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    Old 08-31-2009, 05:39 PM   #1
    Melnwest
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    "opiate induced pain syndrome" and pain meds questions....

    Hi everyone,

    I am new to this board, and I have a question regarding my pain management...if anyone would like to help me out, since I can't afford to see a neuro also right now since I have other specialists. I had to be admitted to eating disorder treatment in June and I had been under a neurologist's care for 2 years and on narcotic pain meds and other migraine/nausea meds and they took me off the pain meds cold turkey and then ended up having to put me back on the percocet and then wean me off but have been off them all except the nausea meds still for 2 months since I am still in treatment now at the outpatient level, and they did that because they said I was going the route of becoming an addict of taking it on a daily basis for so long, and said I had "opiate induced pain syndrome": why my headaches were so severe at that time.

    My pain level did go down a lot, so for that I am thankful, because for the 2 years my headaches and other pains were getting worse and worse on a daily basis, and now more manageable but still at times hard, and I feel hopeless at times, with no real pain management plan. I have naproxen and tylenol...which just don't do anything for my headaches/migraines or when I occasionally have back pain/flank pain with kidney stones I have chronically; They had me on tramadol but then said no to that, because I am taking Prozac and they said it can caused increased serotonin levels and I cant even take triptans because of the prozac either, per the doc, even though my neuro used to prescibe them. I am not sure what meds I could try, and if I should be going up on my other meds; IDK!!!!

    I feel like they treated me like a drug addict, though I understand them not wanting me to become one, chronic pain is just really, really hard! Ugh! Anyone else ever have the opiate induced pain syndrome, and anyone on tramadol or alike meds and serotonin meds like prozac and do ok?

    Neurontin 200 mg orally three times/day
    Zonisamide (Zonegran) 100 mg orally once/day
    Magnesium 400 mg orally once/day
    Naproxen 440 mg orally every 12 hours and tylenol (does nothing!)
    Promethazine 25 mg tablets for nausea

    -Melody

    (In the past was taking Vicodin 5/500: 2-6 tabs/day; migraine meds occasionally: Maxalt MLT, Imitrex 6 mg SC inj, and occasionally IM Toradol shots at home every 6 hours as needed)
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    Old 09-02-2009, 01:26 AM   #2
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    Re: "opiate induced pain syndrome" and pain meds questions....

    Hey Melody,

    I'm really shocked and horrified that you went through that and that you're given no help to deal with your headaches etc.

    Do you have a Pain management doctor. Surely you weren't put into detox by a PM. Were you abusing your meds? If you weren't then you weren't at risk of becoming addicted, just dependent as the rest of us CP patients are. If you don't have a PM dr I'd suggest finding on - if you feel that you need narcotics in order to deal with your pain. You may only need them occassionally (rather than on a daily basis like some of us) and a PM would be able to work that out with you.

    Overcoming an eating disorder is very difficult - if it happens at all, it's like a daily battle. I hope that you're much better in that regard now.

    Can you tell us exactly what it is that you thing you need and how we can help you? This support board is wonderful and you'll find many people who can offer a range of opinions. Keep us updated, ok, I'll look out for your next post.

    Jem (PS: I don't really believe in opioid induced pain syndrome but recognise that some studies are showing that high doses may be no more effective in treating pain than lower ones - and the jury is still out on that one). Perhaps percocet was not the medication for you (hence why you felt better once you were off it) but there are many different medications out there that you can take.

     
    Old 09-02-2009, 01:09 PM   #3
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    Re: "opiate induced pain syndrome" and pain meds questions....

    Melody,

    I think some of the eating disorder programs look at it like an addiction so they then worry about alcohol and drugs. I agree with Jema if you were not abusing your meds just taking them everyday as the doc directed then you were dependant not addicted. This opiate induced pain syndrome is still very much debated. From what I understand it can happen to a very few on opiods but it very rare. It's become a buzz word for when docs or others want someone off pain meds so they say it's the pain meds increasing your pain, not that either your pain is getting worse or your tolerance has gone up(which is natural with narcotics).

    I also agree with Jema that if you can find a PM doc that is your best bet.

    Melissa

     
    Old 09-02-2009, 04:19 PM   #4
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    Re: "opiate induced pain syndrome" and pain meds questions....

    Hi Melody-

    I was on tramadol while taking a relatively high dose of Effexor at the same time. While Effexor is not the same as Prozac, it does increase the availability of serotonin so the risk of serotonin syndrome is the same. I had one doctor who not give me the tramadol due to the Effexor, but several other doctors have prescribed both for me. Both my psychiatrist and pain doctor are okay with the mix for me.

     
    Old 09-03-2009, 08:26 AM   #5
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    Re: "opiate induced pain syndrome" and pain meds questions....

    I have been taking Cymbalta along with Tramadol for almost a year now with no problems. One is prescribed by my pschiatrist and one by my PM doc-but both are aware of it and they communicate about it. I had a lot of questions about it and was given specific things to look for as far as side effects when I started the tramadol-I had none. I guess I am lucky-but I understand there are many who can't take both together.

    I hope there was just a misunderstanding with the nurses-they don't sound very educated if they yanked you off your pain meds cold turkey. They may just not understand what chrionic pain is having dealt with so many people with addiction/eating disorders. It tends to jade some people and they get in a habit of lumping eveyone together.

    Blessings,
    Michelle

     
    Old 09-03-2009, 02:06 PM   #6
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    Re: "opiate induced pain syndrome" and pain meds questions....

    Hello,
    Thank you everyone that posted. I actually was able to just find a doctor in the area that is an internal medicine doctor but also a headache/pain specialist and anesthesiologist that seems really good on her website here in Phoenix, Arizona so I see her in a couple of weeks. I really was hoping to find someone that wasn't just a Neuro, but specialized in pain and/or headaches, and she is both, so I am hopeful that she will be able to help me.
    Your guy's thoughts on the pain med use and dependence versus me being addicted to them if I take as directed and not abusing them is how I was thinking, and they confused me, when they took me off of them, and really frustrated me....I wasn't sure why they as healthcare professionals, didn't seem to quite understand the difference between having an addiction and a tolerance/dependence on narcotics...though if they felt like I had the opiate induced pain syndrome, and not that I was necessarily addicted it made sense why took me off them, but I couldnt even find much information about it on the web.....and hadn't heard of it before ....

    I know I was taking it daily for awhile, but I had pain on a daily basis...real pain, if you know what I mean, and my pain responded for the most part to the meds and that is how I survived and functioned for the most part....a lot of times when I am in pain, like a really bad headache, I just don't think straight and can't concentrate and my memory is crappy...and I get very depressed <removed> because of my pain level.

    So, anyways yeah I do feel a lot better, but I think a lot of it had to do with getting me through therapy and eating again and not purging, etc. etc. and dealing with emotional stuff, not to say my pain was only in my head, but my anxiety definetly was making my migraines worse/triggering them some....BUT, I still have migraines and headaches, that will probably never go away and fibromyalgia, etc etc., and I do agree that as long as I take as prescribed and using them for pain and only for pain, then I am fine..dependence and tolerance are a natural consequence of taking them, though I do appreciate not having to take them daily at this time, cause of feeling out of it, but if I need to take them here and there I think I am ok with that, and if my tolerance goes up, so be it.....idk. I was talking to my mom though because I realized that I had been prescribed pain meds for my kidneys and bladder problems different times this spring because of kidney stones and then would use them when I had headaches and sometimes even my periods because I had such a low pain tolerance, because my neurologist was having me take vicodin for my pain control, but I just didnt need to get refills from him too much because I was taking the percocet already for my kidneys...I was taking the meds for my head and kidneys, if that makes sense.....usually they would be hurting at the same time....I guess I was just a mess...dealing with a lot of pain...I was finally admitted to the hospital in April 09 to have kidney stones removed and had to be on a pain med drip for like 5 days, cause I had a stent placed and then removed...ouch! So, I guess technically, yeah using the meds for a reason as not prescribed is abusing them, right?, I just have a hard time when I am dealing with multiple things on my body hurting, if that makes any sense??? I am taking neurontin and Zonisamide as preventatives, and magnesium. I think I can count only a couple of times on my hands in my life when I have taken an extra Vicodin, and that was only because i felt like my head was going to explode...though I guess, once again that's not good either.

    I guess, my plan would be to see the PM doc and I will be keeping a pain diary before I see her and then talk with her concerning what medication options there are for me with the meds I am taking, and what anything else I can do for the pain control.....thanks for the info on the tramadol and SSRIs..I guess it really is up to the docs comfort level and of course how my body reacts to the meds.

    I am definetly going to keep up with posting on what's going on and any questions I have...thanks soooo much! Sorry that was long....was good for me to write out my thoughts, since this has been rough for me.
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    Old 09-03-2009, 08:21 PM   #7
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    Re: "opiate induced pain syndrome" and pain meds questions....

    Hey there,

    It sounds like you're getting things sorted and have appointments with the right sort of doctors. Please let us know how you get on.

    Jem

     
    Old 09-03-2009, 10:57 PM   #8
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    Re: "opiate induced pain syndrome" and pain meds questions....

    I agree with Boxerluver - many doctors use the pain syndrome to cut you off narcotics. This is especially true in emergency rooms. I went in for a nasty migraine and he immediately told me my headaches are bad because of the Duragesic patch. He didn't take any time to read my history, which if he had, he would have found out that I have the patch for chronic nerve pain. He sent my primary doctor a message stating his opinion that I should go off the patch. Fortunately my primary has good sense and sent a note back telling the ER doc that he shouldn't make recommendations when he doesn't even read a patient's history.

     
    Old 09-13-2009, 06:09 AM   #9
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    Re: "opiate induced pain syndrome" and pain meds questions....

    Hi Mel, I understand your delemma, You stil haeve bad days but you posted

    "My pain level did go down a lot, so for that I am thankful, because for the 2 years my headaches and other pains were getting worse and worse on a daily basis, and now more manageable but still at times hard"

    Your out of the hospital, your overall life has improved, , what's shocking and horrifying if the new tretment plan has improved your condition. I do believe each episode should be treated on an as needed basis, but if your doing better, off the daily opiates, why would you want to go back on them other than to have them araound for the most acute times. Am I the only one that read your feeling much better but still having ocaisional problems. I understand the need to treat each episode as needed, but the blanket of meds that left you in patient continuing to worsen obviously wasn't the way to go based on your own statement and the results of discontinuing the meds.

    Yes cold turkey is harsh, Things could have been done diferently, but it's hard to argue your own discription of your present level of pain. Would it have been better to continue a plan that wasn't working and left you in patient , disabled and cut off from the real world as long as their was a steady supply of narcotics?. You said your doing better, you have to focus on the positive , not on every negative that occured that got your to this point. I applaud your acomplishments and hope you do find a balance where episodes can be treated properly, but finding that middle ground is the hard part of pain managment. Throwing a blanket of drugs over someone is not always the way to to manage pain that may have other commplex components and other mthodsto manage perodic episodes when times are hard.

    I have no problem with helping someone when days are diffciult, but everyone from al walks of life have difficult days. It's the docs that decide what is the correct way to treat those episodes. It may be non opiate methods, Relaxation techniques, biofeedback" "cognative therapy" abortives, acupuncture, There are dozens of ways that don't cause your pain to spirral out of control and worsen on a daily basis when you have experienced rebopund or opiate induced hyperalgesia. People are telling you they don't believe in theis theory but your own description gives this theory great merrit.

    You just have too turn on the TV to see the results of this extreme belief of entitltlement that everyone should be able to use anything they want. Mels' own description and positive experience adds to the validity of this theory if pain improved when daily opiates were discontinued.
    Good luck and take Care, Dave

    Last edited by Shoreline; 09-14-2009 at 04:40 AM. Reason: There rae other options to manae pain when tmes are hard, chomic unrelenting pain is treated differently than acute episodes

     
    Old 09-14-2009, 07:26 AM   #10
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    Re: "opiate induced pain syndrome" and pain meds questions....

    Dave,

    Thank you for your thought out response. I think what I was trying to express was that I was frustrated that I was given no pain management plan whatsoever other than tylenol and deep breathing while I was in eating disorder treatment after they took me off the narcotic meds, which I tried, really tried to manage my pain with the other things including a squishy ball I used to squeeze for anxiety, and aromatherapy, and even a cold pack for my head, and just wasnt cutting it sometimes, and still is not cutting it, so that is where I was frustrated, though I do understand that yes,everyone deals with pain...I get that, I personally though just can't deal with pain like this. I do not want back on daily narcotics or narcotics at all, if it will cause me rebound headaches or this opiate induced pain syndrome since it seems that I most likely had this, since everyone is unique, but to not have anything right now other than OTC meds is hard since I am having daily headaches, I just want something that will work to take away the daily pain...but I guess it just sounds like I am complaining or asking for too much..idk, but that is why I was just looking for some support. So anyways I found a doctor that specializes in headaches and seeing her today so hopefully that will go well, and yes she will know my history...I have it along with my daily meds typed up.

    Thanks,
    Melody
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    Old 09-14-2009, 02:59 PM   #11
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    Re: "opiate induced pain syndrome" and pain meds questions....

    Hey Melody,

    I'm glad you found a new doc and hope it works out. At first, when my health issues began to escalate, I was having multiple pain problems and at times different docs were giving me pain meds. I was getting hydro from my ortho for my joint stuff and then like you I get tons of kidney stones and was getting either percocet or demerol. This was back around 2000 and no one was worrying about things like that too much although they were starting to look at it. Fortunately I had been reading up on stuff and knew that I may run into trouble so I talked with my primary and explained everything and asked him to be the only doc giving me pain meds and he agreed. I say this to tell you I don't think it was abuse for you to use your kidney stone pain meds for a migraine and you are doing the samething by getting a pain doc to deal with all your pain issues since like me you have more than one. I hope she works out for you!!

    Melissa

     
    Old 09-15-2009, 02:37 AM   #12
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    Re: "opiate induced pain syndrome" and pain meds questions....

    No, it doesn't sound like you're complaining at all Melody. You bring up very valid issues and I hope you find resolution soon.

     
    Old 09-15-2009, 04:47 AM   #13
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    Re: "opiate induced pain syndrome" and pain meds questions....

    Hey there Melody,

    How did your appointment go? Hopefully well. I understand your frustration - it sounds like you need something/anything that will help when you have these headaches. Constant narcotics don't sound like the answer from what you've said but they'd certainly come in handy when you've got a migraine. I know many people that use narcotics only when they need to for migraines if the other meds haven't worked.

    Just a note on the 'opiate induced pain syndrome' I did a bit of research and it turns out that some narcotics can induce migraines - i just thought it was worth mentioning.

    Hope all's well,

    Jem

     
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