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  • Are there some people for whom opiates simply do not work?

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    Old 06-26-2007, 06:46 PM   #1
    dianaiad
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    Are there some people for whom opiates simply do not work?

    I'm not talking about "are there some types of pain for which opiates will not work," but are there some PEOPLE for whom opiates do nothing at all?

    If there are, I think I may be one of them.

    After total knee replacement surgery, I was given a morphine pump; trust me, it did NOT help; I got considerably more pain relief from a big batch of ibuprofen.

    This has held true every time I have been prescribed opiates; the results for me, are....nuthin'. Constipation, that's it. NO pain relief. No 'brain fog.' no sleepiness. It's as if I swallowed mints, for all the effect they have. The only time an opiate does affect me is that, a year or so ago I was prescribed a cough medicine with codiene in it, and man....I felt like I had swallowed acid; I was in scary pain for over an hour. I confirmed that it was the codeine by (talk about STUPID!) tried taking it again a day later.

    Nope, not doing that again.

    I suppose that this is a good thing in that there is NO danger that I would get addicted (shoot, in desperation once I tripled the dose...I was hurting rather badly...and I may as well have swallowed M&M's. I didn't even get sleepy.)

    I have done some research, but I haven't found any work on whether it is possible for some people simply not to have the receptors or whatever it is that allows opiates to work. So I'm asking; does anybody here know anything about this? It looks as if I'm going to get the other knee replaced, and I would really like to be able to have something to prove to the docs that, no, morphine doesn't work and yes, there has to be another option.

    Dianaiad.

     
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    Old 06-26-2007, 07:48 PM   #2
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    Re: Are there some people for whom opiates simply do not work?

    Hi Dia.

    I would suggest you consult and anesthesiologist and/or a neurosurgeon before your next surgery. I know there are people with both extremely low and high tolerence to medications.

    I strongly recommend you not increase the dosage by yourself again, You are probably not immune from overdose or liver damage.

    Have you been this way all your life? will a normal dose of tylenol or advil work for a headache, or a sprain?

    I guarantee you that an anesthesiologist could find a medicine and a dosage that would work for you, even if they have to do some kind of epidural med.

    What do you take on a daily basis, if anything, including OTC stuff or herbal suppliments? It may be something else is blocking these types of meds from working.

    Maybe someone can help based on the 'clue' of your reaction to the codiene cough medicine. Dave, anyone??

    Good luck and I hope you find the answers you are looking for.
    ~Fabby

     
    Old 06-26-2007, 08:14 PM   #3
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    Re: Are there some people for whom opiates simply do not work?

    Hi back...

    As far as I know, I've 'been that way all my life.' Actually, I don't KNOW that I have, since the first time I was ever prescribed opiates was for postop pain when I had my gall bladder out. (Not that I was ever in very much pain for that...I seem to have a rather high pain threshold) Ibuprofen worked then, vicodan did not. Vicodan has never worked.

    As for other medication...shoot...I have an asthma inhaler. Does that count? I don't even take vitamins! I will say that stuff like ambien and tranquilizers work fairly well, if they are not opiate based, and no, I don't take those, either. Something about replacing a really bad knee did absolute wonders for the pain there.

    So now...ibuprofin. That's it, that's all I ever take and I don't often take that. This question of mine is preventative. I don't want a repeat of my last post op experience, is all.

     
    Old 06-26-2007, 10:16 PM   #4
    Fabrashamx
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    Re: Are there some people for whom opiates simply do not work?

    Wow that is just odd, I'm going to ask Dave or Jon or Marcia or someone for help here, I just have no idea whats going on with you or what to suggest, although I stand by my original advice to see an anesthesiologist or a neuro.

    Anyone else out there? Dave?

    ~Fabby

     
    Old 06-26-2007, 10:45 PM   #5
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    Re: Are there some people for whom opiates simply do not work?

    I diana, I think you making a huge leap from a few experiences whith what simply may have been too much pain and not enough opiate. It is rather unusual that you start with higher than normal tolerance, but that's probably more easily explained by other metobolic conditions and yoiu reralluyhaven't described that. Just because you had IV morphine, it dopesn't mean you were given enough. If you ned a mg per hour and a doc is giving you a 1/10th of what you need, it's not that your don't have enough receptors, it's that you aren't getting enough opiates.

    When they started me on LA morphine they started at 100 mgs twice a day, it didn't do squat. At 400mgs a day I was still miserable but at 600 I was getting the best relief I had in years. Some people simply need more meds or have more pain than thier body can manage. I would think that if you get relief from an anti inflamatory, that's a pretty good indicator that the pain is related to swelling.That's a good thing to know because at least it's not nerve pain which is notorious for being difficult to manage. Untill the swelling is treated, even opiates can only do so much.

    My mother worked right up untill the day she had her TKR, She never took anything stronger than motrin. She still has pain but she deals with it in a way that works best for her. It's really hard to even consider the posibility that you simply don't respond to any opiates, they are part of the anesthesia cocktail used ijn general anesthesia and you probably would have had problems during surgery if you had no opiate receptors.

    I was never given anything stronger than percocet for any surgery I had and they all were pretty miserable. Surgeons shoot to take the edge off, they don't want you on strong meds long and it's a test of their surgery to see how you do without the meds or with very little meds.

    For some people having the edge taken off is enough, for others, no amount of pain is tolerable. We all fall somewhere along a very long line, but I doubt your not on the line at all because of some bizzare genetic birth deffect.

    It's more likely you have always been undermedicated. It's truly a small populaton of docs that only treat pain or treat exceptional patients with high dose opiates. It's certainly not the norm to take large doses of pain meds and you really haven't said anything about dose to make me think it's not easily explained by low dosing. Horriable pain that meds barely touch sounds pretty familiar for post op pain but hopefully it improves.

    If somone told you it was going to be easy and you would heal quickly and have little pain, It's more likely you were mislead/or the pain was greater and longer lasting than expected. Not prescribing strong enough pain meds was pretty much the rule up untill 5 years ago and docs are slow to change. That's a whole lot more likely than the self diagnosis of a genetic deffect you have never heard off, not have I. JMO

    If My doc decided I was simply unresponsive to morphine at 300 mgs a day, I would still be bed wridden and that happens, docs have an expectation of how much should work and won't go beyond their own comfort level when it comes to prescribing. Patients also have their expectations, something like IV morphine didn't help can be answered as simply as you weren't given enough.

    I had 3 major spine surgeries and they were pretty horriable pain wise even with PCA, so bad that I really can't remeber it all the first few days. I do remeber puking for days after the second back surgery and some of the pain, but is just a blur compared to the pain of coming home with just percs and intructions to stay flat and in brace for 3 months. I couldn't stand without help and no doc was offering more meds as a way to stand. I could easily say oxycodone did nothing after the last 6 level fusion and oxy is stronger than morphine mg to mg.

    That was before they even made 10 mg percoet, 30 mg roxicodone or 100 mg Kadian capsules. Just because the stronger meds are now available, it doesn't mean a doc that has always used 5 mg percs for post op TKR's is going to be comfy prescribing something 3 or 4 times stronger that what they have used for the previous decades. Even if that's what it would take to make you more comfy, the fear of addiction was so engrained in med school and residncy, virtually no doc or surgeon prescribed anything stronger than 5mg percocet or tylox if you weren't terminally ill.

    Undertreatment of pain has gone on for decades and people are so far better off now than just 10 years ago, there is no comparing. If you didn't have cancer , you would have been calalled a junkie if you asked for pain meds 4 months post op, regardless of the surgery or how extensive the injury. If your doc graduated before '98, they weren't tought any different or how to manage a patients with higher doses needs. They spent more time teaching them about drug abuse than propper pain management.


    I have an implanted pump now, I work out daily and work part time. I still have a failed 6 level fusion, broken screws and rods that squeek and grind with every step, but it's tolerable. We shoot for 50% pain relief and I've been extremely stable for years on the same dose once the right level was reached. Even docs that use imklanted pumps still have their own comfort limits, not every doc is so enlightened he will adjust a med to truly manage your pain and not use what he thinks should work for you and others as a guide. I've met folks with pumps that had to change docs 3 times to find one willing to adjust the device to a level that made surgery to install the pump worthwhile. What's the point of having a pump if a doc refuses to deliver enough medication to make a difference in your evel of function.

    It would just be too rare and so far you haven't mentioned a dose of anything that would make me think this is possible. T-3's/ 30 or 60 mgs of codeine really isn't considered stronger than motrin, so that's not realy surprising that an anti inflamatory helps more with a TKR.

    Just my 2 cents.
    Take care, Dave

    Last edited by Shoreline; 06-27-2007 at 03:36 AM.

     
    Old 06-27-2007, 07:14 AM   #6
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    Re: Are there some people for whom opiates simply do not work?

    the one huge thing i have learned over the last seven years is that anything is entirely possible when it comes to the human body.little freaky wierd strange things can happen in people that they just don't know about til the time comes.while it is entirely possible that you very well 'could' have some sort of actual issue when it comes to narcotics,the most likely explanation would be what dave just stated.BUT that doen't mean it would not be possible.i worked with a woman who actually had the very same issue you appear to have with narcotics.it was actually a metabolization issue with her.it wouldn't hurt to really explore this more in depth with your doc.i would simply just ask him if this would be possible and what actual reasons there could be that could cause it.or try doing some research on your own.

    like i said,ANYTHING is indeed possible when it comes to the human body.there are just so many things we don't truely know or understand sometimes when it comes to genetics and other abnormalities going on in there.believe me,my little family is a very good case for that.nothing really suprises me anymore.

    this just really does need some further evaluation.they can also run specific types of tests just to see how you actually metabolize any given narcotic,and your overall kidney and liver functions.i do wish you luck in finding some answers.please keep us posted on things,K?marcia
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    Old 06-27-2007, 10:49 AM   #7
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    Re: Are there some people for whom opiates simply do not work?

    you say no opiate works for you. what all have you tried? Vicadin is weak and I wouldn't expect that to help someone with a knee replacment and or a removed gall bladder, what strength did you take it might have been a 500mg there are much stronger ones than that. have you tried methadone, oxycontin, which is percocet, how about Dilaudid, fentanyl, morphine comes in many forms, how about the lollipos, there are many, many more i have not listed but I don't beleive nothing works for you, you just need to try different pain meds to see what helps you. I am sure you are not opiate intolerate of every opiate known to man, you have only tried a few according to your post so try more, you will need something to help with a knee replacment.

     
    Old 06-28-2007, 06:35 AM   #8
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    Re: Are there some people for whom opiates simply do not work?

    I agree that it is unlikely to not respond to ANY opiates. I was given morphine twice in large doses, one time in the ER and once after surgery. There was NO pain relief to speak of, and it didn't effect me any other way, except to make be a witch! I was extremely irritable and argumentative. After the nurses say the personality change and lack of pain relief, they told me to list morphine as an allergy. I did, and now they use either dilaudid, or demerol. Both of these work very well, in the right doses.

    Vicodin does not help my pain at all, just makes me nauseaous. However, percocet works wonderfully, and I am on the long and short acting versions for that reason. You may have to do some experimenting, but I don't think it's time to throw in the towel by any means. Make sure you don't sabatoge yourself. If you go in with the thought "nothing is going to work", it probably won't!

    Good Luck!

    Amanda

     
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