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Thread: Best Opioid/Non Traditional Med for Central Neuropathic Pain

  1. #11
    Methadone is notorious for killing pain patients because it can accumulate quickly to toxic levels. Be thankful your doc avoids it and is willing to put you on Opana and try ketamine.

  2. #12
    I don't know much about Methadone. I've tried a lot of different pain meds and the only one that has even helped is Morphine MS. I take Percacet for break through pain two or three times a day. Opana did nothing, Nucenta was just as bad, and the patches were useless. I also take Gabapentin and Methocarbamol for spasms.

    Everyone is different, and it takes time to find the right combo of meds for you. I ended up at the pain clinic to get the right treatment. I tried my gp, nuerologist, physiatrist, and finally my neuro surgeon sent me to the pain clinic where he knew the doctor running the clinic.

  3. #13
    Quote Originally Posted by wire.paladin View Post
    I was injured in 1970 and had severe painw/spasms. After ten years of heavy drinking(ease pain)I met an older gimp who suggested i try morphine. I did and have never looked back. Now i have severe addiction but live with lower level of pain and sometimes no pain. good luck.
    Would Morphine have any effect if drugs like Dilaudid and Fentanyl which are much more powerfull don''t have any effect?

  4. #14
    Senior Member ~Lin's Avatar
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    Its not just about how powerful the drug is, but also how your body responds to the drug. So yes its possible for morphine to work better. Since so many drugs haven't worked for you it might be of interest to get the p450 cytochrome testing. Many drugs are metabolized by the enzymes controlled by cytochrome p450. The testing can tell if your body will not metabolize, or metabolize too quickly certain medications. Metabolizing pain meds too quickly can result in them not working.
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  5. #15
    Quote Originally Posted by ~Lin View Post
    Its not just about how powerful the drug is, but also how your body responds to the drug. So yes its possible for morphine to work better. Since so many drugs haven't worked for you it might be of interest to get the p450 cytochrome testing. Many drugs are metabolized by the enzymes controlled by cytochrome p450. The testing can tell if your body will not metabolize, or metabolize too quickly certain medications. Metabolizing pain meds too quickly can result in them not working.
    Interesting. Where would one have this testing done?

  6. #16
    Senior Member ~Lin's Avatar
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    You would speak to any of your Drs about it, most likely your pain specialist in this case. The blood draw would be sent to one of the labs that does the testing. Its not very common yet but is getting more and more common. Drs are saying in 10 years everyone will receive the testing and it could save lives in preventing severe drug reactions. It also can greatly shorten the amount of time looking for medications that work, whatever you are taking the medications for.
    Board Member of Assistance Dog Advocacy Project working in Education. Feel free to ask me any service dog questions!

    I am not paralyzed. I have a genetic connective tissue disorder with neuro complications and a movement disorder.

  7. #17
    The latest medication I got was Opana IR (oxymorphone) 10mg. I've taken up to 5 (50mg) and didn't feel a thing, pain wise or mentally. What else is there to try?

    nucynta ER helps a tiny bit.. makes it not SO unbearable. I'm super tolerant to all meds, regardless if I've taken them before or not.

    Anything anyone else has used? I want to get a 2nd opinion from another PM doc also if possible.

  8. #18
    Did you try the Gabapentin and the Lyrica together, at the same time? Also, how often did you take the meds? You have to play around with the timing. I take 3600 mg Gaba/day, broken into 4 dosages of three 300 mg capsules. If I go any more than 6 hours on a dose, I feel my pain levels rapidly increase. So I religiously take them at exactly 9, 3, 9, and 3. I set my alarm for 3 am, take my pills, and go back to sleep.

    My initial Gaba dosage was quite low, but my body rapidly built up tolerance. My Dr. wouldn't give me any more than 3600 mg/day, so she added the Lyrica, starting at 75 mg, twice a day. It didn't quite do enough, so she increased the dosage to 150 mg, twice a day. Knock on wood, I have not needed a Lyrica dosage increase in a year, so I don't seem to have the tolerance issue like with the Gaba.

    I also take one Amitriptyline 10 mg tablet at night before bed to help me sleep. Any more than that, and I can not get up in the morning. The downside to all these meds is that they all work the same way, by calming the nerves. So, I do have a certain amount of slepiness, lethargy, and brain fog, but for me it's better than the pain. And, they are non-narcotic, which is a big plus.

    None of this completely eliminates the pain, but it keeps me from screaming all day and night! Additional strategies are required, too. It sounds silly, but distraction helps, such as focus on a project or other people or a recreation. Plenty of sleep is essential, and I think a healthy diet helps. I have found that pressure in strategic areas helps. For me, holding my arm in a certain spot or sleeping on that arm is helpful. Also, a heating pad wrapped on to the same spot and/or my side and/or my back help greatly. When all this fails, a very hot bath helps me and the effect stays for several hours. My Dr says that he thinks the flood of sensory signals from heat or pressure helps dilute the damaged sensory signals so that my brain doesn't react as strongly to register pain.

    You need to experiment to find what things or combination of things help you the most. It takes trial and error and time. It takes hard work to be vigilant, but it pays off. Despite all this, there are times when I still get pain that is hard to bear and nothing seems to help. Then there are other times when I don't get enough sleep and miss taking my pills and I don't have all that much pain. Go figure. I believe that stress is another factor, too. But you need to give different things a try and allow time to let them work. Good luck!

  9. #19
    Quote Originally Posted by Geoman View Post
    jbridges, I've just started on lithium this week, so can't coment yet. My doc put me on 2 X 250mg/day and will increase to 3 a day if it's looking promising. I have to have a blood test in a couple of weeks to check serum levels. I'm a T12 and have severe Central NP at and below injury level. I tried all the other meds and got no relief, so I've been on fentynal (opioid) patches 100 mg 2 daily (they say the patches should last 3 days but everyone will tell you it's BS and you need to repatch 2 daily). This doesn't treat the pain, just dumbs everything down and is all that available for me at the mo. Just hoping the lithium helps. Good luck.

    Clayton
    Have you noticed any difference?

  10. #20
    Senior Member rdf's Avatar
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    You might try Tramadol. I've tried everything mentioned in this thread, with no luck. Tramadol actually works somewhat.
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