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Pain Management Message Board

Pain Management Board Index

I also wanted to chime in about the use of opioids for chronic pain. There are common misconceptions. From everything I have read and my own personal experience, taking opioids long term as prescribed for severe chronic pain has a very low risk of psychological addiction (in contrast to taking them for acute pain, such as after a surgery, and especially, recreationally). When taken for severe chronic pain, many (like me) don't get any euphoria type side effects, just pain relief (but also unfortunately side effects, like constipation). I actually think much more clearly when on opioids, as otherwise the pain prevents me from being able to focus.

Sometimes folks have euphoria in the beginning (first couple weeks), but that can be a sign that the dose is too high. It is also more likely to occur with short (vs. long) acting opioids. Oxycontin is a long acting one by the way, the same as Oxycodone, except Oxycontin is time release. Opioid addiction is most commonly seen in folks who have struggled one or more other types of addiction in their life (like alcohol, gambling, etc).

The goal with opioids is not to take away 100% of the pain, but to help manage it, such as with 50% relief. Chasing 100% relief is likely to cause rapid tolerance and subsequent dose escalation, as well as more side effects. So, if your father was feeling overly medicated when he has tried opioids previously and was getting very good pain relief, he may want to try half that dose (or even less) to test if that would have a better result. Each person also responds differently to each med, so some meds may be a better fit for pain and/or side effects.

Also on this note, medications all have different conversion rates, so 10mg of one med may actually be equal to 50mg of another med or similar. Some meds are perceived by the public as being “stronger” than others, but in fact the dose should be converted such that the result would be equivalent. That said, if your father is against trying Oxycontin specifically, asking his doctor about something less potent is an option, especially if it would make him comfortable with the idea. For example, there is now a long acting form of Hydrocodone/Vicodin, Zohydro ot Hysingla

Tolerance to an opioid medication builds over time, meaning you need a higher dose for the same effect. However, this often occurs much slower in older patients (vs. younger patients). There are reports of seniors being on the same dose for 10 or 20 years, and sometimes even needing to decrease their dose as they aged as it became too strong. Sometimes rotating to an opioid when tolerance begins to build is sufficient to get the same pain relief again. Therefore, tolerance may not be a significant issue, and at least shouldn’t be what prevents someone from trying opioids if they are their best option.

There is also a unique med which is primarily for addiction but being tried more for chronic pain that patients don’t build tolerance to, Buprenorphine. It is FDA approved for pain in the form of a patch, Butrans, but it is more common used for addiction in a much much higher dose in the form of an oral strip, Suboxone.

A good pain management doctor should offer multiple pain treatment options, discussing pros and cons of different forms (such as patches vs. oral meds), and ensuring that all non-opioid options have been tried before resorting to opioids. Often just seeing a different doctor opens up some treatment options as not every doctor will use every method (they have their favorites). Often a combination of therapies is used to maximize relief.

There is a big difference between physical dependence and psychological addiction. Dependence means that if you don't take the opioid medication as scheduled, you would go into physical withdrawal (gastro issues, anxiety, trouble sleeping). Dependence happens to nearly everyone who regularly takes an opioid medication (several times a day for a couple weeks), but a small percent of folks don't get it for whatever reason. Addiction is when you want to take the medication for reasons other than pain, such as to get "high", will do things to get more meds that a non addicted person wouldn't do (like fake pain or steal money to buy pills). In some cases dependence can mimic addiction, as a patient will be asking for a dose increase and may seem desperate, but in those cases, the dose increase and subsequent pain relief would stop those actions that appeared like addiction.

Long acting meds are known to be less likely to cause tolerance, side effects (including euphoria), and addiction, as they release a steady dose over a period of 8 to 24 hours (depending on the med). So, until recently they were widely used for chronic pain that didn't respond well to other treatments. However, in the last few years, opioids are being prescribed less - fewer patients are started on them, and patients are having their doses decreased or even cut off completely.

Therefore, opioids are not an option for all pain patients now. Unfortunately opioids are the best pain treatment we have right now; although other treatments are effective for some folks, it can take a lot of trial & error, and combining multiple treatments together. I have hope that things will improve though. I have to, after having this constant severe pain for 12 years.

I'd encourage you and your father to have a sit down with his doctor and discuss your concerns.

It is actually very important to be clear with the doctor that he is not taking the Oxycontin, as it is common to need to take a urinalysis to verify the meds are being taken as prescribed. If he isn't taking them, be sure to bring in the full bottle if it was filled or the script if it wasn't, as without that evidence, not having the med in his system could cause them to put a red flag on his record against future prescribing for any reason.

If the doctor isn’t offering other options, then see another one. Just be sure he doesn’t get medications for his pain (especially opioids) from more than one doctor at a time. Although it sounds like he has tried the major stuff, there are always more things to try; they just may be similar to what was already tried. Starting multiple treatments at the same time may also be beneficial even if by themselves they weren’t. I had to visit several pain management doctors to find a good fit to treat my chronic pain, and that was after having seen dozens of other doctors over the years. Best wishes.

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