Hi and Ho Purple Morning:
Is there an identified reason or cause as to why your pain has become disabling? You mention that you had back pain that was eased by a microdisectomy . . . but that recent leg pain has culminated to confiding you in a wheelchair. Is the leg pain due to the spastic dyplegia? Is the leg pain due to a disc herniation? Other?
I am on dilaudid (hydromorphone) and can try to answer questions you may have.
Background: I am 56 years of age with frail health, former marathon distance runner and physical therapist with an adventuresome outdoor spirit - I love being outdoors and being at one with nature. I am on a narcotic cocktail consisting of the Fentanyl duragesic patch and oral dilaudid. I have a hefty dosing, enough for a small herd of Zebra to counteract severe pain owing to avascular necrosis of both of my hips and jaw. The narcotic cocktail enables me to maintain an ability to stand and walk, albeit for short duration. I am a petite person, 5'1" and 85 pounds.
I found my way to dilaudid only after exhausting medications with lower potency (Tramadol, hydrocodone/Norco, morphine).
I was on lower dosing of dilaudid initially. As my bone integrity has incrementally failed, I have required an increase in dosing.
All narcotics have serious side effects. While narcotics do reduce pain, they are not a panacea.
As with other medications, dilaudid/hydromorphone is available in varied dose sizes. 2 mg. 4 mg. 8 mg.
Hydromorphone/dilaudid is a more potent narcotic than hydrocodone/Norco. It throws a stronger whollop of a punch.
The most serious considerations that to consider in transitioning to a more potent narcotic, as you would in transitioning from hydrocodone to dilaudid:
• The risk of developing adrenal insufficiency. Use of narcotics is correlated with the onset of secondary adrenal insufficiency. Adrenal insufficiency is a serious, life-altering endocrine conditional in which the body fails to produce adequate cortisol - the body's primary stress response hormone. I already had the unfortunate reality of having Addison's disease, so adrenal insufficiency was not a concern for me. For someone otherwise, the possibility of developing adrenal insufficiency needs to be part of the decision equation.
• Risk of physiological tolerance to narcotic/opiate dosing. At 30 years of age, you are chronologically young with many years of life on your horizon. Deciding to take hydromorphone at a younger age will leave you with fewer options should you have higher pain needs in the future. I am currently on Palliative Care (care and comfort medical services). I do not have a long life-expectancy, so taking dilaudid as I am now is a quality of life decision knowing that I have limited life quantity.
• Risk of withdrawal is you should find yourself without your prescript
ion. I was naive about
the physiological tolerance to opiates when I began taking dilaudid. I did not have a prescript
ion refilled in a timely manner. I was in severe withdrawal within a few hours of my last dose, which necessitated medical intervention. Lesson learned. I carefully monitor and record my use and track my prescript
ion refill date.
I do not have the option of not having my prescript
ion dilaudid available.
Discuss the hoped for benefits of dilaudid against the concerns for side effects and long-term impact with your pain management physician.
A few thoughts to keep in mind:
Remember that your use of dilaudid need not be etched in stone. It can be a temporary usage to give your adequate pain control to help get you back up and on your feet and discontinued or tapered when your current health situation eases.
Remember that you can add-in dilaudid to ease your pain to a tolerable level. My narcotic cocktail does not erase my pain but it does enable me to place my pain in a corner of my mind for periods of the day so that I am not all-concumsed by pain.
Remember that you can take the lower 2 mg dose as a starting point so to avoid developing a physiological tolerance that limits your future pain control options.
Remember to keep a wide "tool box" of alternative pain control remedies at the ready. I employ yoga, warm buckwheat packs, swimming in a warmed therapy pool, snuggles with my little tea-cup maltese, reading a good book and traveling to distant ports of call through words, and more. Pain control is more than taking a narcotic pill or tablet.
- Karen -
Pituitary failure, wide-spread endocrine dysfunction
Mixed connective tissue disorder
Extensive intestinal perforation with sepsis, permanent ileostomy
Avascular necrosis of both hips and jaw
Receiving Palliative Care (care and comfort)
Post Edited ((Seashell)) : 3/8/2017 8:27:10 AM (GMT-7)