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Thread: Alternatives to Opioids?

  1. #1
    Super Moderator Top User ddessert's Avatar
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    Oct 2013
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    Alternatives to Opioids?

    With the "opioid epidemic" in the USA news so much this year, I am wondering what are the pain management alternatives?

    I listen to opioid addiction experts in these news stories that say the only role for opioids is:
    a) for a few days after surgery
    b) stage 4 terminal cancer patients

    That has left me wondering what the alternatives are for all the others with chronic pain conditions. The only plan I hear from these experts is to wean everyone off these pain medications and they will all feel better.
    BRCA2 3398del5
    Dec 2010 - back/abd pain
    May 2011 - Unresectable stage III, 2.5cm tumor
    Jun-Aug 2011 - Gem/Cis, 9 rounds
    Oct-Nov 2011 - Radiation+Xeloda, 25 days in 5 weeks
    Oct 2011-Sep 2012 - shrinking tumor
    Feb 2012 - National Familial Pancreatic Study
    Aug 2012 - Downgraded to stage IIA, PGP
    Sep 2012 - Whipple, T3N0M0, 0.5cm tumor, 0/16 lymph nodes
    Dec 2012 - Quebec PanCan Study
    Sep 2012-Nov 2017 - NED
    Mar 2013-present - NCT01088789

  2. #2
    Moderator Top User jorola's Avatar
    Join Date
    May 2014
    I work in a job where I deal with this as well. I work with injured people. It is to the point they even are saying Tylenol #3 should only be given for very short periods of time. I have been told, by medical professionals, that pain medications are designed for short term use only and that after using it for a longer period of time it actually begins to have the reverse affect. Meaning yes it makes the pain worse. Now I admit I have not actually read the material on this that they have referred to, only attended training and had bits of info given to me in training materials - which I cannot find at the moment. I lost my brother to an opioid addiction so i have reason to not like opioids yet I am one of the first ones to say there is a time and place for them - just under proper dr supervision and support is all (in my opinion). Problem I have personally seen and in my job is that there are doctors out there just handing some of this stuff out like candy and not properly educating people (maybe they don't know themselves) on how to take this stuff and the warning signs. Then not properly monitoring their patients. Some drs do but what their patients do after they head out the door a dr has no control over - I mean how much babysitting can be done? So who is really to blame? Good fudge bucking question.
    Anyway off topic. Obv I could go on and on. In my job, I have seen pain clinics teach relaxation exercises, mediation, massage, acupuncture, NSAID (non-steroidal anti-inflammatory meds) and listening to music etc. That may work for some but like for my Dad? Yikes I dread the though of even suggesting it to a man who has worked hard with his hands all his life. I would get banned for life typing the words he would say to me for suggesting it. I wish I knew the solution to this. I know my pain is nothing compared to a cancer patient but a severely arthritic hip and torn rotator cuff at age 45 really sucks and ya I hurt. So those who really need the meds should bloody well get them - with proper support from their dr of course. Ok I have now given my 2 bits.
    Wife to husband with squamous lung cancer stage 3 b
    dx - April 20/14
    tx started May 20/14 - radiation and chemo
    June 23 - chemo finished
    June 24 - tumor 1/3 the original size
    July 4 - radiation finished
    July 8 - PET scan shows tumor almost gone, lymph nodes back to normal
    Married July 19/14
    Sept 9/14 - repeat can shows tumor continues to shrink more, no new spots. New coughing and pain due to chest infection or side effect of radiation.
    Sept 19/14 - not infection but pneumonitis, place on dex for 4 weeks
    Oct 22/14 - now off of dex and facing even more symptoms of withdrawal
    Dec 16/14 - pretty much nothing left but a scar
    April 7/15 - ditto scan and screw you stats
    Oct 6/15 - more scarring but still cancer still gone
    Feb 2016 -scan the same
    Aug 2016 - more of the same
    Aug 2017 - and ditto

  3. #3
    Well, I appear to be on a lifetime prescription of tramadol, azacitidine, venclexta, and several anti-inflamants, plus blood pressure and sleeping aids. My pain levels and quality of life are quite acceptable, and the situation appears stable. Considering how bad the azacitidine can kick my butt sometimes, and with the venclexta having its own nasty little side effects, am I supposed to worry about the tramadol?? I don't think so.

    To provide a more substantial and useful answer, however, in my 8 years in a cancer-only hospice, I was occasionally privileged to watch the 25 year employees of the hospice dole out medications including things like methadone and other anti-addiction drugs, and the quality of life they were able to give to the patients was nothing short of amazing.

    Looking at it in a certain light, doctors and nurses have little if any training in end-of-life medications as the final days, hours, and minutes of a patient's life are ground out inside a hospice. Sometimes the passing is easy, and sometimes it can be downright nasty, and if you don't have an ingrained sense of a higher power somewhere, this job is not for you. I have no idea what kinds of training facilities they have for professional hospice workers, and based on the fact that hospice work does not lie strictly within the bounds of the Hippocratic Oath, it may be a skilled vocation like a violin maker. If you want to learn the high art of terminal caregiving, particularly the administration of palliative medications, find the most highly rated hospice in your area and bring your faith with you.
    05/6/16 pre-op physical for surgery show low WBC & RBC
    5/22/16 [Birthday] Results of BM biopsy: AML 25% blasts with inv t(3:3) mutation, HIGH risk
    5/30/16 Undergo 3+7 chemo, but it doesn't touch AML, infections nearly kill me. Blasts 65%
    7/04/16 Diagnosis now Refractory AML. [:tombstone:]Six cycles of azacitidine, 21 shots over 7 days w/ 1.5" needle into gut + below navel.
    11/05/16 Move to NOLA - Infusion center 4 minutes away. 15 shots for 5 days with 5/8" 25 ga. needle Huge increase in quality of life.
    12/28/16 BMB shows blasts 12%
    4/16/17 BMB shows CD34 16%, cycles dropped to 4 weeks
    7/20/17 Diagnosis changed to "indolent leukemia", aka MDS
    7/27/17 BMB shows CD34 17%
    8/15/17 Venclexta chemo in PILL form added Onc estimates survival time now 2 - 4 YEARS.
    10/26/17 BMB results show 17/20 metaphases with inv(3:3) mutation-low blood cell counts - transfusions ineffective
    12/4/17 Diagnosis: Uncontrolled refractory AML

  4. #4
    Super Moderator Top User Baz10's Avatar
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    May 2011
    As a 6 year Tramadol veteran I can hand on heart say I’m most definitely Not addicted and that is taking as necessary 100 mg 4 times per day.
    The docs tried me on codeine and at my request did not prescribe further, not due to addiction, purely it did not agree with me.
    Latest is Amitriptyline one 25 mg early evening and as necessary topping up with Tramadol.
    So, from my aspect addiction is not even a talking point.
    For myself I can only state that I’d rather be on medication than have a permanent pain score of 7 or 8 out of 10.

    Yes of course I understand the fear of addiction, but wisely prescribed, wisely used and monitored I don’t see a problem.
    Thats my two cents worth.
    Diagnosed stage 3 March 011
    Radical resection April 011
    Restaged 2b April 011.
    12/09 Colonoscopy clear but picked up hospital infection.
    Aorta & femoral arteries occluded.
    Clot buster drugs put me in ICU with internal bleeding. 9 blood units later they got it under control.
    Aortobifemoral surgery 5th May. yughh.
    PET scan indicates clear
    DEXA bone scan clear
    13/5 CT showed "unknown" but no concern from docs.
    Inguinal lymph nodes and severe groin pain.
    Ultrasound and MRI show no nasties. Pheww
    Groin pain and enlarged lymph nodes still there.
    October -still the same pains but under semi control.
    Additional chest CT scan ordered for 11th November prior to surgery.
    Sinus surgery done and dusted.
    July 2014 PSA at 5.10. 2months of antibiotics in case of UTI, jan 2015 PSA at 7.20, 23/08 now 8.2, current 8.1
    Prostate Cancer confirmed Gleason 3+Marginal 4.
    Active surveillance continues.
    PET CT Aug 2017 indicated lung nodule changes
    CT Guided biopsy 7/09
    November 1 Vats Wedge section pathology Glomulated previous infection
    no Cancer.

    Not all's rosy in the garden, but see following.
    Stop grumbling Baz, your still alive and kicking so far.
    Age and illness doesn't define who we are, but more what we are able to do.
    Do what I love doing, when I can until I can't.
    and dodging bullets in the meanwhile, too many bullets at moment.


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