Life With Chronic Pain

I have taken the plunge. I have decided to switch to methadone and slowly start weaning myself of opiates. During the course of my life I am going to need opiates from time to time, but while I am feeling relativity good I would like to see if I can lower my dose. I was hoping to start after my last Dr’s appointment, but the pharmacy had to order the medication. I will pick it up on Tuesday and see how it goes. I have a follow up appointment scheduled with my doctor late next week. Hopefully, I will be able to make the switch and start getting off of them. I will keep you updated with my progress.

Thanks,
Jesus

Last month I was feeling pretty good. My Oxycontin dose had been constant for 5 months. During my monthly check up, I told my doctor that I was feeling okay. He was happy to hear that and he told me to see him in two months. He gave me two sets of prescriptions, one for each of the following two months.

The next day I went to my usually pharmacy and filled my prescriptions with out any problems.

The problem started three weeks later when I dropped off my prescriptions for the next month. I thought that dropping them off a week early would allow more than enough time for them to be ordered and filled. I went in to the pharmacy a few days later and the pharmacist told me that he was unable to fill either of my narcotic pain medications as he was out and so was his supplier, but he would help me call around to other pharmacies to find one that could fill the prescriptions.

The pharmacists and I called countless pharmacies in the area before we found one with the correct does and quantity that I needed. My pharmacist (Tom) gave me specific instructions on what to tell the pharmacist at the other store and he told me to tell the pharmacist to call him if he had any questions.

The pharmacy that I was going to was 2 hours away in Memorial Day traffic. By the time I got there I was exhausted. I went the pharmacy counted and asked to speak with the pharmacist (Michael). I told him the situation and that my usually pharmacist (Tom) had just called him. He then told me that he did not have the medication.

One of the techs gave me the numbers of several other local pharmacies. I called the first and they did not have stock, but when I called the second they told me that they could not tell me over the phone if they had stock. This pharmacy was another 45 minutes away and I did not want to drive all that way if they could not fill the prescriptions.

I then asked Michael if he would call and ask them if they had the stock. He told me that he would not do that and gave me a nasty look.

Long story short, I called my usually pharmacist, Tom, and he called pharmacy number 3 to confirm they had the stock. They filled my prescriptions no problem.

My real frustration was how the pharmacist, Michael, treated me. I have a long medical history all of which was available to him on the computer, but he still treated me like a junkie. I know this is because I am young and look healthy. He cannot feel the pain, nausea, and fatigue that I feel every day. I know that he interacts with drug seekers every day, but I am not one of them

This has really motivated me to try to get off of narcotics. The last time that I tried I was in so much pain that I could not take it. This time I am thinking about a slow methadone taper.

I try not to care what other people think, but unfortunately I do. As silly as it sounds I care what some ass whole pharmacists thinks. I wish I didn’t…

I will keep you updated.

Jesus

It has been a while sense I have posted. I have been very busy with a new job and some other very crazy things have happened in the last few months. I will tell you more in future posts.

Today I wanted to talk about Ativan (Lorazepam). Most people think of Ativan as strictly for anxiety. During some very stressful times in my life I have been prescribed it for that purpose, but right now my anxiety is not bad. I am not carefree, but I am not about to pee my pants in the throws of a nervous breakdown. I am where 90% of American are right now, just okay.

My recent adventure began with a strong desire to stop smoking /vaporizing marijuana and also to stop taking Marinol (Dronabinol). If you don’t know Marinol is synthetic THC. It was getting to the point where my tolerance was way out of control and it was quickly loosing its efficacy.

While I was thinking about how to proceed, I decided to break down how THC helps me. The first is the anti-emetic effect. When you are puking like crazy and cant keep anything down there is nothing like a joint to put your stomach at ease. The second thing is it potentiates opiates allowing a patent to take a lower dose of the opiate. The third thing that it does is act as an anxiolytic (anti-anxiety).

So I went to see my doctor and I told him my I wanted to quit. He was very excited, but his first question was “What are you going to do for your Nausea?” I told him that was his job, but I had a few ideas.

From my own experience and research I have found that Ativan can provide the same three positive effects that Cannabis can. Although Ativan is not a first line nausea med it is often used in conjunction with other medications when treating nausea.

Another positive effect is that sedatives such as Ativan potentate opiates. This can be good and bad. It is good for the patent that can now take a lower dose of morphine or oxycontin, but its bad for Heath Ledger and others using prescription drugs to get high. In his case, the drugs worked to well and he stopped breathing. Please be careful and always talk to your doctor about the medications that you are taking.

The last effect is that Ativan is an excellent anxiolytic with negligible side effects. I don’t like Xanax because I feel like I am drunk, but with Ativan I barely know that I am on it and any anxiety that I might have had is long gone. I also feel almost no cognitive impairment.

I have been taking Ativan for three weeks now and I have seen a significant improvement in my nausea. I have also greatly reduced my Marijuna/Marinol intake. Ativan is truly a wonderful drug, but it can be addictive. So be careful and talk to your doctor.

Biofeedback is a relatively new and exciting treatment for chronic pain and many other conditions where emotions are involved. The best part about it is that it is chemical and side effect free.

Last week I went to a psychologist who specializes in patients with chronic pain. We talked about different treatment options and biofeedback seemed like the best use of our time and my money.

She started by putting sensors on my neck and trapezius muscles. These sensors measure the electrical signals in the muscles and can therefore measure how tense or relaxed the muscles are.

Then she put a heart rate monitor on my finger and a strap around by diaphragm to measure my breathing. She also put sensors on my hand to measure the amount of moisture in my skin and also my skin temperature.

The next step was to get my baseline readings. So I just sat there for about ten minutes while she talked to me about the process. Once my baseline readings were taken she showed me my readings and compared them to “normal.” My heart rate was around 90 beats per minute. The ideal range is between 60 -70. Before I was sick I worked out religiously. My resting heart rate was 45 bpm. I was shocked that my cardiovascular health had declined so rapidly in such a relatively short period of time.

She then explained to me the other readings such as the Galvanis Skin Response or the moisture content of the skin. I am not completely sure about what this does, but apparently the rapid fluctuations in skin moisture can measure emotional stress. This is very similar to the “E-meter” used by Scientology.

On of the other sensors was measuring my skin temperature. I had guessed that my skin temperature was going to be low because my hands and feet are always cold. My average skin temp was about 83 degrees. The ideal skin temperature is about 94 degrees. This indicates that I have poor circulation. Poor circulation can lead to some types of chronic pain.

My breathing was also very shallow and as a result I was taking lots of breaths every minute. Ideally, one should take deep diagrammatic breaths. This super oxygenates your blood and therefore requires your heart to pump less blood and slows down your heart rate down.

The next step was to practice taking deep breaths. It was amazing to watch my heart rate go up as I inhaled and down as I exhaled. As I practiced my heart rate trended down. I have always heard that deep breathing is the easiest way to calm down, but it was amazing to see it before my eyes. There are many other advanced techniques and I am looking forward to learning them

I would defiantly recommend biofeedback to people experiencing chronic pain, anxiety, etc. I was amazed at the results only after one session.

As February turned into March I was in more and more pain every day and the painkillers were becoming less and less effective. There were days that I just felt hopeless. Every day was filled with constant pain. By mid March, Vicodin was no longer effective and so my doctor switched me to Percocet. For the first few weeks I felt so much better. I was actually able to get out of bed in the morning and for the first time in months I did not want to kill myself.

The problem with long-term narcotic use is that your tolerance quickly builds. Especially if you are young and otherwise healthy like I am. This is very concerning as you dig yourself deeper and deeper into the hole of narcotic dependency. At some point in time you have to stop and that is not a fun day.

My doctor began to get concerned with how fast my tolerance was building. In a period of a few months I had gone from using 50 mgs of Tramadol per day to using 20mgs of Percocet each day.

At one of my visits my doctor asked me how marijuana affected me. I had never tried marijuana before so I had no idea. He asked me to try smoking the next time I was in pain instead of taking a painkiller.

The first time I smoked pot it was not effective. I was stoned and in pain and that was confusing. If anything the pain was more intensified. I told my doctor about this and he told me that once was not enough to tell if it was going to be effective. So he sent me home with instructions to keep smoking.

I did some more research and realized that Cannabis Indicia has higher Cannabinoid to THC ratio and is therefore it has better pain relieving properties than Cannabis Sativa which is the more commonly available on the street in LA. So I got my hands on some Indicia and I was blown away. It was very effective at controlling my pain and nausea and it had fewer side effects than the narcotics.

I began to smoke a little every day and my narcotic use stabilized. I was on the same dose of Percocet for almost three months before it needed to be upped. It was amazing.

Overall, Marijuana has helped me deal with living in chronic pain. It helps me with pain and nausea very quick and effectively. It has also greatly slowed my narcotic habituation.

Medical Marijuana is not good for every thing, but don’t knock it until you have tried it.

Last February my abdominal pain was becoming unbearable and my primary care physician felt uncomfortable prescribing me narcotics for a long period of time. As a result she referred me to a pain management doctor.

My insurance was a little sketchy so I had to drive from downtown LA to Pomona to see a doctor that took my insurance. I was a little annoyed with that but it turned out the doctor was fantastic and well worth the drive.

At my initial visit he did a very thorough exam and spent almost an hour with me. I was very surprised because other doctors that I have seen had spent less than ten minutes with me on my initial appointment. Towards the end of the exam he asked me how I wanted to proceed. He was afraid that I was experiencing hyperalgesia from the narcotics. He had two options: start several non-narcotic drugs and try to wean off the narcotics, or continue treating the pain with narcotics. I chose to go with option one. At the time I was taking about 40mgs of Vicoden a day and another 100mgs of Tramadol a day. I also had Compazine for Nausea. That day he prescribed me Tegratol and extended release Tramadol. He instructed me to increase my dose of Tramadol to 200mgs per day and to stop the Vicoden over a period of two weeks.

I knew that stopping Vicoden was going to be tough, but when I started I had no idea. My plan was to drop my dose by 5 mgs every 2 – 3 days. That would have me clean in about two to three weeks.

The first day wasn’t so bad. I was a little shaky, but nothing I couldn’t deal with. I went for a run and felt much better afterwards. The second day was much worse. My pain level began to climb and I felt like crap. I would sit in the bathtub for hours. It gave me some relief, but I still felt horrible. This continued for another week.

After a week of weaning my self off I was still taking 20 mgs per day. I wanted to die. My pain level was about a 6 most of the day and at night it shot up to an 8. I called my doctor and got an appointment for the next day.

He was concerned that I was in so much pain and he decided that it was unlikely that I was strictly from narcotic withdrawal. He decided to start me back on Vicoden and told me to take as much as I needed to keep the pain at a level 3. He also reminded me that my Tylenol intake should not exceed 4000 mgs per day.

So with my first attempt to get off of narcotics a bust, I was back to were I started, but with a great doc by my side.

I have realized during my time living chronic pain, that my mood can greatly affect the pain that I experience and my perception of the pain.  When I first started seeing a Pain Specialist, he recommended that I see a therapist that specialized in therapy for chronic pain.

When I first started see the pain therapist I was a little skeptical that she could help me, but after a few sessions I was amazed.  Her specialty was Cognitive Behavioral Therapy or CBT.  This type of therapy focuses on analyzing your thoughts and thought processes and stopping negative thoughts before they take over.

As a complement to sessions with her she recommended that I read Thoughts & Feelings: Taking Control of Your Moods and Your Life by Matthew McKay.  I found this book so useful that I stopped seeing the therapist and just read the book.  I would highly recommend it.

My first experience with Zofran was in the emergency room in Washington D.C.  When I went into the ER I wanted to die I was so nauseated.  Then they gave me IV Zofran and the nausea went away almost immediately.  It was like a miracle drug.

Through out my hospital stay I received IV Zofran three times a day.  It was a god sent.  As I was being discharged I asked my doc for a prescription. He gladly obliged me and sent me home with a scrip.  When I went to fill it I was a little ticked off.  My insurance company would only pay for 12 4mg pills per month.  A 4mg pill costs almost $30 and that is for the generic!  That is just crazy.  So now I have taken to hording my monthly allotment of Zofran and I use it only when I am really ill.

It is a great drug with very few side effects compared to many of the other antiemetics.  If you suffer from nausea ask your doctor about this fantastic drug.

A few weeks ago, I went to my GI doc for a checkup after I got out of the hospital.  He is a very good Gastroenterologist and he specializes in diseases of the pancreas.

He was very perplexed why my pancreatic enzymes were so highly elevated, but they could find no other signs of pancreatitis.  I have none of the risk factors, I don’t drink, not fat, not old.

Also while I was there we talked about different antiemetics as the nausea drugs my PCP had prescribed me quickly stopped working.  I told him that marijuana had helped a lot and I asked him what he thought of Marinol.  He said that he rarely prescribes it, but there was no need for me to suffer.  So he prescribed me 60 5mg pills for me to try.

At the time I was looking for a job and I did not want to complicate things by having THC in my urine.  I checked with my lawyer and he said a company can legally refuse to higher you because of the prescriptions you are on.  That really surprised me.  So to keep things simple I decided to hold of on the Marinol.

Earlier this week, I decided that I was going to move back to LA and get a job out there.  In LA people are much more understanding about THC and marijuana as medicine.  With that in mind I was eager to try out my new script.

I woke up on Saterday morning with no real plans other than to look for jobs in LA and work on the bog, so I decided to try the Marinol instead of my usual Zofran for nausea.  I did some quick math and decided that good pot is 20% THC by weight. So 1g or 1000mgs contain 200mgs of THC.  I decided that I normally smoke 250mgs at a time. 20% of 250mg is 50mg of THC.  The pills were 5mgs so I decided to take 2 and see how that worked.  The true test was going to be how I felt after lunch.

I knew it would take about 90 minutes to kick in so after about an hour I took the pills I began to feel it kick in.  It was very mild but pleasant.  I could hardly tell that I was stoned.   About an hour and a half after I took the Mariniol I decided to eat.  Usually, I get extremely nauseated after every meal.  But the Marinol effectively killed the nausea.

If I was extremely nauseated my first choice would be Zofran, my second choice would be smoked marijuana, and my third choice would be Marinol.  In my state medical marijuana is not yet legal so I do not smoke while I am here.  Zofran is very expensive so my insurance will only pay for 12 a month.  Ideally, I would take Zofran every day, but I cant .  That is were Marinol comes in to save the day.

The last week has been the week from hell. Last time I wrote I was waiting to get on a plane in D.C. Now I am lying in a hospital bed back in my hometown.  As soon as I landed my aunt picked me up from the airport and took me straight to the ER. They quickly admitted me and got me hooked up to some IV drugs.

You would think with all of my spare time I would be able to write more, but being NPO (nothing by mouth) has drained my energy.  Constantly being in pain and subsequently on narcotics doesn’t help either.  I have been on 2mgs of IV Dilaudid every two hours as well as 10mgs of Norco every four hours.  The first few days in the hospital I was taking the Dilaudid every 2 hours, but now I am trying to only use it when I am in extreme pain.

The doctors are at a bit of a loss for what is going on with me.  I have elevated pancreatic enzymes, which would indicate pancreatitis, but imaging of my pancreas has been normal.  It has been a frustrating and painful week.