ENDO Messages for June, 2007: Re: Pain medication

Re: Pain medication

From: D (anonymous@obgyn.net)
Fri Jun 22 13:26:22 2007

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In reply to: SaraM: "Pain medication"

Hi Sara,

I've been in pain management since September, and have to take some strong meds to control my pain - but I was also teaching until school got out a couple weeks ago, which made it important that I wasn't too effected mentally! I'm on a long-acting opioid (fentanyl skin patches, changed every three days), and take hydrocodone (norco) as needed each day for the breakthrough pain.

The basic idea of managing chronic pain with medication is to find the lowest dosage of long-acting opioids that will keep you comfortable most of the time, then you also take a short-acting drug as needed when the pain spikes. Most doctors will try to get your pain down to a baseline of 4 or 5 on a scale of 0 to 10, 10 being the worst pain imaginable. (something to keep in mind when you are rating your pain! I used to rate pain at 5 that I probably should have been 6 or 7).

It sounds like your primary doc or obgyn has been prescribing for you, if so you might want to ask for a referral to a pain management doctor. Even though your doctor is willing to prescribe stronger meds - and that is very fortunate! - a pain doctor will have the experience and knowledge to help you deal with the side effects and other issues. Here's a link to a really good download "Treatment Options: A Guide for People Living with Pain": http://www.painfoundation.org/Publications/TreatmentOptions2006.pdf There's a lot of good information on their website, too - including a discussion board - I highly recommend checking it out.

Chronic pain should not be treated on an "as needed" basis - waiting until the pain gets bad to take meds makes it more difficult to get the pain down to an acceptable level - and taking high doses is what's going to make you sleepy/loopy. The body builds a tolerance to the drugs pretty fast - I only felt the fentanyl patches when I first started on them, and whenever the dose is raised it takes 2-3 days for me to get used to a higher dose, after that it's like they aren't even there, except I'm not in (as much) pain!

Dependence is a concern, but it's also to be expected and should not be confused with addiction! Pretty much everyone who takes opioids for any length of time will develop some dependence, but the same is true for most anti-depressants. It's one more reason to work with a pain specialist, because they will know how to taper you off the drugs when it's time to do that, and they will be watching you for signs that any problems are developing. My pain doctor had me sign a contract with him stating things like that I wouldn't get pain medication anywhere else, I'd always go to the same pharmacy, etc., I also report how many pills I have left at each visit (some make you bring them in to be counted), I took a drug test before treatment started and can be tested again at any time - there are systems in place to help make sure that I don't get addicted or otherwise abuse the medication, which is all fine with me! I know some people get offended by that sort of checking up, but if that's what's necessary for me and my doctor to work together safely and for me to not be in pain, I don't find it a problem.

Well, once again I managed to over-answer the question! Didn't mean to go on for so long, but I hope it helped!

At Fri, 22 Jun 2007, SaraM wrote: >
>Hello
>
>I have been using pain medication for years, I have to be careful
>because I am employeed in a job that requires me to be clear and not
>impaired. I use a middle of the road stregnth pain killer,although this
>stregnth isnt that helpful. I could use a higher stregnth that my Dr
>has offered many times, but fear of further impairment, dependence and
>more or other increased side effects stop me from moving forward with
>that.
>
>Even these middle strength ones are not very effective on my pain, and
>impair enough already to make me sleepy so going up in strength would
>just make it worse. Does anyone know of a way to lessen those side
>effects?
>If there was a way I may consider moving up in stregnth.
>Thank you
>Sara

-- Find an endo specialist in the ERC's EndoDocs group: http://groups.yahoo.com/group/EndoDocs/

Try an excellent endo support group: http://groups.yahoo.com/group/erc/

Info on pain management: http://www.painfoundation.org/

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In reply to: SaraM: "Pain medication"

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