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How much do opiates/opiods honestly help

SergeP1SergeP1 Posts: 20
edited 10/29/2019 - 11:51 PM in Pain Management Forum

My pain very irritating , makes it impossible to concentrate but i can still tolerate it enough to get around, I can even mask it for short periods of time. But needs several hous of flat on my rest to recover  (solid 6 or 7  out of 10 pain)

Over the years have tried the max dose  of"  60mg oxycodone/day, 90mg morphinr/day , 24mg dilaudud , these meds bring my pain level from a 6-7 to a 4-5] 

QUETION: Is this typical for you other spine paint sufferers ? (30%-40% improvement with these nasty pan killers)  

I thought taking the "max dosage of morphine, would mean zero pain 

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Comments

  • I think for most spine patients 0 pain is a goal we will never reach no matter what we take, but if a medication makes the pain tolerable, it's worth taking.

    Chip

  • As stated above, 0 pain is not realistic.  My PM doc said 50-60% reduction is more common.  In my experience as both a nurse and a chronic pain sufferer, when you get to high doses and are almost maxed out, try reducing your doses.  I know it sounds counterintuitive, but reducing for a while helps wash out those receptors.  Then dont go back up too quickly.  Give each dosage change at least 48 hours.

    Hope this helps.  Good luck, its so hard to deal with sometimes!

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  • dilauroddilauro ConnecticutPosts: 271

    As Chip stated '0' pain may be a goal, but for chronic pain patients, it isnt very realistic.

    Over the past 15 years, I've been on so many different dosages of opioids, some very high.   Right now, I am on what some consider to be a maintenance level.   Thats a total of 20mg of Oxycodone a day.   I've been doing this for several years, except for the ongoing surgeries I have in between.

    I'd love to get down to 10mg a day... Its a goal... But that is also to keep my daily pain level around a 3-4.  Thats my norm.

  • In all my years of living with chronic pain, one thing I learned was that zero pain would never happen. In order for that to occur, none of the injuries or surgeries would have had to happen. 

    Without pain meds, my pain hovers on a good day around a 5.. on a bad, 7-8... very ,very rare occasions it has gone to a 9. Those days required help from my drs to manage it to get it under control. 

    With the pain meds, most days I live with a 3-4... on rare occasions I might even get to stay there for a day or two. That to me is successful. It allows me to fold laundry, make a meal... interact with my familywithout being distracted by pain. 

  • 0 pain, haven't been there for 20 years. We don't mean to be at all discouraging, just realistic. I'm on a huge dose of gabapentin and 15 mg Percocet per day, it's definitely not enough but if I go any higher it becomes ineffective for me. I'm very happy if I'm around 5 pain level but that's rare. I've refused to add other meds because of the side effects, just my choice. Living with chronic pain is a daily struggle to rise above it and do what I can. For me, acceptance is the key, day by day. 

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  • Also seems to me that at least a part of what became a pain medication crisis was that too many doctors and patients were trying to target zero pain with these medications.  Doing that is a recipe for disaster in my opinion, because it meant doctors kept prescribing higher and higher doses, and for many patients that wasn't the right way to go. 

    It's a tough balancing act, but if you look at some of the posters who've managed this for many years, you can see that they have tried to work with their doctors to manage their pain to a reasonable level that improves the ability to function, but haven't pushed their doctors to escalate in order to get the pain to zero.  

    I'm earlier in the journey but find the same thing to be true - it's hard to work and raise kids if your pain is a 6-7 all the time, but if you can get to the right, relatively low dose of medication and get it to a 3-4, that's workable.  And more importantly, it seems like it can work over a long time frame (at least going by many of the stories above), which is critical when managing chronic pain.  Unfortunately, the pain probably isn't going anywhere for all but the most fortunate among us here!

    Kevin

  • SergeP1 - My response to your question, "How much do opioids help", I'll use my own experience with opioids.  From my 22 years of opioid use to manage my pain because of collapsing and excessive movement of my cervical and thoracic facet joints in my spine, I'll say, it depends.  The cause of my facet issues was severe spine trauma.  I'll try to explain my comment. 

    All of us respond differently to opioids, even different opioids (examples, hydrocodone vs oxycodone vs morphine, etc).  I've only ever used prescribed opioids.  Some of us can become very quickly addicted to opioids, some can manage their opioid use and some of us have no issue with opioid addiction.  I fall into the group of those that had no addiction issues. Yes, I'm often called a liar, about my claim.  Yes, I know what all about physiological addiction (dependency), but there are many drugs that one has to tapper off of when quitting them.  My body hated the side effects of opioids, but as long as the benefits were greater than the side effects, I continued opioids. 

    If it had not been for opioids, I would have been forced onto disability 23 years ago.  For me, a very minimal dosage of opioids enabled me to continue my professional work for another 18 years while I tried to get proper diagnosis and treatment.  As an aside, for those of you with complex spine issues that have been told to "live with it", please seek out a regional or nationally high rated spine center for diagnosis and treatment.  Also, don't be intimated about getting a second, third or more opinion(s).  My mistake was NOT getting timely diagnosis and treatment that eventually caused my permanent spinal cord and nerve roots injuries.

    Most of those 22 years I was on low dosage of opioids.  After each of my three ACDFs, I came off all opioids for a period of time until another level of my cervical facet would collapse and I would again have to go back to opioids to manage my pain until I got another surgery.  Nine months ago any dosage of opioids quit working for me.  I tappered off all opioids and took several months for the opioids to clear my body.  I again then tried some opioids and still they did not work.  Those were a very rough nine months.  I was told by neuro doctors to use high doses of gabapentin, which my body would not tolerate.  I had to back down to a moderate dosage.  I asked pharmacologists that specialize in neuro and opioid medications why my changes and the only guesses they could come up with was the changes in my pain triggers.  For 22 years, I had structural pain issues in my spine.  Now that I'm fused from C2 to T10, I'm no longer having vertebral movement at those 15 joints.  The imaging of my cervical, thoracic and lumbar spine were reviewed by multiple neurosurgeons, including the chief of neurosurgery of a regional spine center and I was told that my total spine showed NO narrowing or impingement of the spinal cord and appropriate clearances of foraminal openings for all nerve roots.  My current diagnosis states that my current pain triggers are spinal cord injury related.

    Since I've had an SCS unit implanted, I'm getting significant amount of pain relief.  I hope the benefit of the SCS unit continues.

    As another aside, I'm having a worse time with physiological dependency tappering off of gabapentin than I ever had with any opioid. 

    Sorry that my response got so long.

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