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Thread: Is this normal for now?

  1. #21
    Quote Originally Posted by Cripply
    Wonder, I don´t doubt what you say. I am merely pointing out that addiction is not as common as people think. Only you know if you are addicted, and I am sure you know the symptoms of addiction.
    When narcotics are taken for serious pain, fear of addiction should not be so prevalent as it is.
    Bingo, hit the nail on the head. I'm working at getting better.

    And Chopper, like Buck said, find someone with a SCI in your area and get him to meet him. I've done that and it helped me alot.

  2. #22
    I found this article that Chopper and her husband might want to read: (sorry for the format but I am a lousy editor).

    PAIN MANAGEMENT CONSULTATION–
    INFORMATION FOR PATIENTS
    Opioid Side Effects, Addiction,
    and Anti-Inflammatory Medications
    Scott M. Fishman
    ABSTRACT. Patients in pain often fear medications prescribed or recommend to them by their
    clinicians. Fear of side effects can contribute greatly to medication non-adherence (noncompliance).
    Patients often have fears that exceed the potential problems with which their medications
    are associated. Questions and answers relating to the side effects and the risk of addiction associated
    with opioids are presented. [Article copies available for a fee from The Haworth Document Delivery
    Service: 1-800-HAWORTH. E-mail address: <docdelivery@haworthpress.com> Website: <http://www.
    HaworthPress.com>]
    KEYWORDS. Opioid, side effects, fears, addiction, nonsteroidal anti-inflammatory drugs, NSAIDs
    SIDE EFFECTS OF OPIOIDS
    Question
    My mother has cancer and her doctor has
    given her a medication for pain called MS
    Contin. What sort of side effects should we expect
    from this medicine?
    Answer
    MS Contin is a medicine in the family of
    drugs called opioids (pronounced: o-pi-oids).
    Opioids are a very large group of drugs and they
    have been used as a medicine to fight pain for
    many centuries. The Ancient Greeks first identified
    opium from the poppy flower, and this
    drug is actually a milky extract from the poppy
    plant. The word “opium” is translated from
    Greek meaning “juice.” Although the Greeks
    utilized this drug long ago, it was not defined
    and understood by scientists until the year
    1817.
    The active ingredient in MS Contin is morphine,
    and morphine is also the active pharmacological
    part of the opium poppy extract. The
    MS in MS Contin stands for Morphine Sulfate
    and Contin stands for continuous, indicating
    that it works as a sustained release formula.
    While morphine is the most common type of
    opioid used today, and perhaps the oldest type
    of opioid purified form the exudates of the
    opium poppy, physicians in the 21st century
    have discoveredmanynewopioid type drugs to
    fight pain. These drugs include hydromorphone
    (Dilaudid), oxycodone (OxyContin, in Percocet,
    others), methadone, meperidine (Demerol) and
    fentanyl (Duragesic, Actiq), just to name a few.
    These drugs come in various forms, such as
    tablets, intravenous injections (which means it
    is given into a vein in the arm or hand), a subcutaneous
    or intramuscular route (which means it
    is injected by a needle under the skin or into a
    muscle), and a topical patch (which means it
    crosses through the skin into the bloodstream
    from patch that is placed on the skin).
    Opioid drugs block pain signals by attaching
    to special receptors in the body. These receptors
    are found in the joints, skin, spinal cord,
    and brain. Opioid drugs have the ability to reduce
    or eliminate pain that we feel as a result of
    recent surgery or trauma, or from other disorders
    like cancer or even arthritis. While opioids
    do not heal injured tissue or make the disease
    disappear, they can substantially decrease the
    acute or chronic pain we feel from these horrible
    insults to our bodies. The downside of MS
    Contin and other opioids, however, is that they
    also have possible side effects.
    Side effects of opioids may include nausea,
    constipation, urinary retention, itching, headaches,
    decrease in sexual interest, drowsiness,
    occasional feelings of disorientation, and dizziness.
    Except for constipation, which is easily
    managed, these side effects of opioid pain relievers
    are rare and don’t occur in everyone. Sedation,
    nausea, and itching are more common
    than the others and are usually short-lived. Either
    they wear off over time, or simply switching
    to another opioid drug will reduce them.
    Sexual side effects are more common than previously
    believed and also can be treated. The
    most feared side effect is decreased breathing
    rate which can occur in overdose but rarely effects
    patients who are on opioid for any length
    of time. Like most side effects of opioids, they
    usually wear off over time.
    The most common side effect of opioid therapy
    is constipation. Constipation can add to the
    mix of pain and discomfort the patient is already
    suffering from. The intestinal tract has
    chemical receptors for the opioids, and the drug
    affects these receptors, just like the pain receptors
    are affected. But instead of providing pain
    relief, opioids slow down the intestines and
    make them sluggish.
    This sluggishness can lead to constipation or
    even a total lack of having a bowel movement,
    which is called obstipation. Most everyone
    who is taking opioids is usually prescribed a
    laxative to combat this side effect. Prolonged
    constipation or obstipation can cause very serious
    intestinal problems. It is therefore vitally
    important to ensure that these laxatives are
    working properly. Thus, patients need to watch
    for constipation while taking opioids and take
    action to either prevent it or reverse it once it occurs.
    ADDICTION
    Question
    What is addiction, and how is it possible that
    I won’t become addicted if I take pain medication?
    Answer
    Addiction is a complex disease. It involves
    the body and the mind. Addiction is very much
    misunderstood bymanyclinicians as well as by
    manypatients and by our society at large. There
    are many myths and misconceptions about addiction,
    causing a great deal of fear and anxiety,
    some of which is warranted, but much of which
    are not.
    Addiction is defined differently by many
    different medical, religious, and social organizations
    that try to define it. One of the key ele-
    52 JOURNAL OF PAIN & PALLIATIVE CARE PHARMACOTHERAPY
    ments that we do know clearly defines addiction
    is that it is a biological, psychological, and
    sociological phenomenon. What this means is
    that addiction involves the body, the mind,
    one’s environment, genetic make-up, and social
    situation.
    When clinicians define addiction to a drug it
    means that a drug is used by the patient in a
    compulsive manner. This compulsive use of
    the drug causes dysfunction in the patient’s life,
    and the patient chooses to continue to use the
    drug compulsively, despite that dysfunction.
    The continued use of the substance to which
    one is addicted becomes “out of the control” of
    the individual and causes harm.
    This is quite the opposite of what doctors
    strive for in treating chronic pain with medications
    that can be “addictive.” This is to say,
    when we treat someone with chronic pain with
    an opioid drug like morphine,weare seeking to
    improve the function of the patient as a result of
    administering the drug.
    Pain is always subjective, so we in Pain
    Medicine look for an objective marker of improvement
    when we prescribe any medication.
    This marker, or milestone, is usually a measure
    of increased quality of life for the patient,
    which is typically seen as increased function. If
    a patient cannot complete the basic activities of
    daily life because they are in so much pain (for
    example, one who cannot get out of the reclining
    chair even to sleep in a bed, or is unable to
    take his or her children to a Little League game,
    or s/he cannot physically get out of the house to
    look for a job), and the patient starts to take a
    medication that allows him or her to complete
    these activities, then the drug has been successful.
    Therefore, the marker to determine if the
    medication is actually a success is measured by
    the manner in which patients are able to improve
    their function and the quality of their
    lives.Wetherefore often ask patients to bring to
    the clinic daily written records of their activities,
    and to also bring a family member to talk
    about what they couldn’t do before the treatment,
    and what they can now accomplish after
    starting the treatment. These are things that clinicians
    can objectivelymeasureand evaluate to
    determine if the drug is working. When someone
    is addicted to a medication, his or her function
    usually does not improve and frequently
    decreases.
    There is also a great deal of confusion about
    some terms that are associated with addiction.
    In many medical circles these confused terms
    often do not have any central connection to the
    real phenomenon of addiction. One good example
    of this problem is the term “physical dependence.”
    Physical dependence is often used
    as equivalent to addiction, and in fact, it is not
    equivalent at all. Physical dependence means
    that one’s body has become dependent on a
    substance. If that substance is taken away, there
    will be a reaction called “withdrawal.” Sometimes,
    withdrawal can even be life-threatening.
    There are many drugs that can cause physical
    dependence. Physical dependence is an intrinsic
    pharmacological property of a drug and
    many of the drugs that cause physical dependence
    are not addictive. One good example is
    clonidine, a medicine for high blood pressure. If
    clonidine is stopped suddenly, a life-threatening
    withdrawal reaction can occur. Surprisingly,
    drugs like morphine or other opioid medications,
    which also can cause physical dependence,
    usually don’t cause life-threatening withdrawal
    reactions. A familiar substance that
    often causes physical dependence is caffeine.
    This withdrawal reaction is typically manifested
    as a headache and can occur if one becomes
    accustomed to consuming caffeine and
    suddenly stops. In fact, most patient scan be tapered
    off of morphine or other opioids in a
    week or two with few if any side effects.
    Another common term that is associated
    with addiction but really has more to do with
    the pharmacological properties of a drug is that
    of “tolerance.” Tolerance means that a drug
    wears off in the patient’s body over time. Patients
    who have become tolerant to a medication
    need more and more of the drug to obtain
    thesameeffect. In other words, thesameamount
    of the drug over time appears to deliver less and
    less effect. This again is a pharmacological
    property of a drug and is seen with many drugs
    and does not necessarily herald addiction as a
    problem.
    Unfortunately, many patients become very
    concerned about addiction when phenomena
    like physical dependence and tolerance are either
    possible or do occur. Unfortunately, many
    patients resist using medications that might
    help them because they equate the misconcep-
    Pain Management Consultation–Information for Patients 53
    tion of physical dependence or tolerance with
    addiction, which really is not the case.
    We know that many of the medications that
    physicians prescribe can cause addiction. In
    such cases, doctors must watch closely for the
    signs of addiction, and if they occur, ease the
    patient off the drug. This is not different than
    any other side effect from any other drug. For
    instance, if one gives an antibiotic, there is always
    a risk of an allergic reaction, and if it occurs,
    the doctor simply stops the drug.
    When using addictive drugs for chronic pain,
    pain doctors have the advantage of knowing
    that the hallmark of addiction is opposite to the
    hallmark of effective chronic pain management.
    This vital key to successful pain management
    is to manage the pain in order to improve
    the function and quality of the patient’s life.
    ANTI-INFLAMMATORIES
    MEDIATIONS FOR PAIN
    MANAGEMENT
    Question
    I am 60-years old and work in my garden
    when the weather permits. I have noticed lately
    that the muscles inmyarms and legs ache after I
    garden.Mydoctor has suggested I take anti-inflammatory
    medications called NSAIDs to relieve
    this pain. What are these? Some of them
    are available to patients only by prescription
    and others aren’t. What is the difference?
    Answer
    All people, at some point in their lives suffer
    from mild to moderate aches and pains. Working
    in the garden throughout a weekend, perhaps
    overdoing it at the local gym, or simply
    bumpinga knee while rushing from one hurried
    task to another can all potentially evoke minor
    redness or swelling which is called “inflammation.”
    These aches and pains are usually a sign
    that we have minor irritation of a muscle, joint
    or other tissue. More serious maladies, such as
    varying degrees of arthritis, diabetes, or postoperative
    pain can also stir up moderate aches
    and pains in muscles or joint that can also cause
    distress. This type of pain, in spite of it being
    minor or moderate, can be so distracting that it
    prevents us from completing our daily tasks
    without constantly being interrupted and can
    cause considerable suffering.
    Pain relieving medications or “analgesics,”
    are a group of drugs that can be categorized
    into two categories. The first class of drugs
    is the anti-inflammatory medications–drugs
    that can reduce redness, swelling, and pain.
    The most common of these medications are
    called NSAIDs–an acronym for Nonsteroidal
    Anti-Inflammatory Drugs. Consequently, they
    decrease inflammation in our bodies, while at
    the same time provide an effective target against
    mild to moderate pain.
    NSAIDs are not the steroid drugs that everyone
    has heard athletes utilize to build the size
    of their muscles quickly. As the term “nonsteroidal”
    tells us, these drugs are not steroids.
    A second category of analgesic drugs contain
    acetaminophen, such as Tylenol. Acetaminophen
    is not an NSAID nor is it antiinflammatory,
    but it often is a powerful pain reliever.
    While scientists do know that NSAIDs can decrease
    the inflammation in our bodies, acetaminophen
    appears to lack clinically useful antiinflammatory
    effects.
    In 1899, Friedrich Bayer and Company began
    marketing the first NSAID (Bayer® Aspirin)
    in Europe. Although it is now over 100
    years old, Bayer® Aspirin is still sold today because
    it can reduce fever, pain, and symptoms
    of inflammation. NSAIDs are considered to be
    inexpensive and are also easily accessible to
    patientswhentraveling in virtually every country.
    They are available for everyone’s use at the
    local drug store, and some are available by a
    prescriptionfromyour doctor. Nonpresrcription
    NSAID medications include aspirin, ibuprofen,
    naproxen and ketoprofen. Over twenty stronger
    strengths of NSAIDs are available only by
    prescription because the effects of those greater
    strength tablets and capsules should be monitored
    by a health professional.
    The availability of aspirin and other NSAIDs
    to patients in local drug stores certainly has allowed
    patients to be in control of theirown pain
    without the need to wait for an appointment to
    see their physician. Many patients, however,
    are not aware of the important safeguards that
    must be undertaken while taking NSAIDs.
    Moreover, the side effects of taking these drugs
    can be potentially harmful. These side effects
    54 JOURNAL OF PAIN & PALLIATIVE CARE PHARMACOTHERAPY
    includestomach upset, bleeding problems, kidney
    disease, and damage to the lining of the
    stomach and small intestine, which can lead to
    the development of an ulcer. Although these
    side effects are mostcommonin thosewhotake
    these medications daily, it is important to understand
    thatNSAIDsobtained from your local
    pharmacy can be potentially dangerous if they
    are not taken following careful instructions
    from your doctor and pharmacist.
    While NSAIDs can produce unwanted side
    effects, another drawback of taking NSAIDs is
    that these drugs can also become ineffective,
    once the dosage has been increased to a certain
    level when the drugs are taken regularly. This
    level, which is called a “ceiling effect,” causes
    the drug to not produce any more pain relief, in
    spite of the patient increasing the dosage. While
    the ceiling effect prevents the drugs from decreasing
    pain, it increases the chances of a potentially
    dangerous side effect. These side effects
    are important for patients to understand in
    order for them to take the necessary precautions
    to avoid them. When NSAIDs are taken
    frequently, the dosage should be carefully
    monitored by your doctor.
    By and large, NSAIDs are very effective for
    the treatment of minor to moderate pain and are
    generally well tolerated by adults and the elderly.
    Some NSAIDs are available by a prescription
    from your doctor and only need to be
    taken once per day. If it is easier for the patient
    to remember to take a medication once per day,
    these medications may be best for you. Others,
    like Motrin®, can sometimes require taking the
    medicine every 4 to 6 hours. However, if you
    don’t have problems remembering to take your
    medications every couple of hours, the latter
    medications may be easiest.
    Sometimes, one type of NSAID may not
    seem to work and the pain persists in spite of
    following the doctor’s instructions. Usually a
    test trial of taking one NSAID for two weeks is
    necessary to determine if the drug will actually
    work for you. If one NSAID does not effectively
    decrease the inflammation and pain, another
    NSAID may be more sensitive to your
    body’s needs and a better drug target for your
    type of pain. Your doctormaytherefore wish to
    switch you to another NSAID that is more responsive
    to your pain. These drugs work very
    well to combat minor to moderate pain. However,
    other types of pain relievers may be used
    in combination with NSAIDs for more intense
    or more serious pain.
    Pain Management Consultation–Information for Patients 55

  3. #23

    only u know

    are you serious....only u know???????? get a grip.
    Quote Originally Posted by Cripply
    Wonder, I don´t doubt what you say. I am merely pointing out that addiction is not as common as people think. Only you know if you are addicted, and I am sure you know the symptoms of addiction.
    When narcotics are taken for serious pain, fear of addiction should not be so prevalent as it is.

  4. #24
    I may have missed it, but I have not read anywhere in this thread that Mike is in pain. Why is everyone assuming he is in pain? Just a thought.
    T6 complete (or so I think), SCI since September 21, 2003

  5. #25
    Quote Originally Posted by mckeownp
    are you serious....only u know???????? get a grip.

    Only said poster knows if said poster is addicted, as in...
    Cripply does not know if said poster is addicted. Cripply does not doubt said poster when said poster says he is addicted.
    By the way, beautiful contribution to the thread! Congrats

  6. #26
    Senior Member feisty's Avatar
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    hey, I wanted to add that above and beyond care, medication and everything else- once I got out of the hospital I felt like I hadn't slept in months. I was grumpy/sleepy/not hungry and readjusting for about a week, and then I naturally snapped out of it.

    I think the hospital gears patients and their loved ones up and focuses them on quick fixes...(like- Yay, you're discharged! you must be all better now!) But sometimes time, rest and understanding make for the big payout. Leaving the hospital doesn't fix his disability... it only makes it more apparent, as he's forced to fit his new inabilities into his previous lifestyle.

    Noone should be abusive to you, but I can assure you that Mike's just as frustrated as you are, if not ten times more. He's not irritated at you, he's irritated by the situation- and although hearing that won't make dealing with his bs any easier... you seem to be the kind of person that can empathize with that.
    An administrator made me remove my signature.

  7. #27
    Senior Member CapnGimp's Avatar
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    Quote Originally Posted by paramoto
    I may have missed it, but I have not read anywhere in this thread that Mike is in pain. Why is everyone assuming he is in pain? Just a thought.
    Yeah, you missed it paramoto. Here and elsewhere stated.
    Hey folks, chill out. I beleive we'd be MORE helpful without the 'get a grip' type comments. We are ALL trying to help a situation we have been through. We each know we want to make it as easy for them as possible. Go easy on each other when you don't agree. We are all guilty of getting outta line occasionaly, me included. Just remember the intent here is to offer helpful advice that might have worked for us or someone else. Not to condemn or lash out when we don't agree.
    This AIN'T no picnic for any of us.

    It Ain't the politics and religion forums either.

  8. #28
    Senior Member
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    Quote Originally Posted by paramoto

    Leg rests?? What kind of chair did they recommend for him at rehab?
    I assume they sent him home in a loaner chair? I hated that, but I really appreciated MY chair when it finally showed up.

    It will get better, just hang in there. I really hated the first few days, I coudn't do ANYTHING yet it seemed, and was in a lot of pain. If he is in pain try to encourage him to take the pain meds, but it is ultimately his decision. They do make a huge difference if he needs them. I am about 14 months post and still take them, but at about 1/2 the amount as a year ago, and I when I went home I immediatly went to half the amount I was taking while in the hospital. Addiction isn't a given.

  9. #29
    CC........it is normal. I was like it. Wanted to fight the world. Smiled at my friends, snapped at my wife....told her I wanted to die, cheerily answered everyone else with 'I'm fine thanks.'

    Doesn't make it right. Remind him you've stuck around but maybe give him some space.

    Can't you get him on here with your help? Sit together and let him read posts?
    C5/6 incomplete

    "I assume you all have guns and crack....."

  10. #30
    Senior Member keps's Avatar
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    CC, I'm with the ones who have suggested getting Mike to meet others with sci.

    When I was newly injured, I was perfectly vile to my boyfriend at times.
    I was seriously depressed too. The main reasons for this was that I was in agony after my laminectomy, and I felt sure that I would never be able to do anything ever again now that I was paralyzed.

    The pain eased after a few weeks, but I still felt that paralysis would mean never having a good quality of life.

    Whilst still on bedrest, I got talking to a c6 quad. Hearing her talk about her life - which was very active and fulfilling - I realized that my life was far from over. Before she left (she was old patient in for only a few days), I thanked her for giving me back some confidence and hope.
    The conversations I had with her really were a huge turning point for me. It was like a light had been switched on in my head.

    This is why I strongly believe that speaking to others with sci can work wonders, and why a site like CareCure is invaluable.

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