Pain Management

[Hopefulprayers79]

I feel so bad for my husband. He is in so much pain that he can barely sleep through the night. He said his back and side are killing him. He has been taking ibuprofen and Tylenol but that doesn't seem to do much. I encouraged him to ask his doctor to give him something for the pain. He doesn't like to take anything but he is suffering and shouldn't have to. What is good for managing the pain while waiting for chemo and surgery? I did some research and it sounds like medical marijuana is the way to go! I saw that they like to prescribe OxyContin to cancer patients but it sounds awful!! Horrible side effects!! After reading all the awful stuff that can happen, I hope they don't give him that. I just hate to see him suffer and I am sure they could give him something that would help. Any advice or tips would be greatly appreciated. Thanks.

[Basil]

Medical marijuana can help (I have it) but real pain management is through opioids for the most part.

There's a huge epidemic in the US for opioid abuse and it's a real problem. You don't want to get addicted and there are abusers that game the system looking for that next script.

But genuine pain should be treated appropriately. OxyContin is one of the worst drugs you can get because the addiction risk is high. Luckily there is a sliding scale of drugs to treat pain. Doctors are hesitant to hand out opioids these days (and they should be) but don't be afraid to ask or demand something appropriate.

I recently had LAR and hydrocodone 10mg was sufficient. It killed the pain and helped me sleep.

My advice is to talk to your doc but don't demand anything in particular, at least until you have a handle on everything. But do ask for something. There's no reason to be in pain if it can be managed.

[Lee]

I will admit I am not up on the latest and greatest pain meds. Pain was not a problem I had to deal with, butt I am aware several people having this problem. Marijuana might be the answer, There are many people on this board who support medical marijuana, me being one of them against some of my very conservative friends. Butt gonna throw this out there. Get a pain management specialist. They are worth there weight in gold. There are patches that help with pain followed up with presc drugs designed for break through pain that has helped many people on this board. Does your DH have a palliative team? If not maybe something to think about.

all the best,

Lee

[MissMolly]

I am someone who is on long-term opiates for pain. It is a difficult environment to be a pain patient. It seems everyone has an opinion on the subject of narcotics.

Continuous 24-7 pain that has no end date is a difficult burden to bear. It changes the very fabric of your being and interferes with even the most basic of daily tasks and interactions. It is pain that occupies the forefront of every thought and expression. Continuous pain is an unwelcomed guest.

For someone with continuous, moderate to severe pain the usual course is providing a time released long-acting narcotic. This can be an oral medication or a durageaic skin patch. The narcotic is released at a predetermined rate over time. Oral narcotics have a special coating that releases the narcotic at a predetermined rate. A duragesic skin patch releases the narcotic over a 23 hour period, the patch being changed every 48 hours.

The benefit of a long-acting narcotic is that there is a constant level of narcotic in the system, avoiding hills and valleys of overmedicating and undermedicating.

Long-acting narcotics are prescribed only to someone who is already opiate tolerant.

Short-acting narcotics are immediate release medications. They are often prescribed as adjunctive to a long-term narcotic. They are not meant to be taken on a regular basis but rather during instances of sharp upticks in pain.

The goal of pain management for someone with long-term pain is not complete 100% pain resolution. O zero pain is not a realistic outcome. Rather the goal is a reduction in pain to where a person is able to be able to function and engage with family/friends or an amended work environment. Ex. For someone with a fairly constant level 8 pain, the goal of pain management might be to find a level 4 pain.

Narcotic pain medication helps me feel "normal." I get no euphoria or "high" from the narcotic cocktail that I am prescribed. This is true for almost everyone with debilitating pain. There is no euphoria or "high."

The CDC and NIH released a written report and prescribing guidelines titled in March-2106. It established recommended limits of narcotic prescribing to 90 mg morphine equivalent per patient maximum. Hospice, Palliative Care, and cancer care are exempt from these prescription limit guidelines.

All narcotic prescriptions are entered into a state and federal data base by the name of the person receiving the medication and the prescribing physician.

You can expect to be asked to submit to routine urine drug screens if you are provided with a prescription narcotic. The screening is to monitor that you are taking the narcotic/that the narcotic is in your system (and not sold or diverted) as well as to monitor for the presence of any other restricted drugs or alcohol ex. Anti-anxiety drugs, benzodiazapems).

I am prescribed a Fentanyl patch and oral dilaudid. I am grateful to have access to pain relieving medication. No one can truly understand the agony of ongoing perpetual pain until they have had the misfortune of experiencing its all-consuming nature. When someone is suffering, how can we expect them to suffer more?

There are different strengths of narcotics, a spectrum. Hydrocodone is a relatively low level narcotic. Dilaudid a step higher in effect and potency. Fentanyl a step higher.

While my bone pain is not completely eliminated by the narcotic cocktail that I take, it has enabled me to refind periods of joy and happiness and to find a modicum of restorative sleep. I was cranky and emotionally distraught pre-pain management. I have been able to find glimmers of my prior self with adequate pain Management. Relief from severe, constant pain is a cherished gift.
Karen

[NHMike]

I chat with a guy on another forum and he's been taking opiates for a long time due to severe back issues, likely job-related. He is affected by the drug crises in that it makes it harder for him to get the medications that he needs. Opiates scare me as so many people have become addicted and I can't imagine that it's hard to get hooked if so many people have.

That said, what's the cause of the pain? I had pain in going to the bathroom but that's been relieved somewhat by the tumor shrinking. Is it the tumor that is causing the problem? I was asking why a surgeon couldn't just take part of it out to make things easier and found that surgeons are fairly reluctant to do that. I don't think that those without a big tumor down there really understand what it feels like and maybe can't appreciate the pain and other discomforts that it can cause.

Hopefully he starts treatment soon and the tumor starts shrinking. It was some amount of relief, mental as well as physical, when the tumor reduction made it easier overall.

[Volfan]

Make sure your husband is relaying to the doctor how severe the pain is.
My wife doesn't go to every appointment but Doc does like for her to come to some. According to the Doc us guys sometimes aren't upfront with what is going on. The appointments my wife goes on Doc will spend 15 minutes asking her questions about how treatment is going and I'm always surprised how different we answer.

[MissMolly]

There is a world of difference between physiological tolerance for a narcotic/opiate and addiction.

Anyone who takes a narcotic for an extended period of time will become physiologically tolerant of the medication. That is, the body becomes accustomed to a certain amount of narcotic as a baseline and will go into withdrawal if suddenly removed.

Medication tolerance is an issue with several classes of medications. Anti-depressants and medications to lower stomach acid are both medications where the body comes to expect the medication, developing an acquired tolerance.

Addiction is different than an acquired tolerance. Addiction implies that a person is using more than the prescribed dosing of narcotic/opiate. Addiction also implies that someone is going to extreme measures to acquire or stockpile the drug - often stealing or diverting someone else's prescription or stealing money to buy illicit drugs from other than a pharmacy.

There is an excellent article on the opiate crises and the difference between tolerance and addiction:

http://www.instituteforchronicpain.org

I take prescription narcotics (fentanyl duragesic patch and oral dilaudid) to quell severe bone pain due to avascular necrosis of my hips and jaw (bone death due to lack of sufficient vascular supply). I am obviously tolerant to narcotics but I am not addicted.

Severe, unrelenting pain, 24/7 is not something that many people can contend with. Pain with no end date. Pain that occupies the forefront of every waking moment. Where the only limited respite can be found in sleep, sleep that is interrupted by pain and not restful.

Of all of the health challenges that I have faced, severe and ongoing pain has been the most challenging and the most taxing. Securing a measure of relief from pain has become my most pressed for need of my medical team. I can handle persistent nausea, persistent fatigue, persistent vertigo, persistent diarrhea. My breaking point has become pain.

It is unfortunate to see people with legitimate pain being denied access to pain relief owing to the misuse and abuse of others who are using illicit narcotics to dull emotional pain and other failings in life. The opiate crises has little to do with actual pain and much to do with people who are struggling with socioeconomic shortcomings and personal struggles.

I am on palliative care and still have to "jump" through multiple regulatory hoops to obtain my narcotic prescriptions. I am not an addict. I am but a wee person who has the misfortune of having a "broken" body. Instead of compassion at the pharmacy counter, I am eyed with judgment and disdain. How would any of you feel under similar circumstances?

Behind the face of each person with persistent pain is a personal story.

For anyone enduring ongoing pain, you have my understanding and full support.
Karen

[LeonW]

What is good for managing the pain while waiting for chemo and surgery

Don't hesitate and immediately ask your docs for something better. These days there is no reason trying to tolerate intolerable pain. I'm much like your husband and don't like to take anything either. But the game he's in, is different now; he'll need all the help he can get, pills included. He'll need all his strength to handle the chemo and surgery, don't let him waste it now on pain.

There's plenty other stuff than Ibuprofen or Tylenol. Remember it's not for life but only to survive the waiting period; hardly any risk to get addicted. And remember that most pills need a build-up before they become effective; make sure he sticks to the dosage instructions for a few days before giving up. And tonce he's found something that works, here's no point in stopping until things improve.

Best wishes, Leon