Discussions that mention tylenol

Pain Management board


Hey Rach, I'm sorry you took offense, But when you phrase your use as being addicted, There are two ways to take, One for what you are exactly saying, addicted, whch is very different from dependent, or 2 you simply don't understand the dfference between addiction and physical dependnece. But starting a post with I was addicted to meth for 2 years, It instantly seperates yourself from the folks that know they have to trade physical dependence to have some quality of life and folks that abuse and become addicted. We don't know if you abused or not, but when you used the term addcicted, It implies abuse, not simple physical dependnece.

It's something many people don't understand and think that a med that causes withdrawal means you are addicted. In PM addiction isn't a term used lightly, adicction means the end of pain management for many people. It's destructive and has all kinds of psychological motives for using the meds. Simple physical dependence is enevatable. If you take paxil for 2 years and try to discontinue it cold turkey, You will can end up in the ER, same problem with any benzo. There are many meds when discontinued abruptly cause abstinence syndrome. However withdrawal is used solely for drugs of abuse where abstinence syndrome is used for medications like antidepressants although the problem is virtually the same. There isn't a difference between abstinence syndrome and withdrawal, other than what people think when you use one or the other word.

There is a good article by a PM doc a that explains the difference between addiction and dependence. Basically adiction is destructive, Perhaps you misused the term, But many folks from the addiction forum either believe meth is a lifesaver because now they haven't shot up in 10 years and are content with replacing one opiate for another or the other opinions sound reminiscent of your post.

Folks that have have no choice and the only med that allows them to walk or restores some quality of life tend to get upset by posts from addicts proclaiming the evils of the only med that has restored quality of life for someone in intractable pain. Restoring quality of life is hardly destructive , addictive behavior

You took it for two years and experienced withdrawal. If you had taken an equal amount of oxycontn, MSContin, Kadian, Duragesic or any long acting med it would have been just as unpleaseant to discontinue abruptly or taper incorectly.

Docs actually think meth is easier to withdrawal from due to the long half life and slow ellimination. I don't agree. It just takes longer for meth withdrawal to start and longer to complete, But whether it gets bad after 3 days of no use and last longer or it starts within hours of missing a dose and is a few days or wekes shorter. It's still withdrawal with every single symptom.

When it comes to longevity of withdrawal, that depends on how long you take any med and how much change you have created in your bio-chemistry. Whether you have completely shut down endorphin and enkephlin producton for years or for weeks makes a difference. Whether it's morphine, Heroin or methadone, the longer you take it the longer it takes for your body to reset itself.

If your body could reset tolerance and all the changes that occur in a couple weeks, medication holidays would work. But they don't. If you took a month off from any opiate or benzo, within weeks of reintroduction your med requirements would be right back to what they were previously.

After 2 years of use, I would expect you to go through 3 phases of withdrawal. The initial, barfing, chills, shakes, bowel problems, skin crawling, restless legs etc can last 2-4 weeks. Once you get passed that there is a second phase that lasts from 3-4 weeks out to 3 months. Then a third phase that can take up to 6-9 months to completely reset your biochemistry and for sleep patterns to return.

I just think, Had you taken a long acting morphine product, OxyC or used Duragesic you would have experienced pretty much the same thing., Onset is slightly delayed because of half life and duration, the initial phase is a few days longer. But once you get past the intial sickness, you still have months of fun ahead once you have taken any potent opiate for years. I've done the rehab thing myself 20 years ago and I know from experience it can take 6 months to a year for your hands to stop shaking and to be able to simply lay down and go to sleep.

Opiates may be the most notorious for withdrawal, but benzo's withdrawal can cause seizures and death. The only deaths occuring from Opiate withdrawal are from suicide due to the depression that goes hand in hand whith going through withdrawal.

You are right if you have seen GP"s through Meth at someone with low back pain or a headache, It's the most absurd thing I have heard and haven't experienced or seen it myself. In fact what I have seen is quite opposite, I've yet to meet any doc with a heavy hand prescribing meds. I went threw 7 years, 3 fusions, broke 2 sets of hardware and didn't recieve a vicodin from a dozen PM docs that didn't believe in using opiates. After 3 failed surgeries and more modalities than I care to name and months in PT, work hardening and 3 pain clinics where a tylenol 3 wouldn't be prescribed for anyone. Opiates were offered to me as last resort

No surgical solution and no interventional or procedurural modality or relaxation therapy touched the level of pain I live with. I absolutely agree folks are going to opiates way too fast, without trying other methods . People are aware of what is available now that wasn't just a few years ago, Folks want instant relief and I see advice all the time to seek a PM doc because someone has pain 3 months post op. If the PM doc can do something other than prescribe long acting opiates that's great advice, But I also see posts where the PM doc was a jerk and wouldn't give me meds on the first visit.

When folks sugest keep looking for a doc with a different attitude about opiates rather than try something that doesn't have a gaurentee like opiates, You end up with folks on opiates that never should have in the first place.

Why use methadone or Oxycontin if Elevill and skelaxin works, but because of public knowledge of these potent opiates that gaurentee relief, having to go through a PM clinic that doesn't believe in opiates becomes something to refuse, as if there could be no useful tool or knowledge gained from a doc that doesn't believe in meth, oxy or morphine. All the stuff I went through, I still learned something and was able to take at least one tool away from the experience to manage pain.

I somehow lived through 3 surgerries and the withdrawal when docs decided I didn't need pain medicine anymore. It pissed me off when one PM doc said nobody has every died from pain, But the fact is, he was right. If you arive at a PM docs office in pain, you will not die if you leave that apt without a prescription for opiates that gaurentees imediate relief.

The last surgery I had was a 6 level fusion that failed and left me bed ridden for 9 months. I was miserable, but I didn't die. Even the clinic that first initiated opiates in 2000 used opiates selectively, and didn't use opiates on everyone. It was obvious to me and the docs which patients were willing to try anythng to relieve their pain and which patients wanted nothing but a script for opiates.

Just as you can't expect relief for everyone with a bad disc from an ESI, you can't expect a positve outcome from giving everyone with pain, long acting opiates. We really don't disagree. I explain physical dependence, dependence on the doc to keep prescribing, and dependence on the pharmacy to have your meds when you need them is a huge trade and needs to be justified all the time. It's something the patient needs to be aware of and understand the difference between dependence and addiction but not be frieghtened by horrer stories of addiction and withdrawal.

Better PM docs use contratcs to explain this and yet there are people that feel contracts are rediclous and one sided. What's rediclous about knowing up front your not going to get an early refill, 30 days means 30 days, you will be disharged if arrested for diversion or DUI and that explains what physical dependence is.

It protects the docs from frivilous law suites from patients that say I didn't know I would become dependent on LA morphine. Contracts also inform the patient what the rules are, like don't bother telling me the dog ate your month supply or they fell in the sink. Class 11 meds aren't normally replaced. If a doc is foolish enough to allow early refills and replace lost meds, eventually some pharamcist is going to report him for overprescribing.

Sorry to be long winded, But if you read my posts they can get long and I have a sticky keyboard from my daughter, so you may see some odd words with 12 e's in a row. LOL Here is the article about CP , opiates and explains the difference between simple dependence and addiction.
http://www.hosppract.com/issues/2000/09/brook.htm
Good luck, Dave