[HeyJoe]

http://health.msn.com/health-topics/...ntid=100195150

[nide44]

Joe,
Good article.
Nothing new or enlightening here for those of us who've
been around the block once or twice,
but.... a comprehensive overview on opioids and
dependency vs addiction.

[DanP]

Excellent information. I have used the Duragesic Patch and now it's generic form: Fentanyl Transdermal System, since January 9, 2002 without ill effects. I am using 125mcg/hr and changing them every 48 hours.
The fentanyl in these patches is many times more potent than morphine (I believe Mrsd can verify this) yet I am not addicted - dependent, yes; addicted: NO...and there is a huge difference in the two. I have driven my car since the beginning of using this med and have had no accidents or tickets and I have literally driven from one end of the country to the other. I am able to function normally...my hands are steady, my eyes are clear with normal pupils, and I function normally in every respect. I even walk a mile or two every day! The point is - people with true chronic moderate to severe pain rarely ever have a problem with opioid use. Addiction can happen but it's extremely rare...less than 1 percent though some will argue it can be as high as 3 percent. Either way - this means 97 to 99 percent never become addicted....a percentage I can live with.
I am now 76 years old and my doc and I will continue to use this medication for my pain management until a cure is found or my life ends. My untreated pain on the Mankowski Pain Scale is rated a 7 to 9.5 and my treated pain levels are a low 2 to 4. I have become so accustomed to the 2 to 4 levels that I now virtually ignore it. I feel fortunate and blessed that this medication works for me and my wish is that all sufferers of chronic pain can find a med that will work this well for them. I am convinced that whatever one uses it must be titrated for maxium relief and in the blood stream 24/7/365.
Good luck to everyone.

[daniella]

The issue is not all docs will put you on long term opiates. That is why for me they want a spinal cord stimulator. I am not a pill person.When I went to Cleveland Clinic they said I had to stop vicodin and I quit that day and have taken it a few times only in 9 months. I wait to the last possible moment where I am in crying pain to take but I do feel that quality of life is important. Most of these stars and of course not all but also have addictions to other drugs. That most and I say most people in chronic high pain take meds to give them a better more comfortable life. Dan I really always like your story. Not that you are in pain but that you found something to help you. It gives hope.

[cyclelops]

I would rather NOT be on opiates, I have no good option. Opiates do not fully erradicate pain for me, however, I have more issues than strictly small fiber neuropathy. Opiates DO let me live a more active life, which will in the long run prevent many of the problems associated with sedentary living.

If you are not up and moving, you get osteoporosis, you don't eat well due to pain, your GI system plugs up, and you lose muscle mass, you socially disengage, get depressed and anxious....among other things. Not treating chronic pain causes more problems than treating it. Chronic pain patients seldom abuse medications. I agree with the article.

Taking an opiate is less damaging to me, than not moving due to pain. I will live a better life on opiates than off, and I will cost the 'system' less money in the long run, as I am less likely to develop problems due to sedentary living, and the other numerous problems that chronic pain patients develop.

There is a bias to prescribing opiates to younger people. Young people with chronic pain do not get adequate treatment. I lived 20 years with moderate pain from injuries from a severe car accident, and likely disease intermixed...with no pain management....I got by, but life should have been easier, and I did suffer from the lack of pain management for all those years. Now, being older, perhaps there is less bias, and also, my disease pathology is undeniable, and probably my shelf life is shorter...making me a more acceptable 'risk' for opiates.

The longer you have a relationship with a doctor, the more likely they are to know you, to know your medical problem, and the more likely they will be, if they ever were inclined to, prescribe an opiate for you.

That said, some one may at some time question your doc, and get their defenses up. It takes a lot of courage for docs to treat chronic pain patients with opiates....many take flack for it.

In my experience, "pain clinics" are less likely to prescribe opiates.

After a full evaluation by a specialist, the more likely your internal medicine or primary physician will be to prescribe. They are the ones who end up caring for you long term, and should be the ones who with your neuro or specialist, coordinate your care.

There is a phenomenon of specialists not wanting a long term relationship with patients, especially at some larger research facilities, and you get that 'dumped' feeling.....they refuse to prescribe opiates as that locks them into seeing you long term, and if you are a boring case, they want to invest energy elsewhere....you get discharged to your primary's care anyway. Many will tell you right up front that they do not do pain management.

Many research facilities, see you once or twice and come to some conclusion that is either a diagnosis or sydnrome....and send you to a 'lower tier' for care. I have been fortunate to have been followed for 4 years, but I get less now than I did when I was a brand new interesting case. Unless I manifest new pathology, they have no more to offer me and if I am lucky, they will see me for follow up.

My primary feels confident enough to prescribe opiates for me, based on my medical history, and from what she knows of me, and also her own personal philosophy. As much as I do not like the idea, I don't have a option that works, other than opiates.

Some diseases take a long time to fully manifest, and it is not rare to see many people take 10 years before they get correct diagnosis. That is a long time to suffer and wait, but, you see it happen fairly often.

[Kathi49]

Dan P,

I am right behind you and agree. I wish I didn't have to take the opiates but at least I can function while on them. I just started the Duragesic patch about 16 days ago. However, it is 12mcg and I still take Vicodin once a day for BT pain. I have noticed quite a difference in my pain levels but I am certain it will be "upped" as time goes on. The only thing I complained about to my spinal pain management doctor yesterday (who by the way has a background in Internal Medicine as well as Pain Management) was that I hate the sweating and that it wears off too soon. He said it was common for it NOT to last a full 72 hours and that 80% of that patch is absorbed in the first two days. Anyway, he rewrote the script for every 48 hours. And the whole deal with patch in a nutshell is two things; bypassing any GI issues and having consistent relief without the ups and downs of short acting meds. I can still feel the radiculopathy a bit but for other aches and pains it is working well.

Cycelops,

I have never had my GP deal with my neuropathy or spinal issues. It just isn't his area of expertise. But for the spinal issues it has always been a pain management doctor; one group was with the Medical Center (pain clinic) and the one I see now is with another hospital and Director of their pain clinic. I have never had any trouble being presribed opiates at all. But I have heard from others that they run into the same thing you are speaking of. I just haven't. If anything, they tried everything they could think of...I just can't tolerate meds like Neurontin or Lyrica and have to stay away from the anti-inflammatories other than an injection. Anyway, I realize this forum is of course the neuropathy forum but for spinal issues my current PM is the best! And 9 times out of 10 my Neurologist is in agreement with him. So, I just haven't had issues getting the meds I need.

[jarrett622]

There are some good info links at the bottom (or end, if you will) of the article.

Thanks for posting this. I knew about this and how it relates to my own use of pain meds. And for anyone with chronic pain. The last page I sent to my daughter whose BF is addicted to God only knows what all. He blames it on having lost a finger in a construction accident and the pain killers he was given. That's bull IMO because normal doses taken normally (not snorted) don't cause what he's blaming his addiction on.

[groskilly]

Very good article.

Thanks
Gerald

[shiney sue]

I always like Dan's story because he has found something that works with his pain. Also his Dr. has let him know they can work together,and Dan has
shown his Dr. he will do what he's told. They are showing they can trust
each other,I have the same relationship with my Dr. I have heard from my
sister-in-law my dr. is a pusher and i'm a addit..The type you ignore or
if your lucky you don't see often. Hugs to all Sue