Chronic Pain Management issue regarding nausea

[JohnHicks]

I was in a plane crash 11/08/2014 after several surgeries I'm in pain management for chronic Pain related to my accident. I was diagnosed with colon cancer in October 2018 had surgery and was denied pain medication after my second surgery, not by my doctor but by my pharmacist who said that the Fed and state of Florida would not let him fill a prescription for additional medication I'm currently getting for chronic Pain, I hope they rott in hell, my Pain Management doctor wrote them a letter telling them basically the same thing....
I currently taking Hysingla (an extended release hydrocodone) and 4 10mg Percocet....my issues is my increasing nausea and fear that I may not be able to keep down food or my pain medication, any recommendations as what I might suggest to my pain doctor that will help with my pain I also currently take 2 medication for nausea that help somewhat. If you have experience please help, I have an appointment with my doctor next Wednesday, he suggested I try Fentanyl patches, Butrans patches, or Belbuca strips... any suggestions or I'm put???

[erins]

I’m super sensitive to opiates, so any amount makes me nauseous. I found two things work well for me 1) pressure wrist bands, usually called motion sickness bands like Seabands or Psibands. It’s basically acupressure that helps trick your brain out of nausea. It helps me with both motion sickness and nausea from when I have to take opiates, and I’ve heard it can help with chemo-induced nausea as well.
2) hot and sour soup—I have NO idea why, but it calms my stomach immediately

For pain, I’ve heard wonderful things about acupuncture, but it may be something you’ve already tried (it definitely doesn’t work for everyone).

Chronic pain is awful & sufferers seem to be getting caught up in the fight against the opioid crisis more and more. I’m sorry you’re going thru this— I hope you get relief soon!

[zephyr]

I'm sorry to hear about your pain and nausea issues. I hope you find some relief. I imagine you might be limited in what meds you can take for nausea because of possible interactions with the Hysingla.

The pressure wrist bands also worked for me. I put them on before I started every infusion and didn't take them off until 2 days later when I was unhooked from the pump. It didn't eliminate the nausea but made it tolerable. I couldn't take the anti-nausea meds but I was given lorazepam for severe nausea. If you can take it with Hysingla, it might be worth a try.

Ginger helps a lot of people. There are ginger candies, ginger syrup, ginger ale, and ginger tincture. If you find ginger tincture, you can put a dropperful in your water and sip on it all day.

I've heard from what I consider to be reliable sources that professionals who need to keep their wits about them but also need nausea management during the day use a 1:1 CBD/THC vape pen. It reportedly stops the nausea almost instantaneously. If you're in a medical marijuana state, you might ask your pain doc if it will interact with Hysingla.

Again, I really hope you find some relief.

[MissMolly]

John:
I am in Palliative Care and receive prescription narcotics in excess of the CDC guidelines of 90 mg morphine equivalent.

Florida has passed state legislation that does limit prescription opiates written for acute pain, that is for new patients to opiates. The limitations were not supposed to affect chronic pain patients as you encountered.

Are you getting your prescription from a Walgreens or CVS pharmacy? Both Walgreens and CVS pharmcies are under tightened federal monitoring through the prescription opiate database (that tracks each time an opiate prescription is filled). Walgreens and CVS pharmacies will have tighter dispensing protocols then other comparable pharmacies. This may explain why you received an unwelcome interaction.

Do know that opiates themselves do cause nausea. Is your nausea due to a higher recent dose of opiate?

I am on a Fentanyl patch with oral dilaudid/hydromorphone.

I find the Fentanyl patch a good delivery method. Medication bypasses the gut and intestines. I have short bowel syndrome and have experienced no GI upset nor GI itritation with the patch. Medication is released slowly though the skin. A benefit is a steady blood serum level of pain medication without peaks or deep troughs.

Cons: The patch is normally prescribed to change every 72 hours/3 days. However, most people do feel a noticeable falling-off at the third day. That is, the fentanyl patch does not provide sustained pain medication for the full 72 hours. My patch is prescribed to change every 48 hours. You will want to be aware of the usual 72 hour dosing period and personal expemptions.

I agree with zephyr about the value of folding in some CBD-THC to quell nausea. I use a liquid CBD for nausea related to my short bowel syndrome and get excellent relief - far better relief than with oral distigrating Zofran. Check with your pain management provider as to whether you can add in CBD. If you can, I highly recommend it. Not only does the liquid CBD best aide my cyclic nausea/vomiting but it has also enabled me to take less opiate medication. A win-win.

I hope you and your pain physician are able to decide on medication that gives you some degree of comfort. Unrelenting pain is exhausting and really detracts from any quality of life.
Karen