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PostPosted: Mon Nov 07, 2011 10:57 am 
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In the last year or two, parts of the medical world have been calling for more responsible prescription of opioids when treating chronic pain.

I found some really interesting videos from a non-profit organisation (who receive no money from pharma companies) who discuss the use of opiates in chronic pain, and whether they are actually effective in the long term. Turns out that there are no significant studies into the use of narcotics for chronic pain that went longer than ... wait for it ... 16 weeks! :shock: That's shocking. Chronic pain is, by definition, long term. And we were being prescribed a treatment that was only proven beneficial in the short term, yet is now shown to only make the problem worse in the long term.

Apparently the Physicians for Responsible Opioid Prescribing are linked with the CDC, which isn't surprising given CDC's recent concern about the outbreaks of addiction.

[youtube]http://www.youtube.com/watch?v=QYWykvy3xDI&feature=related[/youtube]

[youtube]http://www.youtube.com/watch?v=qDXCHVGuevg&feature=related[/youtube]

[youtube]http://www.youtube.com/watch?v=yPotN37A5kA&feature=related[/youtube]

[youtube]http://www.youtube.com/watch?v=pILIJ9VyWAU[/youtube]


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PostPosted: Mon Nov 07, 2011 3:44 pm 
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It is interesting to see some of the changes going on. I was with someone this past weekend who is awaiting surgery for a shoulder injury. He is diagnosed, the surgery is scheduled for about 10 days from now and he is clearly in pain. The "problem" is, he is not having his pain treated appropriately and is suffering. It is such a double edge sword. While I don't know for certain, it does not sound like he abused any of his meds. Yet his doc told him he would only give him Tramadol for his pain because they have to "save the Vicodin for after surgery". He had been getting 5 mg Vicodin for a month or two prior to this. From my medical training and experience, typically this patient would be given Vicodin right now, including 7.5 mg or even 10 mg if needed, and then Percocet after surgery. Five years ago he may have been put on Oxycontin either right now or after the surgery. I have no way of known the reasons for his doctor withholding narcotics but clearly it is happening more and more - as these videos state.

Having been in healthcare for over 20 years clearly we went through this huge shift of treating pain. It was preached to us how the pain scale should be used just as often as the blood pressure cuff. Treating pain was at the top of our priority list. Now, I was in emergency medicine so that is somewhat different than chronic pain. Still, I have friends with back problems, etc. who were given huge amounts of opiods to treat their pain.

Did we go down the wrong path? Clearly for those of us who became addicts because of it, we most certainly did. However, what about my friend from this weekend? Is his suffering necessary? Are we better off making him suffer - both now with less than adequate treatment and potentially after surgery by giving him "only" 5 mg of hydrocodone when something stronger may likely be indicated and needed? The answer may well be as difficult as finding the meaning of life. It's almost like suffer now or suffer later. By that I mean, suffer now with your pain or suffer later with your addiction.

It is truly a very, very difficult choice for doctors and patients to make.


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PostPosted: Tue Nov 08, 2011 12:49 am 
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donh wrote:
Did we go down the wrong path? Clearly for those of us who became addicts because of it, we most certainly did. However, what about my friend from this weekend? Is his suffering necessary? Are we better off making him suffer - both now with less than adequate treatment and potentially after surgery by giving him "only" 5 mg of hydrocodone when something stronger may likely be indicated and needed? The answer may well be as difficult as finding the meaning of life. It's almost like suffer now or suffer later. By that I mean, suffer now with your pain or suffer later with your addiction.

It is truly a very, very difficult choice for doctors and patients to make.


It's so true. Unfortunately when these changes in practices first occur, it's common for the pendulum to swing to far the other way, and it takes some time to find the balance.

Your friend has really found himself in the wrong place at the wrong time, at least for now. Perhaps though in the future he will be grateful that doctors forced this investment on him?

I can understand the doctor's motives. The doctor is acknowledging that the post-op pain will far exceed the pain he is going through now, and is perhaps trying to keep his tolerance low so the pain can be treated better come that time. It would mean that less painkillers are required then, and dependence would be less likely.

It's a difficult one. Pain seems as unpleasant to solve now as it can be to experience.


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PostPosted: Mon Apr 23, 2012 7:53 pm 
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I thought nothing was "stronger" than the other just different chemicals that's what I was told. I mean an opiod is an opiod whether it's morphine or oxycodone I think in psychiatry there is a "guinea pig" thing and I'm on psych meds so I mean no disrespect I call it that because as with psych meds you don't usually know the right med till you try a few. Same in PM I think. I hate morphine because I get horrific headaches but diluadid doesn't do that.

We are all biochemically different and what works for one might not work for another. It's a hit an miss and then you get the problem of finding the "perfect drug" then you could as in my case did get to the point where I could not take them as Rx'd and that still upsets me since I have right leg RSD, Endometriosis, and psoriatic arthritis and I'm only 32 so for me I have to figure out why I "failed" shall we say.

I feel great on the Suboxone and it is helping my pain right now so I'm counting my lucky stars! It's hard because I would not discriminate if a person really needs pain meds they need to talk to their Doc about what works ect but most are afraid to because they know a pain doc will not give anything "good" if they have an addiction background. I for one haven't figured out my elbow surgery. I have been avoiding it because I'm afraid the RDS will go to my hand and I can't handle another ketamine infusion (ego death) nuff said so I would hope someone more knowledgeable than me can chime in.

I for one do not want to be in pain that is uncontrolled or be looked at like a dirty addict when I'm a human with pain and messed up and have taken the steps to treat it!

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PostPosted: Thu May 31, 2012 2:24 am 
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Hey, I'd rather have people being treated for chronic pain with the mildly-addictive and relatively harmless opioids, than with dangerous and HIGHLY addictive serotonin reuptake inhibitors. Apparently, SRI's can cause PERMANENT erectile dysfunction after CESSATION OF TREATMENT. Does that sound like better than old fashioned morphine to you? Just watching telly on a good night, I see five to ten Cymbalta (oh, hayull, no!) adverts. Take your Cymbalta and shove it where the sun don't shine.


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 Post subject: U R kidding?
PostPosted: Wed May 22, 2013 7:47 am 
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Advertisements on TV for Cymbalta? I've been on both Cymbalta and Effexor? I was not made aware of the w/d's, even with slow tapering. Effexor = 6 months of cattle prod like jolts, day and night, avoiding Benzo's as much as possible (I didn't need another addiction to contend with). Cymbalta was a roller-coaster, near bi-polar like w/d's, although not much in the Manic high range compared to the lows. At the mental health facilities I stayed, many patients reported these effects.
This seems very odd[font=Arial] [/font] :?


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PostPosted: Sat May 25, 2013 7:45 am 
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My first doctor didn't care one bit to prescribe any of the SRI's, I tried a few of them but after some side effects (embarrassing and non embarrassing) that I didn't care to go through, I left those alone. Prozac give me horrible gas, to the point that I would fart with every step. Zoloft wasn't bad but it took my dreams away and when I would forget to take it, they came back with a vengeance. Celexa made my fingers jerk like they had electric currents going through them, didn't have any nightmares at all but the finger jerking was driving me insane. I think those types of drugs should be burned and never used again, they have too many whacky side effects.
Whatever happened to treating depression with a kick in the pants? I know it doesn't work for some, but the doctors just want people hooked on whatever they can make you think will help you out. I take nothing for depression now, I feel fine. I think I was just going through a rough patch. Some people do fine on them and that is wonderful. I just think that they are too crazy with the side effects for me to ever fool with them again. I wanted something to help me sleep and she give me Trazodone. That is the worst shit that I have ever had in my life, my face felt like it was on fire and the Suboxone makes me sweat enough. So I constantly had to walk around with a cold wash cloth or I felt like I was going to just burst into flames. I figured this stuff is either too strong or not working right, I went with Tylenol PM. Now I have no problem sleeping, I can take a 1mg piece of Suboxone and I am out for a few hours.
If I came out of surgery and they wouldn't give me something for post op pain, I would tear someone's head off. After my gall bladder surgery, I rose up out of the bed and squalled for something. They came with two 10mg Percocet's and a Diet Sprite (yuck I know). I cant imagine if they came out and told me to deal with it. I know that the Suboxone makes your tolerance to those medications crazy high and it takes more, but I think the risk of not feeling like my insides were coming out would be worth it.


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 Post subject: Effexor
PostPosted: Sat May 25, 2013 3:10 pm 
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Hey JohnB007,

You were really able to get off of Effexor? Damn, I wish I could do it. And yes, the Dr.'s had them out like candy w/o telling you about the side effects or inability to get off them. When I asked my doctor about getting off the Effexor he said that they joke around with the name of it. Meaning, a lot side Effects if you try to leave it. I actually got down to 5-7 of the little beads inside of the capsule. Then the darkness came and it scared me too much. Guess I'll stay on it for now. Plus, it's good to see someone was able to do it and come out the other side.

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