Is addiction automatically bad?

[TheDuder]

Sorry for another addiction question, but my question is different from at least what i've seen asked.

I'm a C-6 quad for about 15 years and i have sensation. While i have sensation, it's different all over the place and for whatever reason, my feet have hurt/burned since my injury. Cold weather increases the burning by quite a bit and since i live in frozen hell Wisconsin, cold is unavoidable. I basically just dealt with the pain for the majority of time since my injury, but after having a surgery for my acid reflux about two years ago, they gave me a bottle of liquid Roxicet which is basically Oxycodone for pain. As an unexpected surprise, i noticed it made my feet burn less. Ever since then, i've been taking around three 5mg pills of Oxycodone twice a day when the foot pain comes. It doesn't remove all the foot pain/burning, but it certainly helps.

Well, last month i forgot to call in the refill until i was nearly out and by the time i got it in the mail and had someone go get it filled, i was out for 3-4 days. During that time, i got to see i was addicted to the Oxycodone even though 30-40mg a day isn't all that much. It wasn't crazy bad addiction where i was puking, sweating like crazy, and my body was aching all over. That said, i felt irritable, my appetite was all goofy, it was hard to sleep, and just overall i felt the obvious uncomfortable feelings that i knew had to be withdrawl. This alarmed me somewhat, especially since i'm not taking tons of Oxycodone.

All that said, the Oxycodone does help my pain which has overall made life better. So since it has helped with my foot pain, my doctor always gives me a refill each month, and i'm not on some super high dosage, should i really have much concern over that fact that i now know that i do have some addiction to the Oxycodone?

[David Berg]

There's addiction, then there's dependence. It's not the same thing, though both can exist at the same time. You already understand addiction. The difference is that if you have a condition that calls for any particular med, that's a dependance. A diabetic is dependant on insulin. A pain patient is dependant on pain meds. Some of them happen to be physically addicting. So the answer to your question is NO, it's not automatically a bad thing. That doesn't mean to not be careful about the meds, they're serious stuff, but there's automotically nothing "evil" about a physical addiction.

[arndog]

I totally agree with David Berg. Addiction has a psychological component that you take the drug even if your feet weren't burning. You experienced the effects of withdrawal and that only means you have some dependence. It is okay. If 30 to 40 mg a day makes your life and pain tolerable and you aren't having to increase the dose, then that is complete okay. That is what my pain specialist would tell you.

That being said, there are other meds that target neuropathic burning that might be worth a try like Lyrica, Neurontin, or Elavil.

But you should not feel any guilt about finding a med that gives you some peace. It is worth learning the definitions of the words addiction, dependence, tolerance, physical tolerance, withdrawal. Maybe go to pain.com and they may have good descriptions of these terms. It might be worth while to be sure your prescribing physician sees things the same way too.

[TheDuder]

Thanks for the responses and they make sense, it was just eye opening to see i was addicted to the Oxycodone. I used to smoke more weed than Cheech and Chong in my younger days, but pot isn't physically addicting so i've never felt a physical addiction before. I can't imagine how much it much suck to have big time withdrawls.

As for trying Lyrica instead, i actually did try it, but the horror strories of withdrawls from that scared me and i backed of continuing to take the Lyrica. Plus, i felt weird while on the Lyrica. Not so much a buzz feeling, just a little spacey and slower. The doctor said it would take some time before i might get less pain via the Lyrica, but i simply didn't want to take it anymore. Maybe i let the Lyrica withdrawls horror stories freak me out, but i just wanted no part of taking the Lyrica for awhile, have it not work on the pain, yet i end up addicted and crawling out of my skin if i stopped taking it.

[David Berg]

Elavil can also help with neuro pain, and is often used in conjunction with either Lyrica or Neurontin.

[arndog]

TheDude - I feel compelled to correct you, you are not addicted to oxycodone, you have developed some dependence and tolerance to it which is a physical phenomena that would happen to anyone who takes 30 to 40 mg daily.

Too bad Lyrica didn't help. I try to discount all the horror stories about Lyrica on this forum.

[TheDuder]

Elavil can also help with neuro pain, and is often used in conjunction with either Lyrica or Neurontin.

You seem knowledgeable about this stuff, so i have a question. Does 30-40mgs a day of Oxycodone have much of a bad impact on a persons body? I was crapping bricks, but since taking Senna Plus, my bowel program is back to normal.

I ask because overall, i'm happy with how it helps me for the most part. For over 10 years i just dealt with my daily foot pain, i never asked a doctor for medication. I just sorta got used to my feet always hurting, but the worst parts were when my feet got cold or sometimes at night my feet kept me from sleeping. Thankfully though, my pain has never been mind bending bad, more just very annoying. Weed would help sometimes, but i hate feeling high during the day so i'd only smoke it at night before bed if my foot pain was extra bad. I also have been taking about 80-100mg a day of baclofen for spasms since my injury.

Well, about two years ago i had a surgery for the brutal acid reflux i dealt with for many years and they sent me home with Roxicet for pain. By fluke i noticed that after taking it, the pain in my feet often dulled somewhat, it would sorta warm my feet if that makes sense. The pain wasn't entirely gone, but it was far less annoying. I did try Lyrica, but besides being scared by the withdrawl stories i read, it made me feel a little spacey and lazy, so i dropped it quick. The Oxycodone i rarely feel nothing when i take three 5mg pills unless i have an empty stomach. So even though it only takes the edge off the pain sometimes, i rarely struggle sleeping from foot pain and i'm good about never taking more than three at a time even if it's not working as well as other times because i don't want to become some Oxycodone junky.

[duge]

TheDude - I feel compelled to correct you, you are not addicted to oxycodone, you have developed some dependence and tolerance to it which is a physical phenomena that would happen to anyone who takes 30 to 40 mg daily.

Too bad Lyrica didn't help. I try to discount all the horror stories about Lyrica on this forum.

Got to agree on the lyrica part Arn! it has done nothing but help me! my feet and legs are so much better with it and it does nothing to the way I feel, and luckily so far I have not gained any weight with it ( knock on wood) but yeah I'm going thru withdrawl from the fentanyl patch as we speak!:(

[Kimmel21]

them pills can be very addictive, I had a friend in a quad accident who was put on those and now he's pretty much a junkie for em, and its really sad becuase he's a good dude....My advise for you is to try mybe roxycode or Tramadol (i have no clue what the proper spellin is for either, but you can sound it out lol) Being that i use to be a heavy drug abuser and it being why i have a SCI i always ask my doctor for non-narcotic/no-addictive meds (i.e perks,oxies,xanax, or anything of that nature) seems like tramadol and tylenol work ok for me though

[Kimmel21]

Got to agree on the lyrica part Arn! it has done nothing but help me! my feet and legs are so much better with it and it does nothing to the way I feel, and luckily so far I have not gained any weight with it ( knock on wood) but yeah I'm going thru withdrawl from the fentanyl patch as we speak!:(

Duge im sorry you're goin through that. Fentanyl patches are nasty and as you know very very addictives. I know of 3 kids around my age maybe a bit older from my area that died experimenting with those for recreational purposes....In my opinion (being a former generalized drug addict) perscription drugs are the devil. I myself am currently experiencing mild heroin withdrawl and I've been clean and sober since June

[dejerine]

Duge

Hi.

Have enjoyed your posts. I need your help. I am mystified by the failure of Lyrica to touch my burning pain, even at very high doses.

Would you be kind enough to indicate what type of pain it is helping in your feet and legs. I will list some possibilities and if you would be kind enough to say which type it is helping I would be most grateful. The first three refer to pain on the surface of the body, more or less.

1) burning (of a bizarre quality) which is constant

2) burning (of a bizarre quality) which is intermittent, worse with contact or touch, temperature change

3) burning of a normal quality, more or less like sunburn

4) pins and needles

5) shooting pains (lancinating pains)

5) muscle pains

Thanks

[Josh A]

dejerine

arndog is an encyclopedia when it comes to neuropathic pain which it sounds like you have, send him a message.
sorry for butting in only suggesting. lol

[David Berg]

You seem knowledgeable about this stuff, so i have a question. Does 30-40mgs a day of Oxycodone have much of a bad impact on a persons body? I was crapping bricks, but since taking Senna Plus, my bowel program is back to normal.

I ask because overall, i'm happy with how it helps me for the most part. For over 10 years i just dealt with my daily foot pain, i never asked a doctor for medication. I just sorta got used to my feet always hurting, but the worst parts were when my feet got cold or sometimes at night my feet kept me from sleeping. Thankfully though, my pain has never been mind bending bad, more just very annoying. Weed would help sometimes, but i hate feeling high during the day so i'd only smoke it at night before bed if my foot pain was extra bad. I also have been taking about 80-100mg a day of baclofen for spasms since my injury.

Well, about two years ago i had a surgery for the brutal acid reflux i dealt with for many years and they sent me home with Roxicet for pain. By fluke i noticed that after taking it, the pain in my feet often dulled somewhat, it would sorta warm my feet if that makes sense. The pain wasn't entirely gone, but it was far less annoying. I did try Lyrica, but besides being scared by the withdrawl stories i read, it made me feel a little spacey and lazy, so i dropped it quick. The Oxycodone i rarely feel nothing when i take three 5mg pills unless i have an empty stomach. So even though it only takes the edge off the pain sometimes, i rarely struggle sleeping from foot pain and i'm good about never taking more than three at a time even if it's not working as well as other times because i don't want to become some Oxycodone junky.
I'm afraid you're reaching the limit of what I should go into with the specifics of the meds. I'm just relating what I've learned from others here and on other pain forums. Perhaps one of the nurses or Dr Wise can kick in with a better answer.

[Wise Young]

I'm afraid you're reaching the limit of what I should go into with the specifics of the meds. I'm just relating what I've learned from others here and on other pain forums. Perhaps one of the nurses or Dr Wise can kick in with a better answer.

Duder,

In my opinion, pain medication should be treated like all other medication. All medications have benefits, side-effects, and risks. If the benefits exceed the risks and side effects, then use of the drug may be justified. Addiction is a side-effect of pain drugs, just like bleeding is a side-effect of coumadin (a drug that you take to resolve clots in your legs) and drowsiness is a side-effect of baclofen. For many people, the side-effects of Lyrica or Neurontin exceed the benefits of pain relief and they can't go to the doses of the drug that may be effective.

Oxycontin is addictive both physically and psychologically. You will get withdrawal symptoms if you stop taking the drug suddenly. From that perspective, oxycontin is less desirable than another drug that is less addictive. It also has many of the side effects, such as constipation (which you have already noted). On the other hand, if the benefits of the oxycontin (i.e. pain relief) exceed the side-effects and risk (withdrawal) and you cannot find a drug that has benefit without that these side-effects and risks, then it is the drug that you should take.

I believe that pain treatments are decisions that doctors and patients should make together, that the FDA should not be interfering as much as they are doing with these types of decisions because of societal and historical biases concerning drugs. For example, I disagree with the federal government's decision to forbid use of cannabis drugs for pain and other conditions because of their bias about the addictive side-effects of the drug. I can understand why governments are very concerned with people becoming addicted to drugs and have laws to prevent such drug use, because much crime is associated with such drugs. On the other hand, society has to consider the pain that it is forcing millions of people to suffer by withholding or restricting the use of such drugs.

Getting back off the soapbox, let me comment on your medication situation. It seems to me that you have not tried some of the less addictive treatments of neuropathic pain. If you have not tried, you should take amitriptyline (Elavil). A relatively low dose of 25 mg once or twice a day may help take the edge of burning, pressure, or buzzing types of pain. From my reading on these forums and other places, I get the impression that it is not particularly effective against spasmodic pain (i.e. pain that occur like spasms) and that drugs such as gabapentin (Neurontin) or pregabalin (Lyrica) may be more effective for such pain. Note that these drugs were originally anti-epileptic drugs and they reduce the excitability of pain neurons.

About 15% of people cannot find any relief from these anti-epileptic type drugs and require opioids. Another risk of opioid treatment of pain is that the person usually accommodates to (gets use to) the drug and requires higher and higher doses. At some point the side-effects of the drug itself (in addition to the risk), such as constipation, make the higher doses intolerable. At such doses, the person is addicted and withdrawal symptoms may be severe. At this stage, many people go to Duragesic patches, which contains a very potent opioid drug called fentanyl. Because the drug enters the body through a skin patch, it has less effect on the bowels and it provides a baseline level of analgesia. The person can take oxycontin or other drugs orally for "breakthrough" pain.

I hope that this is helpful. Please understand that this is mostly my opinions based on observations of neuropathic pain over the last decade or so. I am sure that others will have different opinions.

Wise.

[SCI-Nurse]

I would just add to what Dr. Young said that there is a big difference between physical dependence upon opioids and addiction. Addiction is an illness that does NOT occur just because you are taking drugs that may cause physical dependence.

Drugs that cause physical dependence will result in withdrawal symptoms of a different severity depending on the dose and type of drug in question. Some of these drugs in large numbers can also impair judgment, coordination, and clear thinking, so may not be a good idea as a method of treatment for chronic pain. Rarely will long term use impair your health otherwise as long as you are getting FDA approved drugs and administering them as prescribed (and not combining with street drugs, alcohol, etc.).

Addiction is indicated by addictive behavior. Generally this is seen by drug seeking behaviors such as taking and seeking higher and higher doses of the drug, and taking the drug primarily to self-medicate for emotional pain, depression, or to get high. This is an illness, and treatment should be sought through drug rehab programs, Narcotic Anonymous meetings, etc.

The vast majority of those who take opioids or other dependency creating drugs do NOT have addiction or display addictive behaviors. Unfortunately our government and the DEA don't recognize that (in spite of a lot of research), so there can be sanctions legally against physicians who prescribe these drugs in large amounts, even for legitimate reasons and not just to support addiction.

Regardless, those with chronic neuropathic pain may want to explore the full range of medications that may help with this. This includes the following:

Neurontin
Lyricia
Mexilitin
Tricyclic antidepressants

as well as non-medication modalities such as:

TENS
Acupuncture
Massage therapy
Rapid Relaxation Response and other meditation strategies
Self Hypnosis

(KLD)

[duge]

Duge

Hi.

Have enjoyed your posts. I need your help. I am mystified by the failure of Lyrica to touch my burning pain, even at very high doses.

Would you be kind enough to indicate what type of pain it is helping in your feet and legs. I will list some possibilities and if you would be kind enough to say which type it is helping I would be most grateful. The first three refer to pain on the surface of the body, more or less.

1) burning (of a bizarre quality) which is constant

2) burning (of a bizarre quality) which is intermittent, worse with contact or touch, temperature change

3) burning of a normal quality, more or less like sunburn

4) pins and needles

5) shooting pains (lancinating pains)

5) muscle pains

Thanks

I have to say more like #1 but the bottom's of my feet hurt worse with the pressure of standing as to the burning part, It has helped a bit with the pain in my feet,"feels like I walk on broken glass is the best way I know to describe it" but I have said if it has only taken away part of the burning and pain that it's been well worth it.

[duge]

Duge im sorry you're goin through that. Fentanyl patches are nasty and as you know very very addictives. I know of 3 kids around my age maybe a bit older from my area that died experimenting with those for recreational purposes....In my opinion (being a former generalized drug addict) perscription drugs are the devil. I myself am currently experiencing mild heroin withdrawl and I've been clean and sober since June

They are! Ended up I had a guy who was stealing my lortabs anyway I caught him on camera but he had broken into my house also for them. Was suppose to be a freind you know........ended up chewing on one and it did him in!! So bad for people to die for that shit!!! he was in his early 30's

[dejerine]

Duge

I apologize for what may seem like interrogating you, but I am very interested in these matters. I will be speaking to a professional group in the near future, and I want to be as explicit as possible. You are helping me.

Thank you very much for your description. I also think of my skin surface as "broken up", although I mentally kind of compared it to the brittle cracked soil of a burning hot dry lake bed. This feeling is part of what is called "atopoesthesia", which means a disturbed ability to perceive the skin surface, not only in 3 dimensional space, but as an intact skin surface. (topology means the study of the surface of something so "a topos" means you aren't so sure about the nature and location of the skin surface, hence atopoesthesia, which is not sensing the skin surface properly.) Some CP people perceive their atopoesthesia as being unsure of the dimensions of their feet or legs, ie not sure where the surface stops and starts in relation to three dimensional space. No one feels their feet are smaller, it is always described more like swelling, or merging of all foot parts into one structure. It is a kind of impaired sensation. For those who can walk, it can make them clumsy since they cannot tell precisely when the center of gravity hits bottom in a step (which is called sensory ataxia).

I am assuming from your "standing" comment that you are incomplete. If I am wrong, please correct me. Also, is the broken glass only present when you are standing (ie when the sensation is evoked, or is it present when the weight is off your feet?) Does wearing shoes ever cause this sensation or any other pain?

Going just a little further on your use of pain meds, would you please compare the relief you get from Lortabs with the relief from Lyrica. Are they additive or do they work on different aspects of your burning dysesthesia? The reason I am asking is that I have tried many, many drugs, and found that most of them were really just sedating me, and not actually taking away the pain. I have found that the most effective for me is clonazepam. It feels as if the pain is better, but I tend to think this is because stress and excitement make the pain harder to bear, and that the clonazepam, by keeping down the adrenalin and associated angiotensin II release, is calming my nervous system. This makes my nerves less likely to fire, although it is not strictly speaking pain relief.

Again, what does Lortab do to the broken glass feeling, and what does Lyrica do to it and what do they do together that neither does alone.

I appreciate your taking the time to answer this.

One extremity (leg) is 15% of the total body surface area. Feet would be individually about 5%. What percent of your total body surface area is involved with the central pain?

Do you also have muscle cramps? (not talking about AD, talking about burning in the muscle when it takes on a load or AFTER muscle exertion).

[dejerine]

SCI Nurse

Yours is a very informed and compassionate viewpoint toward those who must take pain meds. You seem like the consummate professional. I am glad there are people such as yourself around. Thank you for your considerable efforts toward the SCI patient in pain. You are in the best tradition of nursing.

[TheDuder]

Duder,



Getting back off the soapbox, let me comment on your medication situation. It seems to me that you have not tried some of the less addictive treatments of neuropathic pain. If you have not tried, you should take amitriptyline (Elavil). A relatively low dose of 25 mg once or twice a day may help take the edge of burning, pressure, or buzzing types of pain. From my reading on these forums and other places, I get the impression that it is not particularly effective against spasmodic pain (i.e. pain that occur like spasms) and that drugs such as gabapentin (Neurontin) or pregabalin (Lyrica) may be more effective for such pain. Note that these drugs were originally anti-epileptic drugs and they reduce the excitability of pain neurons.

About 15% of people cannot find any relief from these anti-epileptic type drugs and require opioids. Another risk of opioid treatment of pain is that the person usually accommodates to (gets use to) the drug and requires higher and higher doses. At some point the side-effects of the drug itself (in addition to the risk), such as constipation, make the higher doses intolerable. At such doses, the person is addicted and withdrawal symptoms may be severe. At this stage, many people go to Duragesic patches, which contains a very potent opioid drug called fentanyl. Because the drug enters the body through a skin patch, it has less effect on the bowels and it provides a baseline level of analgesia. The person can take oxycontin or other drugs orally for "breakthrough" pain.

I hope that this is helpful. Please understand that this is mostly my opinions based on observations of neuropathic pain over the last decade or so. I am sure that others will have different opinions.

Wise.


Thanks for responding and now that you mentioned amitriptyline, i do remember years ago a doctor having me take that, but i can't remember the reason and i know i wasn't on it long. Maybe it was for the foot pain, but between all the medications i've been tried on for various reasons that had nothing to do with my foot pain, i forget what all the medications are that i was on. I used to suffer with very chronic dysreflexia and doctors tried many different medications and one doctor tried to get me to use other medications for my spasms besides Baclofen, but none worked nearly as well. Can amitriptyline be used for anything else on SCI patients besides pain because i do remember taking it years ago?

Speaking of Baclofen, i've also noticed over the years that often my foot pain/burning is worse the longer it's been since i last took Bacolfen and the pain often lessens after i take my Baclofen. I generally take 40mg of Baclofen after getting up in the morning and 40mg more about an hour before going to bed. Then in between is usually when my feet start hurting bad again, so i'll take 15mg of the Oxycodone and 15mg more right before bed because since taking the Oxycodone i have far few nights where i lay in bed trying to talk myself to sleep because my feet are driving me crazy.

I'll keep all the advice given here in mind the next time i see the pain doctor, every six months i have to see him in person and i'm due to see him again in a few months. He seems a good listener and has told me that not a SCI patients are the same because each injury effects the person different, especially ones with incomplete injuries like i have. My sensation is so goofy since my injury. I have sensation everywhere still, but take my legs. My thighs are a mix of normal and dulled sensation, but from my knees down, i have almost hyper sensativity and my feet are so sensitive, i think i could feel a spec of dust in my shoes. In fact, it took awhile after my injury to find shoes that didn't hurt my feet and if my feet get even the slightest bit cold, they hurt like crazy even though i'll often not be cold anywhere else. My feet remind me a lot of the acid reflux, from day to day i never know how bad they'll hurt or why they hurt more than other days because often i see nothing that different in my routine or where i am that should make the pain differ as wildly as it does. Oh well, i guess that's just part of life when you have an injury like mine.

[arndog]

from day to day i never know how bad they'll hurt or why they hurt more than other days because often i see nothing that different in my routine or where i am that should make the pain differ as wildly as it does. Oh well, i guess that's just part of life when you have an injury like mine.

Duder - your last sentence here is so true from my experience. I have been perplexed by the pattern of burning and it really follows no pattern that I can determine. Like you said, some days are worse than others for no obvious reason.

Thanks for your post and this good discussion about narcs. Sounds like you have a good pain doc too.