Opiates denied to young CP patients. IRK! - Pain Management Message Board

conductor · 11-11-2005, 04:19 AM

To all:

Many young patients are told they are too young to receive strong, potent opiates. One of the most often-stated reasons is that such young patients will develop tolerance so early that they will not have adequate options later. For an example, if a young person is given a 75 mcg Duragesic patch (1 patch every 48 hours--15 patches per month--like I was), they will develop such an opiate tolerance there will no longer be an appropriately strong opiate as their tolerance grows with age. I'm sure there is some validity to this argument.

Others will argue that there is no upward limit to the amount of opiate narcotic pain medication. I don't think this reasoning is completely true.

I will state right now that I am not a physician and do not have medical experience. However, I believe the truth lies somewhere within the middle. Tolerance develops to a signifcant degree (higher than the typical prescribing dosage), and there is--obviously--a point when an upward limit is reached.

I know of older pain patients who use almost 200 mcg of fentanyl (Duragesic) patches for their base pain med. For their Break Through (BT) pain meds, they use nearly 2400 - 2800 mcg of Actiq (fentanyl lozenges) at a time or about 16 mg of Dilaudid (hydromorphone) every 6 - 8 hours (at least).

This sounds like a tremendous amount to many readers, but it is not unusual to those pain patients who have been long-term pain patients. Naturally, there is an upward ceiling, but the limit obviously varies from one person to another!!

This hits very close to my heart because I was started on Duragesic around 1992/1993. Then, I moved from KY--when I finished my Master's Degree--back to my home (with my parents) in FL. At first, the pain doctor I found in FL continued my Duragesic treatment. But, within a couple of months (or even less), he quickly removed me from my opiate treatment. He declared that I was "far too young" to take narcotics!! Plus, he had a strange way on Rx'ing them. I would use 1 for 2 days, then go off it for 1 day. It seemed like going through W/D every 3rd day--even though the literature said the medication stayed in my body for 72 hours (I think). I didn't feel very good, nonetheless.

Well...it didn't take too long for me to plummet into the pits of hell!! I spent nearly the next 5 years in tremendous pain, and I could not find another pain specialist to give me aqequate relief. My Internist, at the time, did her best to offer me relief to the best of her ability. But, she gave me medications that simply were momentary--things like Percocet (which contained only 5mg of Oxycodone at the time), occasional shots of Demerol, and Stadol Nasal Spray (which helped the most since she Rx'd it regularly). She wasn't overly well-versed in Pain Management, although she tried her best to be compassionate! There simply wasn't anyone else in the area who offered Pain Management services.

My ultimate point is that there isn't anyone in their late teens "too young" to be prescribed opiates as a means of pain management. The whole idea disturbs me since I truly understand how disruptive chronic pain can be to a person's life.

Again, this is only an opinion. And, I'm IRKED at the idea that young folks cannot be treated with opiates (some use the term "narcotics", but that's not an accurate term).

I expect to receive some opposing responses, but I can handle them. Bluntly, I think I would have lost the will to live if I had not been permanently Rx'd the fentanyl patches when I was in my late 20's. I was so depressed when they were first taken away. To be forced back into that chronic pain made life very bleak! In spite of that, I was teaching full-time, directing a Church Choir part-time, and going to Law School in the part-time Evening Division.

To those of you who are young and in Chronic Pain, do your best to insist on being treated appropriately (you know...like a human) for your pain. I disagree with many of the concepts about being "entitled" to things. However, I think appropriate pain relief is one of those things!!

Best wishes to you!

Sincerely,
Jon

Chaddyfriend · 11-11-2005, 07:46 PM

i am 19 and havnt recieved any grief yet about using stronhg narcotics. i take 90mg of la morphine in the morning and 90mg at night, as well as 20mg oxycodone as needed. i havnt heard anything like this yet. i have post heperatic nerualgia from shingles.

ladyalaska · 11-12-2005, 03:40 PM

i was told that in the beginning, by my primary doc and i was 36!! "those types of meds are only for old people dying from a horrible disease", whatever! but he wasn't versed in the pain mgmnt field and when i went to a "real"pm doc it was a different story. if you have never been in pain you have no real clue as to what it feels like, i wish docs would remember that--oh i'm sorry that would get in the way of their god complex silly me!

friendly_one · 11-13-2005, 10:19 AM

I can relate. I was 9 yrs. old when my problems and surgeries started. I'm now 34. I was 30 when I finally found a doc who would treat me. I would get the same speech "you are too young for opiate treatment and what are you going to do if you live another 30 yrs. for treatment of pain?" My response was "I won't live another 30 yrs. like this because I will end it." Well, that just made the docs more defensive.

Anyway, I have been in PM for almost 5 years. It has saved my sanity, and quite frankly, my will to live. I still have bad days, and who doesn't while in PM? My doc tells me not to think like that...what will I do for pain in the future? He said, all we can do is deal with right now. So, for 21 yrs. I suffered and my family suffered. I was hospitalized twice for suicide attempts and went into the depths of depression hell. Nobody should be told they are too young for current medical treatment.

Bictwin · 11-17-2005, 11:15 AM

I can totally relate. I am 20 yers old and just received my first spinal fusion T10-L1. I have had this pain for 5 years and they started me on simple anti-inflammatories and muscle relaxants, physical therapy, a back brace...hoping those would limit my pain. It didnt...it took me 31/2 years before i found a pain management doctor that would prescribe me the meds i needed. The first appt with her i was scheduled for facet joint injection in L1-L5 and she gave me a scrip for vicodin. A few months later the vicodin wasn't working anymore so they put me on morphine. I lost almost 20 lbs on the morphine in a month (and im a very small person. 5'1'' and after i lost the weight i weighed about 89 lbs.) So they changed me to dilaudid which i was on for about 8 months. I finally found a surgeon to do the fusion and had surgery 17 days ago. Im doing ok, sitting up and walking. No bending, or lifting, or driving for 3 months. But the pain is still bad, hopefully just from the surgery, and incisoin pain. They have me on oxycodone and its working wonders my surgeon is only giving me enough for the 3 weeks though. I have to go back to the pain management doctor to get more. (which she already said she would give me, because she knows how surgeons dislike prescribing pain killers) The only problem i really had was over the weekends when i cant get to my PM doctor cause she's closed, or if she's on vacation. Her office is also 1 1/2 hours from my house so i cant just run down there and pick up a scrip. I've landed myself in the ER for running out of pain meds and my normal physician wont write the scrip for that heavy of a pain killer, even with all my PM doctors notes and my charts. So make sure y'all dont get stuck like i did. Hope all is well with everyone. Keep the Faith!