Shoreline

Hey Deb, Although opiates do and can raise BP and pulse, and women often have a much lower BP and pulse than men, THese are both natural responses to pain, anytime I have been in pain they are extremely elivated. I had a heart attack on 36th bday,"3years ago" for years my combined BP was over 300 and it was dismissed as simply being from pain, pulse was always over 120 too. Because of my age and outward physical apperance, I was considered healthy and was never put on BP meds untill after the heart attack. On good days I'm in the 120/80 range but on bad days even with loads of opiates, muscle relaxers, benzos my BP meds it still spikes the 180/90 range. I'm turn white as a ghost and start sweating. They pretty much know how I'm doing when I check in and they look at me. I wouldn't worry about having naturally low blood pressure and not being believed that your pain is high. But it is part of a physical exam and visual exam.

My docs do nothing by phone, they want to see the whites of someones eyes. Not simply to apease the DEA "drug enforcement agency " but someone that can't stay awake through a 15 minute eval can stay awake long enough to make a phone call. So physical observation is one of the techniques used to evaluate pain. The clinic I go to has Video outside and watch people get in and out of cars and walk to the building, It's not uncommon to see people change from walking pefectly normal to suddenly they can't get out of a chair.

Unfortunately it's the natuire of the beast and pain is something they can't measure. So they look at diagnois, measurable signs like BP,pulse respiration, and observation, Are you slurrring, problems keeping eyes open and still complaining how horriable the pain is. I've never fallen asleep while asking for an increase in meds, but it happens or people just don't bother to come in when told they can't have one over the phone without being seen.

With the extensive testing you have done I'm sure they know you have naturally low BP Debs, Don't worry about that. A greater majority of the population will have measurable signs of distress, if there that obvious you don't need to explain as much, it's just makes things a little easier. Not that it did for me any good for 7 years but once with the right docs, it does. You do have to wonder why nobody ever followd up on my high BP but my last cholesterol was 110, rediclously low. But the heat attack was very real.

As far as Nubain. It's an opiate agonsit/antagonsit and someone already dependent on opiates will go into withdrawal from a drug that has an opiate antagonist it. Antagonist block and purge opiate receptors, the most well known is Narcan "neltrexone" the drug used to instantly reverse heroin OD's. They gave Nubain to me in the cardac intensive care unit the morning after the cardiac cath. It was the cardiologist standing order for pain. They knew I was taking 600 mgs of morphine a day, but the meds hadn't made it down to CICU yet and I assumed it was another shot of mophine, the same thing I had been given the night before.

Withn 15 minutes I was in full blown withdrawal, They could have easily killed someone who just had a heat attack by cramming 3 days worth of withdrawal into the 45 minutes it took them to get me sedated.

Stadol is also a combination agonist/antagonist. It's available in IM syringe "but people abuse it IV, and as nasal spray. The antagonist action is believed to put a cap on the amount of euphoria and the potency of the drug. Unfortunately people abuse it anyway, if it's the only opiate your using, that cap thing isn't entirely true. There was a lady that robbed the drug stoor at gunpoint for all their stadol a couple years ago just blocks from where I lived. The studpid thing she was one of their 3 customers that used it??? DUH.....

I need to check and see if your talking about levorphanol or something else. Levorphanol is potent, It's an oldie that never got much use so wasn't lucrative to produce, It's in the family of methadone but the only manufactuer in the US stopped producing it a couple years ago. I think it can stil be compounded and the bulk ingredient is made but not forumaleted for the US.

Hope your doing well. What's new on your treatment plan. Sorry I haven't been up to sitting lately.They did remove half the Baclofen from the pump last week which relieved some anyoing symptoms and hopefully they can adjust he pump now without extra baclofen side effects.
I have a tooth exctraction tommorow but will check out that med. Not every thing is available here that's used elsewhere. We have the FDA and DEA deciding what meds are legal.

They still use Dimorphone in the UK which is Heroin. It's deemed to have no medical value in our country. Dihydrocodone is commonly used in the UK and hydrocodone commonly in the US, both are available but I haven't met many americans that have taken dihydrocodone. The only difference is a couple hydrogen molucules and potency. But it's just the difference in the way drugs are agressively marketed in the US.
See ya later, Dave

Hey Deb, I got a chance to check out levomorphanan The closest thing we have is Levorphanol, the drug they no longer market in the US. Levomorphanan isn't patricularly potent on it's own and I would have to spend 3 pages describing stero chemistry and racemic chem but for example, the cough syrup dextromathorphan is an identical mirror image of the opiate Levorphanol. Because it's oppostie in moleculor structure, the only opiate property it has is cough supression, like all other opiates. So detromathorphan isn't a controlled drug buy our govt, meaning you don't need a prescription to buy it from the drug stoor.

Howevr Levormorphanan can be combined with certain drugs to make it incrediably potent and have the same disasociative properties as Ketamine. Ketamine isn't used outside of the Vetrenarian or the hospital. No such thing as script for ketamine however Ketamine is also know as special K, a very popular designer drug used by the Rave culture similar to Exstacy. Levormorphanan is about half the stenght of morphine which should make it a lesser controlled drug, but due to the high potental for abuse, increased potency and increased psychotrophic effects by bathtub chemists', it has always been a carefully watched drug and slowly phased out of production.

Some of the reading I have done has proposed using some of these combination opiate agonist/anatagonist as a first line method to treat chronic pain. Once someone becomes physically dependent on pure opiate agonist these meds are no longer options due to the potential to cause instant withdrawal when the antagonist action of the drug blocks and purges opiate receptors.
Take care, Dave