find a doc that's not afraid to use opiates, but if he isn't offering anthing else or sugesting anything else He is doing you a great disservice.
Good luck and don't write off anything that might potentially help. If my doc told me to stand on one leg with an orange under each arm pit for 10 minutes a day, I would at least give it a try.
Take care, Dave
Last edited by Shoreline; 03-08-2012 at 12:36 AM.
Reason: Dont spell my best at 3 am.