Discussions that mention demerol

Pain Management board


[QUOTE=IZZY'SMOM;3648903]...but since all of the meds work on different receptors, I chalked it up to that....

This is something we need to clear up.

All of the opioids that are prescribed for chronic pain target one specific opioid receptor - the mu receptor (except buprenorphine mentioned later). This is the only receptor involved in analgesia for chronic and acute pain. Most of the opioids used for pain relief are not even active at the delta or kappa receptors. A few have limited activity at one or the other of the delta or kappa receptors but this activity has no effect on pain relief, and does not cause users to feel or react differently.

I have mentioned that a few of these opioids we use for chronic pain activate an "excitatory pathway" in our nervous systems. As far as I know this is limited to hydrocodone, oxycodone and demerol. The effect this causes seems to make folks feel stimulated, up, energized. I found this happens to me when I'm given demerol. When I had my knees rebuilt at Stanford they would give me demerol as a pre-op medication to reduce anxiety and prepare me for anesthesia. Instead it had me climbing the walls. Full of energy. Waltzing around with my IV stand in tow.

Again, the mu opioid receptor is the only opioid receptor specifically targeted by the narcotics we use. Any activity these meds have at the kappa or delta receptors has nothing to do with pain relief.

There are a few other opioids used to treat pain (e.g. stadol, buprenorphine, pentazocine, etc). Of these, only buprenorphine is used to treat chronic pain. These meds fall under the category of partial agonist/ antagonists, or just partial agonists. Most of the time these meds will bring on WDs in anyone dependent on full agonist opioids (morphine, methadone, oxycodone, oxymorphone, hydrocodone, fentanyl) unless used in very small dosages.

By all means, do look this up for yourselves.

steve
So what you are saying is that it is the pathway and not the receptor - is this true for everyone because on demerol I got out of bed after surgery and cut off all my drains and removed all my dressings and got back in the bed and I still (7 years later) do not remember that - on fentanyl I get high as a kite but with a xanax I just sleep 12 hours

this is so confusing, I thank you so much for information - I want to get my meds right - I want to take them for only the right reason soooo I have stayed away from fentanyl because it makes me very happy

from what you are saying the oxy and the hydro are the same so maybe what I am really missing is my oxycontin and the opana is just not cutting it
hugs Aver
I keep missing the h and hitting the j so it would be jugs Aver, which I do not have, mine are reconstructed -fake - is that funny just to me
[QUOTE=Aver00;3650691]So what you are saying is that it is the pathway and not the receptor - is this true for everyone because on demerol I got out of bed after surgery and cut off all my drains and removed all my dressings and got back in the bed and I still (7 years later) do not remember that - on fentanyl I get high as a kite but with a xanax I just sleep 12 hours...

Exactly, it's the excitatory pathway that delivers the "energized feeling," as Marcia explained. Demerol is probably the strangest of all the opioids, and is falling into disrepute as a result. Like you, I also felt kinda high on fentanyl, but that seemed restricted to when I would get an increase in dose. It would wear off after awhile. That must've been real scary to wake up and find you had done all that stuff after surgery. I remember demerol giving me the munchies. One time after a knee surgery they gave me an injection of demerol in the recovery room to prepare me for my trip back to my room and then another after I got settled into my room. I was sky high and all I could think about was food, so they sent me some spaghetti, I ate it all and then crashed for 12 hours. Weird stuff.

[QUOTE=Aver00;3650691]...this is so confusing, I thank you so much for information - I want to get my meds right - I want to take them for only the right reason soooo I have stayed away from fentanyl because it makes me very happy...

You know, Aver, your openness and desire to resolve this situation is remarkable. For what it's worth, I do not get the sense that you are addicted to the hydro, but I do think you could. And I can't say it enough how awestruck I am at your willingness to share so openly.

I am in a somewhat similar situation in that I have loads of addiction in my family, and depression, and even suicide. Because of all this I choose not to drink alcohol on any kind of regular basis. In fact, I can't even remember for sure when I had my last drink. I get a buzz from the slightest sip of wine or beer. I watched my grandmother destroy herself with alcohol and drugs and it was an awful sight. My brother is an alcoholic and has fought so hard to remain sober. There's just too much in the way of bad genetics for me to take a chance.

[QUOTE=Aver00;3650691]...from what you are saying the oxy and the hydro are the same...

Pretty much, the oxy to a slightly lesser degree, from what I've researched.

[QUOTE=Aver00;3650691]...so maybe what I am really missing is my oxycontin and the opana is just not cutting it...

I heartily agree with some of the other posters who have said that it might be you need a better LA med, or a higher dose. I think docs are not dosing Opana correctly, leaving many CPers with uncontrolled pain. Can you go back to the OxyContin? And, IMHO I think you would be better off using a different BT med. Just like you refuse to use fentanyl, if I were you, I'd put hydrocodone in the same category.

I can't say it often enough - how impressed I am with you. Please, please do not, as others have written, "beat yourself up." You have admirably recognized a vulnerability in yourself with regard to the hydrocodone. You are evaluating the situation and looking for guidance on how to proceed. You are willing to do whatever it takes to ensure you are doing the right thing. That's all good, in fact incredible. But please don't take that next step and view yourself in a bad light. OK? If anything, you should be very proud of yourself. As the rest of us are. You are one exceptional human being Aver.:)

[QUOTE=Aver00;3650691]...I keep missing the h and hitting the j so it would be jugs Aver, which I do not have, mine are reconstructed -fake - is that funny just to me

I don't feel safe answering this question, but I can see why you'd be tickled by it. And that's just another of your wonderful attributes - the ability to laugh at yourself.

I hope you have a great day Aver. Your willingness to be vulnerable has opened a discussion that can be valuable to so many. I am so thankful you started this thread. Most of all I'm thankful for you.;)

steve