johng
Board Addict
Reged: 02/13/03
Posts: 358
Loc: great lakes
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I Have finaly gotten proper care for my pain. I had a real problem of rapidly upward doseing of opiates especally oxycodone based meds. My PMD told me that I am one of those that my body doese not properly utilzes opiates.
Has anyone heard of this problem? also Beside higher doses which he wont do. what can be done for this?
The Pmd has me on 15 mg vicoprofen twice a day. They were having me take motrin and the 7.5/750 I asked for the vicoprofen I wanted to kill 2 birds and lowere my Apap.
any one have oppions
johng
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Ask and it will be given to you Matthew 7:7
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PIGINPAIN
Journeyman
Reged: 06/10/04
Posts: 85
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I posted this around somewhere, but it is an important topic... Everyone has slight variations in the size of their opioid receptors, according to my CP doc. He said that different types of synthetics don't work on everyone so you have to experiment, under doctor's supervision of course, with different types and quantities of meds.
The other problem is that people develop tolerance at a different pace and each type of opiate is different. Someone saying that any pain killer workers for everyone is like saying we all have a mouth, therefore we all have the same mouth. Faulty logic. Oxycodone doesn't work for me at all, not even a little. I can, and have, take three percocet 10's at one time with NO effect (under my doctor's direct supervision and I don't recommend this at home). The next day I took two Vicodin ES and darn near passed out from the meds.
Encourage your doctor to experiment with different types and different doses. I have found that taking in articles from JAMA or New England Journal of Medicine regarding pain treatment encourages doctors to try new things. They are humans like the rest of us, the are subject to getting stuck in a pattern of using the same meds over and over again.
There are a couple of cool tips out there that many docs haven't heard or don't use. For example, my oral surgeon prescribes Vistaril with Vicoprofen. Vistaril is quite simply an antihistamine, drug books actually list it as a mild sedative, but it has a synergistic affect with the hydrocodone and allows the patient's body to maximize the meds. My migraine doc has me take an OC Pepcid 20-30 mins before my Vicoprofen to slow the absorption rate of the hydro.
Good luck
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yawkaw3
Pooh-Bah

Reged: 03/22/03
Posts: 1193
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When you develop a high tolerance over a short period of time, the rate at which you metabolize opioids increases dramatically. The bottom line here is that they will kick in more quickly and leave you more quickly. So what used to take an hour to kick in might only take a half hour, and you may only get an hour and a half of pain relief as opposed to the previous 4 hours you used to get.
If I remember correctly, you were off opioids for some time before seeing the PMD, right? I could be wrong about that but I thought I remembered it. I can't tell you how long it will take for your opioid metabolism to return to normal (or as close to it as it will ever get), as that's even more of an individualized thing that depends on sooo many factors.
Hopefully, your opioid metabolism slowed somewhat in that waiting period. Your best bet are really the potentiators. Just also keep in mind that tolerance to the sedation is normal and to be expected- tolerance to the pain relief occurs at a different rate. So just because you're not getting the same sedation you used to, doesn't mean the pain relief isn't working as well- that can sometimes psychologically cause you to think the meds aren't working as well as they should, so watch out for that.
-yawkaw
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johng
Board Addict
Reged: 02/13/03
Posts: 358
Loc: great lakes
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yawkaw3 I was of all opiates for 6 weeks. my tolerance went down to 2 tabs worked very well. By the end of the 4 week cycle I was haveing pain after 6 hours where at the start the releif was 8-10 hours. It was very nice to feel the nausa again. I know that sounds stupid be it told me that my tolerance was way down.
I am on a my holiday cycle (4 weeks off) and I have no withdrawl like I would before. The pain level went up after the first few days but it is barley tolerable with Apap/ asa mix.
I stinks that my body is like that. Would a patch work better for me. I know he wont do that but what do you think
johng
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Ask and it will be given to you Matthew 7:7
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yawkaw3
Pooh-Bah

Reged: 03/22/03
Posts: 1193
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I definitely think the patch, OxyContin, or methadone would be better for you, as long as you don't take more on your own initiative. If you are prone to doing that, stick with hydro. A long-acting pain med with breakthrough meds will be much better for you, as I do think the Vicoprofen eventually will not be enough if that has already happened to you in the past with hydro. Hopefully you can prevent that as much as possible with non-opioid meds and potentiators.
-yawkaw
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Julz
Enthusiast
Reged: 11/17/03
Posts: 223
Loc: NJ Shore
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Quote:
When you develop a high tolerance over a short period of time, the rate at which you metabolize opioids increases dramatically. The bottom line here is that they will kick in more quickly and leave you more quickly.
Yawkaw~
Does this mean that if you have a high tolerance as stated above & were asked to take a drug test, you would test negative for opiates sooner than someone who does not have a high tolerance?
Just Curious,

Julz
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Love never fails. 1Cor 13:8
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johng
Board Addict
Reged: 02/13/03
Posts: 358
Loc: great lakes
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I think what yawkaw ment was I have more opiate receptors in the brain and spinal cord. So the opiate is converted to its by by-product. the elimation of that is fixed. the by-product is bound to plsma et al in the blood. it can only be filtered by the kidneys and liver at a certin rate so while the usefulness of opiates is less in me I still exrecet the by-product at the a normal rate. I only have to kidneys and on liver. the nervous system is dynamic and can adapt. hence I have more opiat receptors.
Yawkaw please correct me if I am interpting it wrong??
johng
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Ask and it will be given to you Matthew 7:7
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neonsign2003
Veteran
Reged: 12/26/02
Posts: 532
Loc: midwest
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potentiators? SUCH AS? I MAY NEED THEM AS MY ORDER WAS SHIPPED TO SOME BLOODY FREAK ON THE NWW BOARD! TELL CRAZYMARIE I WANT TO TALK TO HER AS SOON AS SHE IS DONE SNACKING ON A PUMKIN PIE ( WITH WHIP CREAME) 6 CANDY BARS,
AND A MILK SHAKE. NWW CUT FATTY, FATTY,2 X 4 OFF! I HOPE TO
GREET HER HERE........potentiators??????? WHAT ARE potentiators?
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catman1
Journeyman
Reged: 08/17/02
Posts: 87
Loc: SE USA
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I also have an extremely high tolerance for oxy, hydro, etc. I was taking 3 (yes THREE) 80mg oxys a day, plus breakthru (4 percs a day). Doc switched me to the patch (duragesic). Tried 75, went up to 100mcg every 2 days, with 4 percs a day. I can walk a lot better now. Unfortunately, my new ins won't pay (fully) for the patch. My last ins made me change to the patch. No sense.
Anyway, back to the point. You may well be better off with the patch.
One strange note about the patch vs oxy: I actually feel slighty more pain with the patch, but it bothers me less!
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It's not what they give you that counts, it's what works
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yawkaw3
Pooh-Bah

Reged: 03/22/03
Posts: 1193
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johng,
That's not quite what I meant, but is part of it.
I will explain a little more about tolerance. It can be caused by:
1) More/weaker opioid receptors, as you said
2) Faster excretion (so no, it's not a fixed rate)
3) Faster liver metabolism (also not at a certain rate)
...and whatever we haven't discovered yet. Keep in mind tolerance is very well documented but not very well understood why and how with proof.
So it's not just that you've got more or less efficient opioid receptors. There actually are metabolic changes, and what your liver and kidneys can do changes, both in good and bad ways (faster or slower metabolism, depending on if you're taking it or aren't).
-yawkaw
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yawkaw3
Pooh-Bah

Reged: 03/22/03
Posts: 1193
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neon,
They make opioids (and certain opioid effects) stronger. Do a search here and visit http://www.coldwaterworld.com for more info.
Vistaril (hydroxyzine) is the best, IMO.
-yawkaw
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neonsign2003
Veteran
Reged: 12/26/02
Posts: 532
Loc: midwest
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yawkaw, thanks for the info. what about any otc aids.
also, what do you think of using benzo ( klonopin in my case) and hydro? might not be so, but I do not get the same pain releive when I use the K. ?
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yawkaw3
Pooh-Bah

Reged: 03/22/03
Posts: 1193
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OTC meds, http://www.coldwaterworld.com will probably be the best for that- has a ton of OTC meds listed and how/why they work.
As far as Klonopin, that's only going to make the sedation stronger, but not by that much if you take your usual prescribed dosage. Me personally, Valium is the post benzo potentiator because it has muscle relaxant qualities, kicks in quickly, and the sedation lasts.
Look into tagament and the various OTC antihistamines, keep an eye out for those when you check out coldwaterworld (which doesn't have extraction info on it anymore, btw, for anyone concerned about that- now it only has info on potentiators.
-yawkaw
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