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Thread: Alternatives to Opioids?

  1. #1
    Super Moderator Top User ddessert's Avatar
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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
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    Feb 2012 - National Familial Pancreatic Study
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    Sep 2012 - Whipple, T3N0M0, 0.5cm tumor, 0/16 lymph nodes
    Dec 2012 - Quebec PanCan Study
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    @pancanology

  2. #2
    Moderator Top User jorola's Avatar
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    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
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    Married July 19/14
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    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
    Aug 2018 - 4 yrs NED

  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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    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.
    Barry
    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.
    Motto
    Do what I love doing, when I can until I can't.
    and dodging bullets in the meanwhile, too many bullets at moment.

  5. #5
    Only place for opioids being terminal cancer patients and surgery? Yeah, well, they are wrong. I would never have survived my allo transplant without dilaudid, oxycodone, and codeine. When the pain hits a 12, and you wake up nearly screaming, it's pure hell. If I wasn't given my pain medication every 4 hours on the dot, I could do little but lie in bed and whimper until it kicked in. Sometimes, I was given 2 medications concurrently, plus the Fentanyl patch, to try to control my pain. Even then, it sometimes felt like it only took the edge off. I never want a repeat of those days. I was on oxycodone off and on for 2-3 months. I've been codeine since April, largely for a chronic cough, and no addiction problems so far. Codeine sure beats coughing my lungs up every day! By now, my body is so used to it, it doesn't even make me sleepy anymore. However, it still works dandy as a cough suppressant when nothing else does.

    I agree with Baz. When pain medications are taken properly with correct dosage and discontinued when no longer needed for pain, there is little risk of addiction. However, sometimes it does mean being vigilant. Because of previous trauma, I've always known I'm at a higher risk for addiction, which is why I have always been careful to stop taking pain medication just as soon as I longer need it.
    5/12 Dx at age 24 with DLBC NHL Stage 2B presenting as <10 cm tumor in left lung
    5/12-9/12 R-CHOP x 6. Followup 3 month scans
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    6/14-7/14 R-ICE x 2 inpatient
    8/21/14 BEAM and auto transplant
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    2/15 Relapse
    3/15-9/15 GVD-R x 7
    10/15 Dx restrictive lung disease.
    1/16 Relapse
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    9/16 Relapse
    10/16-1/17 ESHAP x 3 inpatient
    1/17 Diagnosis changed from DLBC to PMBCL
    2/21/17 Bu-mide. Myeloablative allo transplant. Sibling donor 8/8
    3/9/17 Discharge on Day +16 to Hope Lodge
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    4/17/17 Discharged to my home
    5/1/17 Readmitted. Dx pneumonia
    5/10/17 Discharged on 2 liters supplemental oxygen.
    8/17 Readmitted briefly for a flareup of pneumonia.
    9/27/17 Relapse. PET confirmed.
    11/1/17 First treatment of Brentuximab Vedotin. Total of 16 planned.
    1/25/18 50% tumor reduction!

  6. #6
    Moderator Senior User BrigitteM's Avatar
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    I probably will make some of you cringe, but hypnosis (hypnosedation) is being used in some some surgeries to reduce the use of opioids or even replace them. The same is true for some chronic pains; not all pains respond to hypnosis, but I think it is worth looking into that technique, which is used in many hospitals in Europe.

    See article in Cure Today: https://www.curetoday.com/publications/cure/2017/fall-2017/using-hypnosis-to-treat-cancers-side-effects

    Brigitte
    __________________________________________________ ___________________
    1/12/2016 No symptoms except ongoing fatigue; blood test revealed elevated liver enzymes
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    2/12/2016 DX Borderline resectable pancreas ductal adenocarcinoma - Stage 3 @ 61
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    Sept 2016 Know Your Tumor - PANCAN.org
    11/4/2016 CT Scan clear - NED
    May 2017 Liver lesion - DX mild fatty liver disease - NED
    Aug 2017 Several tiny lung nodules - NED
    Feb 2018 Stable lung nodules - NED
    May 2018. Lung nodules are growing; possibly mets, but still considered NED
    Aug 2018 One lung nodule has reached 1.7 cm. Biopsy confirms it is pancreatic metastasis.
    Sept 2018 Starting clinical trial with RX-3117 and Abraxane (NCT03189914)

  7. #7
    Super Moderator Top User Baz10's Avatar
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    Your post doesn’t make me cringe at all.
    i have seen some very few I admit studies as well as actual surgery being undertaken following hypnosis, now that made me cringe. Fortunately they were videos.

    The key is despite eminent research we still know only a infinitesimal amount as to how the brain works and the powers therein.
    Who knows what our brain is capable of given the right triggers.
    Barry
    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.
    Motto
    Do what I love doing, when I can until I can't.
    and dodging bullets in the meanwhile, too many bullets at moment.

  8. #8
    Moderator Senior User IndyLou's Avatar
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    With the "opioid epidemic" in the USA news so much this year, I am wondering what are the pain management alternatives?
    While I don't discount that there may be an "opioid epidemic" in this country, that doesn't mean opioid medicines don't have a place in treating pain.

    Some pain is more "legitimate" than others, and many of the pain scales are subjective; e.g., "On a scale of 1 - 10, with 10 being the worst, what would you say your pain level is today?"

    Speaking from my own experience, the pain in my throat from my radiation/targeted therapy was excruciating. The hydrocodone tablet I took at 10 pm was supposed to last 4 hours. Taking that pain medication, I was able to sleep. At 2 am sharp, I would awaken with more pain in my throat. I'd get up, walk to the kitchen, and take more pain medication to get me through until morning. If the water I used to wash down my medication was too cold, it felt as though I stabbed myself in the throat--from the inside. I would get more tepid water, take my medication, and walk back to bed with tears in my eyes.

    Alternatively, a few years later, I suffered sciatica with a lower back injury. Aleve alone, even in larger doses, wasn't enough to take the edge off. I was prescribed tramadal--a 3-week dose, if I remember correctly. It was enough to allow me to walk, and eventually receive a cortisone shot, followed by physical therapy.

    Even more recently, I had a small cavity filled recently by my dentist. It was in an awkward place, and required some local anesthesia (lidocaine), followed by some drilling. Afterwards, my dentist gave me a couple of Tylenol and a couple of Advil...two packages of 4 capsules each. I took one of the packages, and that was sufficient. I took nothing else.

    In those scenarios, the treating physicians responsibly prescribed pain medications commensurate with the anticipated level of pain. Could I have "faked" my pain and asked for more/stronger meds in each of those situations? Maybe. That requires both a willing patient AND physician. There are simply too many variables among disease states, and to dismiss ALL opioids as bad, or restrict them to only convalescing patients or those with Stage 4 cancers takes tools away from physicians.
    Age 52 Male
    early Feb, 2013 - Noticed almond-sized lump in shaving area, right side of neck. No other "classic" cancer symptoms
    late Feb, 2013 - Visited PCP for check-up, PCP advised as lymphoma. Did blood work, orders for CT-scan, referred to ENT
    3/7/13 - CT-scan inconclusive, endoscopy negative
    3/9/13 - FNA of neck mass
    3/14/13 - Received dx of squamous-cell carcinoma, unknown primary
    3/25/13 - CT-PET scan reveals no other active tumors
    3/26/13 - work/up for IMRT
    4/1/13 - W1, D1 of weekly cetuximab
    4/8/13 - W1, D1 of IMRT
    5/20/13 - complete 8 week regimen of weekly cetuximab
    5/24/13 - Complete 35-day regimen of daily IMRT
    mid-July 2013 - CT-PET scan reveals no active tumors, but shows necrotic tissue at site of original tumor
    early Sept 2013 - partial neck dissection to remove necrotic tissue. Assay shows no cancer present.
    Spring 2014 - No signs of cancer
    Spring 2015 - NED
    Spring 2016 - NED
    Spring 2017 - NED
    Spring 2018 - NED

  9. #9
    Hello all..first time on one of these forums, I am currently taking care of my grandmother and she is currently doing chemo 3 times a week and has lost a lot of strength. She is constantly in pain and it just kills me inside because I don't know what I can do to treat her pains. I believe we are going to try Oxycontin but Im not sure yet on how much to start her with...

  10. #10
    Super Moderator Top User Baz10's Avatar
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    What I and others have said,
    Correctly prescribed by a doctor at the right strength and frequency there should be an improvement in pain control.
    You suggest “You believe we are going to try OxyContin but I’m not sure yet on how much to start her with ....).

    That to me suggests It hasn’t been prescribed by a medical doctor (I may be wrong in my assumption) as the dosage and frequency would have been clearly stated to match with her general health condition and age.

    Unless you know what you are doing and have knowledge with opiates one doesn’t play with them., period.
    Seek advice from a medical doctor before you or anyone who is not qualified administers anything.
    Barry
    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.
    Motto
    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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