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Question bout pain meds?

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Posted 8/18/2008 4:01 PM (GMT 0)
Ok here we go again.

I am having trouble with the new pain meds as well as the last ones they put me on.  Was on the percocet and was having heart palp and really bad itchy probs so they doc took me off and put me back on loritab.  Now im having really bad itchy probs with these as well.

I know that opitates can cause itching intil you system gets used to them.  My question is how long does this take?  I am itching very bad.  I cant stand it!

Are there any pain killers out there that work that arent opitates? AI have called my GP back and am waiting for him to call me back about this and was just wondering what all info you all might have if any. 

Sence I got my injections I have been in more pain than I was in before them arghhhh!  Going back to pain management doc today for that as well, they said something about electric stimular to help ease the pain.  YA YA YA on that one.  Sorry all just not in the mood for some doc to tell me this will help when nothing else has.  Quess Im kinda down today as I havent slept but about 5 hrs in the last 2 days. I just want to sleep for days right now!

Well any info would be helpful

Thanks all

Lara

Posted 8/18/2008 6:21 PM (GMT 0)
I am not sure what the "itchy" scale index is for opana but this is a newer pain reliever that is being highly advertised. It is a narcotic (oxymorphone) and according to the adverse reactions section on the package insert itchiness occurred about 15% (I think it is in 15% of the patients). As far as non-narcotic alternatives, I am not sure what is out there. I am not really advocating the above mentioned drug either; I guess I am just throwing it out there to see if anyone has any opinion about it as a reasonable alternative. But it is hard to suggest this because you figure that your doctor is well aware of any alternatives that could work for you and offering other choices may not go over very well with him / her.

The other thing that you could ask her about is benadryl. Oftentimes taking a benadryl 30 minutes or so before your narcotic can lessen the itch or prevent it all together ( it is an anti-histmine and opioids cause itching because it causes our mast cells to release histamine). However, you need to make sure that this is OK for you to take. Another way to maybe down play the reaction is to slowly increase your dose; again, you can ask your doctor if that is an option for you. Sometimes splitting doses or slowly titering up can give your body a chance to gain tolerance to the meds. But again, you need to make sure that your meds can be split. Many, many of the pain killers cannot be split (if they are an extended release version for example) and it can be very, very harmful to do so!

Some people can become tolerant to the itchiness so there is a possiblity that within 5 to 10 days this will go away for you. But in the meantime there may be things that can help. Even a topical anti-histamine cream can help (like benadryl). I have used it at times when I have had to double up on my doses for flares and it seems to calm things down.
Posted 8/18/2008 10:42 PM (GMT 0)

Thanks Disce

I called the pain management doc today and was told to go to my GP as he prescribed the loritab.  Called the GP and still didnt here back from him so I stopped by the office and he was not in today grrrrrrrr... So I left a message for whom ever was in the office.

Got a call back from the PA what ever that is and she said that its a allergic reaction and I was telling her about others saying its just part of the process of the opiates and how it can take time to get in your system she said that wasnt true.  That its an allergic reaction and that all you can call in for me is Darvocet.  Never took that either so I have no idea what it is but she did say it was less of a pain killer.  What ever that means.

In the mean time Im in pain and so tired that I cant keep my eyes open but cant sleep as teh pain is to much and Im still itching even though I havent taked the loritab in a day in a half.  I feel like Im going to fall over.  This is so frustrating!  I cant even seen to get one thing with the pain in order without having 10 more pop up.

So im sitting here debating on weather or not to head to the ER cause I dont think I can manage another night of pain and not sleeping.  Which I so dont want to be there sitting in er all night! Plus I feel bad cause I have been snapping at my kids all day as well.

Thanks for the post Disce and the info

Lara

Posted 8/19/2008 2:53 AM (GMT 0)
Hi ladyred,

I am saying this with all due respect and with the caution that I have no special medical knowledge - only sharing what I have learned throughout my own trials, mistrials and tribulations with pain meds and asking questions from expert physicians and expert patients......but I doubt highly that you are experiencing a true allergic reaction. True allergies are rare with narcotics and itching by itself is not an indication of an allergic reaction to a narcotic. With other medications it can be the first (and only sign) of an allergic reaction - like what we are told to be alert to when taking antibiotics for example. But for narcotics itching is a common side effect - every type describes this in the adverse event section of the drug description that is included in the packaging. It is a well-known and common reaction that is related to the immune system (our mast cells) but it is not an allergic response. Basically it is just a natural reaction to the medicine. Like our receptors which block the pain when the narcotic binds to it, other components of the drug bind to receptors on our mast cells and this binding tells the cells to release histamine. Under other conditions, when a substance binds to these same receptors it too tells the mast cells to release histamine. But those are normally substances that we associate with allergies (like dust, pollen, dander etc). So while the end result is the same (itchiness, hives, etc) the cause is different. It is not a true allergy - your body is not reacting to it because it is "foreign" in the same way your system recognizes dust, dander etc. In those cases you need an antibody to cause the reaction and it is virtually unheard of for a person to make an antibody to a narcotic (I think it is too small - most things that cause allergic reactions have to be a large size molecule and be bound to certain other structures - like a protein, etc, if I remember my college days right). I think people taking "dirty" or unpure street drugs can get an allergic reaction but that is usually to the stuff that they use to "cut" the drug with.

So my guess, and it is just a guess, is that your nurse is mixing up her information and not remembering her basic immunology studies and is unfamiliar with the specific properties of narcotics. Now that being said, I don't expect you to take what I say as being infallibly accurate. I just wanted to allay any fears you may have that you could end up with a serious anaphylactic reaction to your med; while nothing is ever impossible, I think that it is a rare chance (most package inserts say this - for what that is worth). However, having your itch last this long is a little unusual and you may be very sensitive to histamine release - that once it gets going, it isn't being turned off for some reason. If you are also experiencing red welts and hives or have any swelling near your face, in your mouth, on your lips or eye swelling- or any difficulty breathing, then you are probably having an allergic reaction. If your itching is non-specific, creepy crawly feeling all over your body, but without raised red welts, then it is most likely just the common side effect that is not settling down for you.

The Darvocet, I think is considered a lesser pain killer as a class but again that is all relative (ir is recommended for mild to moderate pain). It depends on your individual metabolism. For example, I have a friend who takes darvocet for chronic pain and she gets immediate and effective relief. But when she takes percocet - a class of pain killer considered useful for moderate to severe pain - she gets no pain relief at all. So for her, taking the "higher" class is really not a stronger med at all. So you never know for your case: you very well may get better pain relief and a lesser side effect of itching.

The other thing that surprises me with this nurses advice is that if she really thinks it is an allergic response why didn't she recommend benadryl for you (if your medical history allows it)? Benadryl is commonly used to pre-treat for mild allergies when undergoing medical treatment like CT scans with contrast for example. In your case, it could be what helps you through this episode. But only you and / or your doc will know if you can safely take this or any other anti-histamine. It will work whether it is an allergic reaction or just a side-effect to the med. The other benefit to anti-histamines is that for some people, it is a good sleep aid. MY PM doc recommended a small dose at bedtime to help sleep through the night, It works for me, but I know for other people it can wire them up (my husband for example).

If you are not sure about taking an antihistamine pill, maybe it is OK for you to try the topical cream. Or you can try the cortisone topical cream. One or the other may get the itching to go away. As far as the pain - the only thing I can suggest is to give the darvocet a try and maybe it will work for you like it does for my friend. That is the thing with pain meds - it is all trial and error. And I really would bring this up with your doc and see if he thinks pretreating with an antihistamine would help you; if the pain killing is working but the itches are causing you to stop, maybe you can deal with the itchiness AND get the pain relief you need. Keep the faith - there should be an option out there for you. Hopefully your doc is wiling to keep trying. If you need me to, I can try to find medical literature that describes the histamine action of narcotics if you think your doc needs to be reminded......and post the reference here for people to review.....
Posted 8/20/2008 3:35 PM (GMT 0)

Hello Disce and I hope you are well,

Once again thank you so much for the information. 

I went and make an appointment with my GP and was seen yesterday.  He told me the same thing  and put me on Atarax to deal with the itching and kept me on the loritab and was a bit suprised that the PA told me that as well. 

He also gave me a sleeping pill to help me to sleep at night as I have had about 3 to 5 hours a night if I'm lucky and said that dealing with not sleeping only makes things worse.  He gave me Trazodone 100MG.  I did try the darvocet and it didnt really work.  Not that the lortab does much either seem like when I take it I get about 2 hrs of taking the edge off them its back in bad pain again so not sure what to do about that.

He also suggested that I go and get a cain so will check into that today prob hit the thrift store for that. 

As to date I feel like I am a pharmacy of late and the amounts of meds I am taking

Naproxen 500 mg

Atarax 25mg

lortab 5/500mg

Trazodone 100 mg

flexeril 10mg

I go back to the pain doctor on the 27th of this month so will see what he has to say about all this.  I know that my GP was a bit mad that I am seeing a pain management doc and ortho surgeon and to have to go to him for pain management made him a bit mad and he was going to make phone calls today to get it all sorted out for me.  One can only hope right lol.

Well anyway once again thank you do much for all the info It was very helpful!

Lara

 

Posted 8/20/2008 6:10 PM (GMT 0)
Hi Lara,

I am happy that you are getting some help with your pain problems. I also hope that your PCP can get the whole mess straighten out for you - dealing with that alone is enough to drive your pain levels up. Getting good sleep is also a big way to help with pain - either by having stronger coping skills and / or by giving your body a chance to do mini-repair work while it is shut down. Plus just giving your conscious mind a break from that inner dialog of pain is a big help, I think.

I sure hope you figure out what is going to work best for you. It can be a long process, but from my experience it can be done.
Posted 8/21/2008 12:55 AM (GMT 0)
Disce, I am beginning to see that it can very well be a long process.  I still dont know what I am going to do about keeping my kids as I can only work part time right now.  So I still have alot of decission to make concerning my CP and how to manage it all.  But I am just trying to take one day at a time and deal with things as they come.  Not always a easy feat when things start piling up.  But I quess we are all in that one together. 

I am hoping to be dealing with the pain management doc and only him most of the time now.  He has a whole PT thing set up in his office as well...So I think that would help alot instead of running to 4 different docs all week long, sigh, It really is time comsuming.

I am really tired and hurting tonight so I'm not staying on late tonight am hoping that sleeping pills will just knock me out tonight.  My kids have first day of school tomorrow and I must admit I am a bit scared about that as well because my kids have to catch the bus at 545 and at 645 and 7.  They have to stagger them here as there are so many newbes in the neighborhood and not enought busses.  And as I, on most nights, either dont fall alseep intil 4am or 6 or fall alseep and wake up somewhere between 3 and 4am.  So getting up early to get kids out and off is worrying me a bit.

But I quess I will see and if I cant manage then I will have to send them to there dads intil I get back on my feet.  Think I have been in denial up until this point thinking that I can manage and the last 2 weeks has just about did me in.  But I came to the conclusion that if I cant take care of them with any quality then just being a body here wont do them any good at all anyways and I have to accept that as well as everything else. 

Just another long list of things this last while to deal with.  But I am strong and will find a way to cope with it all one way or another.   At the end of the day we can only do what we can, by no fault or lack of trying on our part. 

Thanks again Disce

 

Posted 8/21/2008 1:11 AM (GMT 0)
Dear Lady,
I just wanted to send hugs to you and say I'm so sorry you have to struggle with this tough decision about your children. Chronic pain robs us of so much. I can definitely understand your fear about getting up early in the morning - and functioning to get 3 children off at 3 different times! The average person would have some difficulty, but most people do not understand that what is simple or a little difficult for most othes can be nearly impossible for us.

I wish you all the best, and even though I don't have children, I do know about things piling up and becoming scary and feeling alone in managing it all. But at least we all have found eachother!

PaLady
Posted 8/21/2008 1:47 AM (GMT 0)

Thanks so much PAlady for all the encouraging words and thoughts it means so much to me and it gives me so much hope for my day to know that others are dealing just like you in the same struggles and to see that they manage even if its in there OWN way, it helps alot.  And thanks so much for the hugs man you have no idea how much I really need one. Praying for you as always Palady.  Hope you have a good day tomorrow.  Im off to bed with hopes of sleeping in a drugged out sleep lol at this point I will take what I can get.

Hugs to you as well ((((((()))))))

Lara

Posted 8/21/2008 8:44 PM (GMT 0)
My doctor suggested Benadryl for my ITCHING ITCHING ITCHING. Since I
told him about the itching, it went away! Good for me. I don't know how I
could have taken it any longers. This has happened before. I have had itching pain and
then it miraculously disappears.
I'm going to get an injection for Shingles. I'm afraid of Shingles and for a time
I thought that's what I had.
Good Luck, Lady.
Pamela
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