trowftd3
11-02-2005, 02:43 PM
Sorry, I didn't respond sooner.
The reason my hubby is on board with the medication rotation idea is because he saw me suffer for a month when the medication wasn't working. He kept telling me to go in and get a med increase but I didn't want to rock the boat.
Both the doc and my hubby are talking about rotating medication the next time I grow tolerant. My question was why a different med and why not just an increase when the oxy works for me?
I am still not quite at the place where I'm accepting of the fact that I'll have to take these meds for the rest of my life. First of all because I have no diagnosis...I keep thinking they'll come up with one and along with it a cure!!
I'm also afraid that since I don't have a diagnosis they'll take the meds away from me!
My last pm visit he basically said that I will have this pain forever and there's nothing they can do about it...I guess I have to get used to it.
I also fear the side effects of meth, etc...I know...what's a couple weeks when you'll be in pain forever....it all comes back to me not accepting the life-long sentence.
Thanks for listening...I just wanted you to understand my point of view.
Also, my hubby does understand chronic pain. He has had disc problems since he was 13(docs say there is nothing they can do) and just went back to work yesterday after a year off with a fractured heel. He's still in a lot of pain but is a MAN so he can tough it out!!LOL I keep telling him he needs to get in pain management.
He suffers and occasionally goes in and gets a few percocet to make it through the toughest of times. He understands...he just doesn't want to see me in pain.
The reason my hubby is on board with the medication rotation idea is because he saw me suffer for a month when the medication wasn't working. He kept telling me to go in and get a med increase but I didn't want to rock the boat.
Both the doc and my hubby are talking about rotating medication the next time I grow tolerant. My question was why a different med and why not just an increase when the oxy works for me?
I am still not quite at the place where I'm accepting of the fact that I'll have to take these meds for the rest of my life. First of all because I have no diagnosis...I keep thinking they'll come up with one and along with it a cure!!
I'm also afraid that since I don't have a diagnosis they'll take the meds away from me!
My last pm visit he basically said that I will have this pain forever and there's nothing they can do about it...I guess I have to get used to it.
I also fear the side effects of meth, etc...I know...what's a couple weeks when you'll be in pain forever....it all comes back to me not accepting the life-long sentence.
Thanks for listening...I just wanted you to understand my point of view.
Also, my hubby does understand chronic pain. He has had disc problems since he was 13(docs say there is nothing they can do) and just went back to work yesterday after a year off with a fractured heel. He's still in a lot of pain but is a MAN so he can tough it out!!LOL I keep telling him he needs to get in pain management.
He suffers and occasionally goes in and gets a few percocet to make it through the toughest of times. He understands...he just doesn't want to see me in pain.
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madhatter
11-02-2005, 03:08 PM
Hi,i'm just wodering if your doc. told you some of the side effects from meth,one being that they deteriate your bones.They make pin-like holes in your bones if used for a long period of time. Not to be nosey,but i read about that on this forum,and figured it wouldn't hurt to share that with you.
trowftd3
11-02-2005, 03:14 PM
Yikes, no I hadn't heard that. If that's the case it's another reason I don't want to take meth. I'm already at risk for osteoporosis...don't want to do any more damage.
Shoreline
11-02-2005, 04:50 PM
Hey T3, Although all opiates have very common mechanisms of action, they bind to opiate receptors, there are some differences in the receptors they bind to and how well. There are basically 3 classes of opiate recepturs, Mu Kappa and Delta, each receptor has has unique propeties when an opiate binds to it. In each class there are sub class . Like MU1, MU2, MU3, Delta1, Delta2, Kappa 1,2 and 3 etc.
THis is where you get some distinction from one opiate to another. The class and sub class of receptor activity and what it's effect is. It's also compared to a lock and key or puzzle. Often when working on a 1000 piece puzzle, you may find several puzzle pieces that almost fit but isn't the right piece or perfect fit. The better an opiate binds to a receptor the more pain relief you will get. What makes Hydromorphone "Dilaudid" stronger than morphine is the way it fits. IT basically locks in place better than morphine, it also locks into different receptors and sub receptors that morphine may not or doesn't lock as well into.
So rotating allows different receptor activity and allows for a better fit depending on the opiate and the individual.
There are some opiates that have properties that others don't. ethadone blocks the NMDA receptor and only Levorphanol, another opiate in methadones same class does this. There are other drugs that block the NMDA receptor but often when switching away from methadone, the loss of certain opiate receptor activity can cause diferential withdrawal. Meaning withdrawall because the opiate has unique prperties that the new drug doesn't. Tpeople switching away from Fentanyl can have the samsame problem. Fent has more Kapa activity than morphine or oxy so when you switch away from duragesic, your may experiences some withdrawal from lack of the specific kappa receptor activity.
The basic presumption is that an opiate is an opiate, they bind to basically the same receptords rproducing pain releief. But the suttle differences between the differnt class of opiates can offer a greter degree of pain relief . The type of pain you have also is a factor, whether it's nouropathic, somatic or vusceral, different opiates seem to work beter on different types of pain. The synthetics are one class, "Hydro,Oxy, Hydromorph, and oxymorph." Then you have natural opoids like morphine, codeine and dimorphine "Heroin" These are a seperate class from the synthetics with an extra hydrogen or oxygen molucule atached. . The fentanyls and demerol are a completely different class and then you have methadone,levorphanol and Darvon in a 4th class of opiates. Each opiate in each class are all keys that will open receptor locks but the fit may be better and the activity at each different opiate receptor and sub group is slightly different. Each class of opiates also has slightly differtent side effects or the side ffects may be more severe from ne class of opiate to the next. Morphine is genrally more sedating than oxy or hydromorph, but that is a side efect most people becom accomadated too. This could make one class of opiates intolerable and another more tolerable.
Basically you have a dozen peices of a puzzle that all fit into the same spot but some fit better than others and some will be the right fit for the type of pain you have and the receptor activity you need for that pain. So there are a number of variables aside from the basic idea that an opiate is an opiate.
Does that make sense?
If your not getting a good lock from oxy and you continously need to increase to obtain the same relief, why not try another key? In theory when you find the right key for the right lock you can go for years before tolerance becomes an issue.
What is your present dose and how long where you able to maintain on your last dose, what do you use for BT pain. Don't worry, I serriously doubt your going to shock me with a number of mgs and if you're still low, I would likely say stick with it untill it becomes a problem.
As far as the meth eating pin holes or causing osteo perosis, I have read a post here too where someone mentioned that but haven't read any study that has suggested or proven this. There also cold be other variables. If thy are looking at the meth maint population for addiction, are they considering the years of heroin use and mal nutrition prior to going on MMT? I'm not saying it's not true, I just haven't come across any info that would worry me about long term effects of methadone on bones. Do you have a link MH to that post or a study I could see? I think many patients would agree it has an effect on hormones like testpsterone, you could easily make a jump from decreased hormones to casausing other problems like OP but I haven't seen a study. However there are lots of things they haven't studied and simply don't know why certain meds works, what it's mechanism of action is, other than it simply does the job and that's good enough. There are plenty of drugs that if you look at the mechanism of action they say it's unknown. That just means they haven't studied it long enough or looked deeper into a drugs effect on a specific system like the endocrine system.
Take care, Dave
THis is where you get some distinction from one opiate to another. The class and sub class of receptor activity and what it's effect is. It's also compared to a lock and key or puzzle. Often when working on a 1000 piece puzzle, you may find several puzzle pieces that almost fit but isn't the right piece or perfect fit. The better an opiate binds to a receptor the more pain relief you will get. What makes Hydromorphone "Dilaudid" stronger than morphine is the way it fits. IT basically locks in place better than morphine, it also locks into different receptors and sub receptors that morphine may not or doesn't lock as well into.
So rotating allows different receptor activity and allows for a better fit depending on the opiate and the individual.
There are some opiates that have properties that others don't. ethadone blocks the NMDA receptor and only Levorphanol, another opiate in methadones same class does this. There are other drugs that block the NMDA receptor but often when switching away from methadone, the loss of certain opiate receptor activity can cause diferential withdrawal. Meaning withdrawall because the opiate has unique prperties that the new drug doesn't. Tpeople switching away from Fentanyl can have the samsame problem. Fent has more Kapa activity than morphine or oxy so when you switch away from duragesic, your may experiences some withdrawal from lack of the specific kappa receptor activity.
The basic presumption is that an opiate is an opiate, they bind to basically the same receptords rproducing pain releief. But the suttle differences between the differnt class of opiates can offer a greter degree of pain relief . The type of pain you have also is a factor, whether it's nouropathic, somatic or vusceral, different opiates seem to work beter on different types of pain. The synthetics are one class, "Hydro,Oxy, Hydromorph, and oxymorph." Then you have natural opoids like morphine, codeine and dimorphine "Heroin" These are a seperate class from the synthetics with an extra hydrogen or oxygen molucule atached. . The fentanyls and demerol are a completely different class and then you have methadone,levorphanol and Darvon in a 4th class of opiates. Each opiate in each class are all keys that will open receptor locks but the fit may be better and the activity at each different opiate receptor and sub group is slightly different. Each class of opiates also has slightly differtent side effects or the side ffects may be more severe from ne class of opiate to the next. Morphine is genrally more sedating than oxy or hydromorph, but that is a side efect most people becom accomadated too. This could make one class of opiates intolerable and another more tolerable.
Basically you have a dozen peices of a puzzle that all fit into the same spot but some fit better than others and some will be the right fit for the type of pain you have and the receptor activity you need for that pain. So there are a number of variables aside from the basic idea that an opiate is an opiate.
Does that make sense?
If your not getting a good lock from oxy and you continously need to increase to obtain the same relief, why not try another key? In theory when you find the right key for the right lock you can go for years before tolerance becomes an issue.
What is your present dose and how long where you able to maintain on your last dose, what do you use for BT pain. Don't worry, I serriously doubt your going to shock me with a number of mgs and if you're still low, I would likely say stick with it untill it becomes a problem.
As far as the meth eating pin holes or causing osteo perosis, I have read a post here too where someone mentioned that but haven't read any study that has suggested or proven this. There also cold be other variables. If thy are looking at the meth maint population for addiction, are they considering the years of heroin use and mal nutrition prior to going on MMT? I'm not saying it's not true, I just haven't come across any info that would worry me about long term effects of methadone on bones. Do you have a link MH to that post or a study I could see? I think many patients would agree it has an effect on hormones like testpsterone, you could easily make a jump from decreased hormones to casausing other problems like OP but I haven't seen a study. However there are lots of things they haven't studied and simply don't know why certain meds works, what it's mechanism of action is, other than it simply does the job and that's good enough. There are plenty of drugs that if you look at the mechanism of action they say it's unknown. That just means they haven't studied it long enough or looked deeper into a drugs effect on a specific system like the endocrine system.
Take care, Dave
BrittleBones
11-03-2005, 10:51 AM
I would also like to know if any studies have been done to determine the effects of methadone on bone mass. I have severe osteoporosis which is the cause of my spontaneous fractures (most vertabrae, right hip, right femur, heel, foot, wrist). My doc started me on Methadone about 6 months ago and he was very aware of my condition and consulted with my rhumy and my endocrn docs. If I could find a legitimate study that showed that meth caused bone loss I'd be on the phone with my doctors in a heart beat! So Dave, or anyone else, if you find anything on the web that looks promising, please point the way. Thanks! KathyMac :wave: