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Topic: Long-Term Prescribed Narcotic Use for Chronic Pain (Read 2639 times) |
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CHTom
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Long-Term Prescribed Narcotic Use for Chronic Pain
« on: Sep 5th, 2005, 3:32am » |
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There continues to be a number of posts concerning CH suffers becoming addicted to narcotic analgesic medication, even after being used for only a very short time. I am publishing the following statement to try to allieve concerns that CH sufferers, who may be or have been prescribed such medications, are in great danger of becoming drug addicts. I am not endorsing the use or non-use of these medications but just hope to put some sufferers' minds at ease and also to clarify, which I think that the statement does an excellent job of doing, the difference between dependence and addiction. This statement was updated in Feb. 2004. PFDANs.
Prescribing Controlled Substances for Pain
A statement by the Medical Board of California, 1997
On May 6 the Medical Board formally adopted the following statement on "Prescribing For Pain Management.". It is the first formal statement of its kind in the nation made by a licensing board. This statement was adopted after a year of testimony at hearings held by the Board's Task Force on Appropriate Prescribing and a day-long "Summit," sponsored by Governor Wilson, involving scores of experts from around the country.
The Appropriate Role Of Opioid Analgesics
There are numerous drug and non-drug treatments that are used for the management of pain and other symptoms. The proper treatment of any patient's pain depends upon a careful diagnosis of the etiology of the pain, selection of appropriate and cost effective treatments, and ongoing evaluation of the results of treatment. Opioid analgesics and other controlled substances arc useful for the treatment of pain, and are considered the cornerstone of treatment of acute pain due to trauma, surgery and chronic pain due to progressive diseases such as cancer. Large doses may be necessary to control pain if it is severe. Extended therapy may be necessary if the pain is chronic.
The Board recognizes that opioid analgesics can also be useful in the treatment of patients with intractable non-malignant pain especially where efforts to remove the cause of pain or to treat it with other modalities have failed. The pain of such patients may have a number of different etiologies and may require several treatment modalities. In addition, the extent to which pain is associated with physical and psychosocial impairment varies greatly. Therefore, the selection of a patient for a trial of opioid therapy should be based upon a careful assessment of the pain as well as the disability experienced by the patient Continuation of opioid therapy should be based on the physician's evaluation of the results of treatment, including the degree of pain relief, changes in physical and psychological functioning, and appropriate utilization of health care resources. Physicians should not hesitate to obtain consultation from legitimate practitioners who specialize in pain management.
The Board recommends that physicians pay particular attention to those patients who misuse their prescriptions, particularly when the patient or family have a history of substance abuse that could complicate pain management The management of pain in such patients requires extra care and monitoring, as well as consultation with medical specialists whose area of expertise is substance abuse or pain management.
The Board believes that addiction should be placed into proper perspective. Physical dependence and tolerance are normal physiologic consequences of extended opioid therapy and are not the same as addiction. Addiction is a behavioral syndrome characterized by psychological dependence and aberrant drug related behaviors. Addicts compulsively use drugs for nonmedical purposes despite harmful effects; a person who is addicted may also be physically dependent or tolerant. Patients with chronic pain should not be considered addicts or habitues merely because they are being treated with opioids.
(Edited to fit the alowed space; bold face and underlining done by me for emphasis)
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LeLimey
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Re: Long-Term Prescribed Narcotic Use for Chronic
« Reply #1 on: Sep 5th, 2005, 3:36am » |
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Hmm.. John used to advocate narcotics as pain relief wheras everyone else including Professor Goadsby says they have no place in the management of clusters.
Your veil is slipping Mata Hari.
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pubgirl
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Re: Long-Term Prescribed Narcotic Use for Chronic
« Reply #2 on: Sep 5th, 2005, 3:39am » |
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Helen, that cracked me up!
Ground control to Major Tom, your circuit's dead, there's something wrong 
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E-Double
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Re: Long-Term Prescribed Narcotic Use for Chronic
« Reply #3 on: Sep 5th, 2005, 8:36am » |
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There are definitely a few that do not respond to typical meds and are in need of narcotics to survive.
I can name a few here but will let them pop up and advocate for themselves.
I'm honestly for whatever works!
The problem that I see is with the medical community and the improper treatment and inappropriate diagnosis'... If people are given hard core narcotics prior to conventional CH meds and then find themselves screwed because they are dependent.
The problem wiht dependence is the increase in need for the med. When one habituates because and starts to get rebound they will take more & more.
Now you not only have CH but an additional headache type which could be extremely excrutiating(trust me!!)
If narcotics are used, I think we are talking more along the lines of Fentynl or acqtic lollipops as opposed to popping mass amounts of percs or vicadins.
Whatever helps BUT one does need a good Dr.
E
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pubgirl
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Re: Long-Term Prescribed Narcotic Use for Chronic
« Reply #4 on: Sep 5th, 2005, 12:02pm » |
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Oh don't encourage him E!
We'll never hear the last of it 
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Karla
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Re: Long-Term Prescribed Narcotic Use for Chronic
« Reply #5 on: Sep 5th, 2005, 12:31pm » |
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All I can say is I think what he wrote is well said. Last year after taking the duragesic (fetanyl) patch for over a year I quit taking it cold turkey and had virtually no problem at all with stopping it. However, I had tried over 35 different meds to prevent my ch from occurring and nothing worked and I was chronic getting hit 8x/day for 1 1/2 ea. That was 16 hr mostly at kip 10's. I couldn't work at home or else where and I had no life at all. Eventually I needed to go back on the patch because the ha came back. This medicine has given me a quality of life with my family and just life and living in general that I would never have had otherwise. I have 0 ch occurr that is 0 pain. I may be dependent on it but I am not addicted and I thank God for a compationate dr I have who isn't affraid to perscribe to me and we have a good patient /dr relationship where he trusts me.
However I do believe it should be a last resort and only after you have tried everything else under the sun because there are alot of other meds out there that work for people.
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| « Last Edit: Sep 5th, 2005, 12:34pm by Karla » |
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Karla
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CHTom
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Re: Long-Term Prescribed Narcotic Use for Chronic
« Reply #6 on: Sep 5th, 2005, 10:12pm » |
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Fentanyl patches and Actiq (fast acting fentanyl "lollipops" have shown the most promise for chronic, intractable CH pain-the patches as a preventive and the "lollipops" as an abortive for breakthrough pains. I agree, E-Double, that a good doc is essential and will add that a good pain clinic is best, along with a neurologist who knows how to diagnose and treat CH. Karla, I'm glad that the patches have given you back a normal life and agree that such medications should be used as a last resort if everything else fails. Perhaps the article could be shown to ignorant people who think that you (or other users) are not "drug addicts"; being dependent is not a problem and when the time comes to stop using the drugs please do so under medical supervision. PFDANs.
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| « Last Edit: Sep 5th, 2005, 10:16pm by CHTom » |
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gore2424
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Re: Long-Term Prescribed Narcotic Use for Chronic
« Reply #7 on: Sep 5th, 2005, 11:50pm » |
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I do agree with you Karla i too wear the pain patch its the 75ug/h been my life saver been chronic since Nov 1999 and for many years tried 67 different meds in all combos even went as far as have brain surgry cut nerve i have no feeling on whole right side of face so after all that finally been getting relief with the patch i get mine supplied thur the VA and twice they were late first time 8 days without and second 7 days without should of been in hospital cause i had nasty days and nights laying in bed toss and turning couldnt sleep when my Neuro found out he now supplies me with 30 mg of morphine pills 14 a month for the really bad days and if am late with them again he will put me in hospital so i dont withdraw ok i rambled enough Terry
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hdbngr
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Re: Long-Term Prescribed Narcotic Use for Chronic
« Reply #8 on: Sep 14th, 2005, 4:42pm » |
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I'm really glad that someone posted on the difference between depend vs. addiction.
I used to use the Duragesic patch. I used them for a year and a half, and when the worst had passed, I weaned off of them. It wasn't fun, but it was doable. Like Karla, I honestly think it saved my life and I'm deadly serious when I say that.
The patch is sometimes used when they are worried about addiction. You get exactly enough to last one month. Each patch last three days. When it's gone, it's gone, so that inhibits anyone using them when they aren't needed.
If you feel a narcotic would improve your life, offer to have voluntary bloodwork each month. That way the Doc knows the amount in your system. It also red flags folks who are taking them inappropriately. Narcotics do have a place in treatment of chronic CH.
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nani
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Re: Long-Term Prescribed Narcotic Use for Chronic
« Reply #9 on: Sep 14th, 2005, 6:56pm » |
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I'm glad they work for some folks. They have never touched my CH. The last time I was in the ER, I got 2 morphine/phenergan shot within 3 hours and it didn't do a thing. I never even fell asleep or felt drowsy. Come to think of it, I drove (with no "under the influence" effects) within 2 hours of the last shot. I'm a freak. 
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madprof
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Re: Long-Term Prescribed Narcotic Use for Chronic
« Reply #10 on: Oct 16th, 2005, 1:38am » |
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Is treatment with narcotics really a problem for CH patients? I'm a great admirer of PJ Goadsby's and was surprised at his assertion that narcotics have no place in the treatment of CH. Clusterheads know better than most that nothing works for everyone. I typically get 5-7 attacks a day, most 120-140 minutes, relatively slow onset. Unfortunately, with the exception of Imitrex, none of the standard treatments work reliably. 02 is good, can't live without it, but often it is not enough. So I save Imitrex for work, take PKs at night, and await Verapamil salvation. Thirty four years of PK use, no problem ever getting off. One would think that we would have fewer problems than other chronic pain patients, given that the consequences of permitting tolerance to increase are so severe and the association of the high with the pain so unpleasant. New to this excellent board, been cluster-free for ten years (after a last cycle that lasted 14 months), brushing up on my long-neglected mycology, will let you know how it goes.
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burnt-toast
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Re: Long-Term Prescribed Narcotic Use for Chronic
« Reply #11 on: Oct 16th, 2005, 7:57am » |
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I have often posted concerns about using narcotics for treating CH. but maybe I wasn't being objective. Not being a doctor I can only provide my point of view, about my situation.
Blood serum levels of narcotics would have to be maintained at sufficient levels for relief 24X7/365. I don't believe that those experiencing Chronic or Lengthy On-Cycles are good candidates for narcotics treatment. The word zombie comes to mind.
But I believe the best point made is that everyone is different - narcotics may be just the ticket for sufferers with short or infrequent On-cycles. This group probably has the least amount of risk for addiction as a result of treatment.
As long as there is a reasonable certainty of not causing more problems - Whatever it takes to get relief is a good motto.
Tom
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CHTom
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Re: Long-Term Prescribed Narcotic Use for Chronic
« Reply #12 on: Oct 16th, 2005, 8:24am » |
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Amen Brother!
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Sean_C
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Re: Long-Term Prescribed Narcotic Use for Chronic
« Reply #13 on: Oct 16th, 2005, 8:48am » |
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on Oct 16th, 2005, 7:57am, burnt-toast wrote:| Blood serum levels of narcotics would have to be maintained at sufficient levels for relief 24X7/365. I don't believe that those experiencing Chronic or Lengthy On-Cycles are good candidates for narcotics treatment. The word zombie comes to mind. |
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The phrase "not a cluster sufferer" comes to my mind.
Opioids will not abort a cluster and thats fact. Don't spread rumors to all these newbies that Oxcy's make it go away because it won't. Any doc that gives you pain pills for CH shouldn't be treating a patient IMHO.
There is no relief in Opioids.
Sean.............................
BTW google Oxy and read the facts for yourself. I've lost 3 friends to that crap  Dependence is addiction. READ
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E-Double
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Re: Long-Term Prescribed Narcotic Use for Chronic
« Reply #14 on: Oct 16th, 2005, 11:44am » |
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Sean,
The only problem is that there are some who do not respond at all to the traditional meds/can't use them and can not or will not try the alternatives that we are learning about.
Those like Karla & Terry who are like the above don't have a choice if they want to live functional lives.
Like I mentioned there are certain narcotics like fentynl that has helped.
In fact I have that listed on my emergency card as a med to be given if I have run out of options and have to go to the ER.
That is a different case than taking regularly but it is a necessary evil sometimes if a break is needed like many of us encounter.
I personally think the nature of our disorder shows that narcotics overall do not have much of a place when used the way they are for other types of pain or disorders that cause extreme pain yet if used properly and strategically along with the aid of a CH knowledgable doctor than it can not be ruled out as a last resort.
E
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Kevin_M
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Re: Long-Term Prescribed Narcotic Use for Chronic
« Reply #15 on: Oct 16th, 2005, 12:04pm » |
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Quote:| The Board believes that addiction should be placed into proper perspective. Physical dependence and tolerance are normal physiologic consequences of extended opioid therapy and are not the same as addiction. Addiction is a behavioral syndrome characterized by psychological dependence and aberrant drug related behaviors. Addicts compulsively use drugs for nonmedical purposes despite harmful effects; a person who is addicted may also be physically dependent or tolerant. |
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It says, an addict is characterized by psychological dependence and aberrant drug related behaviors, a person who is addicted may also be physically dependent or tolerant. A lot in common with psychological/physical dependancy and addiction. The dependence exclusions as defined here are tolerance and "aberrant" drug related behaviors.
Quote:| The Board recommends that physicians pay particular attention to those patients who misuse their prescriptions, particularly when the patient or family have a history of substance abuse that could complicate pain management. The management of pain in such patients requires extra care and monitoring, as well as consultation with medical specialists whose area of expertise is substance abuse or pain management. |
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I would change the word "or" to "and" as the third from last word in the above quote for the reason I highlighted, also within the quote.
Where applicable and for the right reasons, although I would not be an advocate of it for clusterheadaches and would agree with Dr. Goalsby for personal reasons.
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| « Last Edit: Oct 16th, 2005, 12:11pm by Kevin_M » |
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Re: Long-Term Prescribed Narcotic Use for Chronic
« Reply #16 on: Oct 16th, 2005, 12:23pm » |
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Ok I've read just about all who contributed to this post,and all I have to add is this.When I feel a ball busting CH on it's way,and believe me I always know,and a Vicodin is all I have available I'll damn sure use it.It doesn't make the CH vanish into the air but it does somewhat deaden the pain.Wish I new a magic pill that would make it disapear.My doc said no more triptans because of a heart attack,so if O2 is not available I'll do whatever it takes.  David Been a little while since my last post,hope everybodies doing great!
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Sean_C
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Re: Long-Term Prescribed Narcotic Use for Chronic
« Reply #17 on: Oct 16th, 2005, 12:31pm » |
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on Oct 16th, 2005, 11:44am, E-Double wrote:| The only problem is that there are some who do not respond at all to the traditional meds/can't use them and can not or will not try the alternatives that we are learning about. |
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But they choose a medication not intended for short term pain. Am I correct?
Pain medication does work bud, if I had my hips replaced this morning. Not if I had a CH.
I've tried to scratch myself to relief many times my friend It doesn't work
Cheers 
Sean....................................
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CHTom
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Re: Long-Term Prescribed Narcotic Use for Chronic
« Reply #18 on: Oct 16th, 2005, 1:58pm » |
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There are narcotics that are slow release which are intended for chronic pain (i.e., Fentanyl patches) and then there are those that are fast acting (i.e., Dilaudid) for use when pain becomes so severe that it breaks through the slow release medications. Sometimes a combination of both is required. A pain clinic is the best and safest place to get either or both types as their use is strictly monitored and the physicians there are specially trained regarding the use of these medications. For certain chronic CH patients, where nothing else has worked to control the pain, a pain clinic is the appropriate place to be evaluated for and obtain, if the doctor deems it necessary, these medications. They have very strict controls regarding a patient's use of these medications. While not for everyone, for some chronic CH patients, narcotics are the only option to relieve the severe pain. In a good pain clinic, an extensive work up is done, including a neurological consultation by a neurologist who specializes in chronic CH, before a decision is made to place one on these medications and can enable a person with severe, chronic CH to live a productive and as near to normal as possible life. Whether or not someone chooses to use these medications is a personal decision, just as it is a personal decision to use any other medication, be it conventional or mushrooms. "Judge not lest ye be judged" and "Walk a mile in my shoes." PFDANs to all.
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Sean_C
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Re: Long-Term Prescribed Narcotic Use for Chronic
« Reply #19 on: Oct 16th, 2005, 2:07pm » |
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OK help me here.
For all practical purposes its 1am and I wake up with an attack, its a kip 8 and growing.
What do I do now opioid speaking?
How long will it take to abort my CH?
Sean.....................................
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CHTom
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Re: Long-Term Prescribed Narcotic Use for Chronic
« Reply #20 on: Oct 16th, 2005, 2:13pm » |
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It depends upon the drug, but something like hydromorphone hydorochloride will start decreasing the pain withing 15 minutes or so and at the proper dose, decided upon by the prescribing physician, the pain should be gone or very significantly reduced (so that you can sleep) within an hour at the longest. What you take and what doseage is something to be worked out by you and your physician. I hope this helps.
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Jonny
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Re: Long-Term Prescribed Narcotic Use for Chronic
« Reply #21 on: Oct 16th, 2005, 2:31pm » |
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on Oct 16th, 2005, 2:13pm, CHTom wrote:
Sounds like youve tried them all....LMAO
TROLL!!!!
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It is up to YOU to educate yourself and then help your doctor plan your treatment. If you just sit down in front of your doctor and say "make me better" you are setting yourself up for a great deal of pain.
- Guiseppi
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LeLimey
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Re: Long-Term Prescribed Narcotic Use for Chronic
« Reply #22 on: Oct 16th, 2005, 2:42pm » |
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You got that right Jonny.. thats why in a previous incarnation he was dissing the diamond headache clinic.
They had the temerity to insist he had to try other stuff than cocaine nasal sprays so he checked out..
Some of us here have good memories in spite of CH eh?!
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Kevin_M
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Re: Long-Term Prescribed Narcotic Use for Chronic
« Reply #23 on: Oct 16th, 2005, 3:51pm » |
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Posted by: CHTom Posted on: Sep 5th, 2005, 4:32am
Quote:Prescribing Controlled Substances for Pain
A statement by the Medical Board of California, 1997
Addiction is a behavioral syndrome characterized by psychological dependence and aberrant drug related behaviors. |
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Posted by: LeLimey Posted on: Today at 3:42pm
Quote:in a previous incarnation he was dissing the diamond headache clinic.
They had the temerity to insist he had to try other stuff than cocaine nasal sprays so he checked out. |
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| « Last Edit: Oct 16th, 2005, 3:53pm by Kevin_M » |
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pubgirl
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Re: Long-Term Prescribed Narcotic Use for Chronic
« Reply #24 on: Oct 16th, 2005, 8:37pm » |
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on Oct 16th, 2005, 2:13pm, CHTom wrote:| It depends upon the drug, but something like hydromorphone hydorochloride will start decreasing the pain withing 15 minutes or so and at the proper dose, decided upon by the prescribing physician, the pain should be gone or very significantly reduced (so that you can sleep) within an hour at the longest. What you take and what doseage is something to be worked out by you and your physician. I hope this helps. |
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Can I be very dim here? Why would you take something so strong and potentially habit forming ( morphine derivative, dilaudid??) if it may take longer to work than it would take for the attack to stop on its own?
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| « Last Edit: Oct 16th, 2005, 8:45pm by pubgirl » |
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