Work, Opioids, and Pain

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cogito
Veteran Member


Date Joined Oct 2010
Total Posts : 932
   Posted 7/13/2011 3:05 PM (GMT -6)   
Hi all,

It has been four or five months since I last posted.

As my pain has been getting worse, and my Ultram inadequate to deal with it, my PM wanted me to try Kadian. I was not able to function on it -- made me too cloudy and couldn't keep my eyes open.

I didn't want to increase my opioid use and after the Kadian, I asked to try Wellbutrin, hoping that upping norepinephrine would help. The Wellbutrin had no effect. So we then tried Savella. I started with the titration pack and after about 3 days at the 50mg level, I had to stop taking it. It was hard to think, constipated (since even the 12.5mg dose), and it felt like there was pressure crushing my head (sort of like when one's sinuses and eustachian tubes are clogged -- but they weren't).

That was about 3 weeks ago and felt the linger effects for another week.

Anyhow, I'm posting again today in part because it is just a bad pain day and I can't get myself to work.

As an alternative to more opioids, I've rearranged my work area so I can work from my recliner. That has been helping, but yesterday I decided to clean my office -- and today I'm dealing with the consequences.

I'm also posting for a bit of support/advice/therapy.

Most of my work is related to writing and I was solicited by a major academic press (with whom I have previously published) to write another book for them. This would be my first since my CP issues arose and I'm quite anxious about it.

I've published a few hundred pages worth of articles in the past couple of years, but committing to the book is different. I have no deadlines with an article and can drop it if I want. But my book contract is on its way and I'll be committed to an 18-month deadline.

Although I can still write when taking hydrocodone, I need to keep the dose and frequency fairly low. I can work on 5mg, sometimes 10mg, but around there I start to get a drifty-feeling that I must fight against.

So, I've been researching Provigil. My thought is that if I were to take something to increase concentration, perhaps the pain would distract me less. That was part of the rationale for trying Wellbutrin and Savella. But Provigil has a different mechanism. It is also quite unlike other concentration-enhancing drugs (Strattera, Ritalin). I'm thinking about discussing it with my PM -- but am worried about what he will think about my request.

It seems reasonable to me -- the goal is being able to focus on work vs. the pain and maybe Provigil would help -- ideally on its own -- but if not, then maybe in combination with my usual hydrocodone. In fact, it is sometimes prescribed for opioid induced fatigue.

White Beard
Forum Moderator


Date Joined Feb 2009
Total Posts : 3702
   Posted 7/13/2011 4:33 PM (GMT -6)   
cogito
 
I am a bit baffled and confused about your reluctance to take opiate based pain meds. Are you concerned about the tiredness and fatigue  that you have previously experienced taking them? or the light headness and spacy unable to concentrate feeling that you described? Most of these things are just temporary until the person is used to and adjusted to taking these type of meds. Every one reacts differently to pain meds, and just because you have a certain reaction to one type of opiate based pain med, does not mean you will have that same type of reaction to all of them. As an example, for me,  hydrocodone based pain meds often are not very effective, and to get a dose that is effective for relieving my pain, I have to take allot of it, and then it makes me feel dopey and spaced out, which  is a feeling that I hate!  But if I am given pain meds that are oxycodone based  they are very effective and I get no drugged out spacey tired feeling while taking them, all they do is relieve the pain for me.  Before being put on Oxycontin I had been taking Vicodin and Vicoprofen  I had to take allot of them to effectively relieve my pain, and they made me so groggy and spacey and drugged out, and I  just hated that feeling, I would rather have the pain!!! . The Oxycontin was totally different,  all it did was relieve my pain and that is it!  No excessive tiredness or fatigue or spacey, loopy  or drugged out feeling. Now I know everyone is different, but the thing I am getting at is, if one certain  type of opiate based pain meds have a negative affect on you, why not try some other type of opiate based pain med, and see if it works? There are many different types, and I would think maybe at least one of them might just be the thing you need???  Just something to think about???  Personally I would be a little leery about trying provigil, as that also has its own set of problems, I have known people on it and it often loses its effectiveness  rather quickly and then has to be increased. I have not heard of it being used to relieve pain???  I know it is primarily used to combat fatigue and excessive tiredness.
 
I do wish you well and hope you find relief! Good Luck to you!
 
White Beard
Moderator Chronic Pain
After spending nearly 22 1/2 years in the USAF, I retired in Sept, 1991. I then went back to school and became a licensed RN in 1994, and I worked on Oncology and then a Med Surg Unit, I became disabled in late 1999 and was approved SSD in early 2002!-- DDD, With herniated Disk at T-12 and L4-5. C5-C6 ACDF in Sep 2009, C6-C7 ACDF in Mar 1985, Osteoarthritis, Ulcerative colitis, Chronic Pain, Fibromyalgia, Complex Sleep Apnea, and host of other things to spice up my life!(NOT!) Medications:Oxycontin, Percocet, Baclofen, Sulfasalazine, Metoprolol, Folic Acid, Supplemental O2 at 3lpm with VPAP Adapt SV I am White Beard with a White Beard!

Resty
New Member


Date Joined Jul 2011
Total Posts : 3
   Posted 7/13/2011 7:17 PM (GMT -6)   
Cogito.

Ive had Chronic pain for 20 odd years. Ive herniated, ruptured and bulging disks in the lower back as well as neck/shoulder level. My back has been broken twice..across the lower back and across the shoulders twice. Ive had 25 major surgeries on just about every joint possible (knee replacement, ankle surgeries, neck surgery, back surgery, shoulder reconstruction etc). I was in a semi truck accident almost 3 years ago that left me with three tiny fractures in my neck........then I was diagnosed with fibromyalgia just about 3 years ago as well. Now I get to sport the spiffy new label of having some form of severe sleep apnea though no one wants to mention the "word Sleep Apnea"

All that to say.........Ive taken some form of opiate in high doses for more years than I can count. Ive used 150mcg of fentanyl ever 72 hours with vicodin (10/325) ..up to 5 a day for break through. I also happen to work full time........though GOD only knows how most days.

I stopped the fentanyl about 4 months ago just because I dont think it worked good enough. I have a lot better luck with just the vicodin.

I wish you much success and also support what White Beard has said in his post.

Stand strong

Trudy2
Regular Member


Date Joined Dec 2010
Total Posts : 213
   Posted 7/14/2011 9:01 AM (GMT -6)   
In my opinion, and it may differ from others - but jumping from just hydrocodone up to Kadian is quite a big jump. kadian is a time released type of morphine. I am not positive of the doses, but they could have tried you on a generic MS contin at a low dose and see what happened. Or could have tried percocet or oxycodone.

I agree that the side effects of these meds normally do go away fairly quickly. I actually do not remember any side effects when I had to first start taking opiates, but I was on high doses due to cancer and when I got out of the hospital the doses were far reduced.

Good luck!
Trudy
DX pyoderma gangrenosum, Acute Myelogenous Leukemia, Bone Marrow Transplant, Chronic Pain syndrome, Chronic Kidney Disease Stage 3, Major Depressive Disorder, Radiculopathy, Bilateral Hip Pain, Insomnia,Left Groin Hernia, Bulging Disk in Lumbar Spine, Tear in Lumbar Spine, Tendonitis and Bursitis in both hips, hypoxia due to sleep apnea and new problems with my lungs. Have had 2 abnormal CT scans.

cogito
Veteran Member


Date Joined Oct 2010
Total Posts : 932
   Posted 7/15/2011 11:40 AM (GMT -6)   
Thanks for the replies. I'm not feeling up to working this morning, so let me respond.


Trudy was surprised that my PM shifted me from Ultram to Kadian. For time-release meds, he doesn't like oxycontin. He said he would prescribe it if the Kadian doesn't work out, but he finds that patients need it every 8hrs vs 12hrs as labeled. That causes an issue with prescribing, given that it is a schedule II drug (maybe there are state issues too?). He also said that too much tends to get released in the stomach vs. intestines which often causes patients nausea. There's also Opana ER and a time release dilaudid, I believe. But I've tried the IR versions of them and they didn't agree with me.

So, we tried a low dose of Kadian. As a once-a-day pill it has an advantage over MS contin. I forget the dose now, but it was equivalent to the Ultram dose per the equivalence tables. But as I couldn't deal with the side effects, I stopped using it.

White Beard and Resty brought up my opioid reticence. I'm in my 40's and I probably have 30-40 years left. Assuming nothing changes, I'll probably need opioid medication for the rest of my life and so the less I take now, the more effective in future decades.

In addition, my pain levels are usually 2-6. 2 when I wake up, within a few hours, 4, a few hours later 5 or 6. Opioids can bring a 5 down to a 3, but often at the expense of my concentration.... yet the pain too would interfere with concentration. So, either way, it gets harder to work. Thus, the pursuit of an alternative strategy made sense. If I can find something whose primary role is to improve concentration, then whether or not I take an opioid too, my main goal would be accomplished: to be able to work despite the pain.

After researching the medications, and trying a few, I now see Provigil as the next one worth attempting. My PM appointment is in about 2 weeks and I'll see what he thinks.
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