Work, Opioids, and Pain

Hi all,

It has been four or five months since I last posted.

As my pain has been getting worse, and my Ultram inadequate to deal with it, my PM wanted me to try Kadian. I was not able to function on it -- made me too cloudy and couldn't keep my eyes open.

I didn't want to increase my opioid use and after the Kadian, I asked to try Wellbutrin, hoping that upping norepinephrine would help. The Wellbutrin had no effect. So we then tried Savella. I started with the titration pack and after about 3 days at the 50mg level, I had to stop taking it. It was hard to think, constipated (since even the 12.5mg dose), and it felt like there was pressure crushing my head (sort of like when one's sinuses and eustachian tubes are clogged -- but they weren't).

That was about 3 weeks ago and felt the linger effects for another week.

Anyhow, I'm posting again today in part because it is just a bad pain day and I can't get myself to work.

As an alternative to more opioids, I've rearranged my work area so I can work from my recliner. That has been helping, but yesterday I decided to clean my office -- and today I'm dealing with the consequences.

I'm also posting for a bit of support/advice/therapy.

Most of my work is related to writing and I was solicited by a major academic press (with whom I have previously published) to write another book for them. This would be my first since my CP issues arose and I'm quite anxious about it.

I've published a few hundred pages worth of articles in the past couple of years, but committing to the book is different. I have no deadlines with an article and can drop it if I want. But my book contract is on its way and I'll be committed to an 18-month deadline.

Although I can still write when taking hydrocodone, I need to keep the dose and frequency fairly low. I can work on 5mg, sometimes 10mg, but around there I start to get a drifty-feeling that I must fight against.

So, I've been researching Provigil. My thought is that if I were to take something to increase concentration, perhaps the pain would distract me less. That was part of the rationale for trying Wellbutrin and Savella. But Provigil has a different mechanism. It is also quite unlike other concentration-enhancing drugs (Strattera, Ritalin). I'm thinking about discussing it with my PM -- but am worried about what he will think about my request.

It seems reasonable to me -- the goal is being able to focus on work vs. the pain and maybe Provigil would help -- ideally on its own -- but if not, then maybe in combination with my usual hydrocodone. In fact, it is sometimes prescribed for opioid induced fatigue.

Cogito.

Ive had Chronic pain for 20 odd years. Ive herniated, ruptured and bulging disks in the lower back as well as neck/shoulder level. My back has been broken twice..across the lower back and across the shoulders twice. Ive had 25 major surgeries on just about every joint possible (knee replacement, ankle surgeries, neck surgery, back surgery, shoulder reconstruction etc). I was in a semi truck accident almost 3 years ago that left me with three tiny fractures in my neck........then I was diagnosed with fibromyalgia just about 3 years ago as well. Now I get to sport the spiffy new label of having some form of severe sleep apnea though no one wants to mention the "word Sleep Apnea"

All that to say.........Ive taken some form of opiate in high doses for more years than I can count. Ive used 150mcg of fentanyl ever 72 hours with vicodin (10/325) ..up to 5 a day for break through. I also happen to work full time........though GOD only knows how most days.

I stopped the fentanyl about 4 months ago just because I dont think it worked good enough. I have a lot better luck with just the vicodin.

I wish you much success and also support what White Beard has said in his post.

Stand strong

Thanks for the replies. I'm not feeling up to working this morning, so let me respond.


Trudy was surprised that my PM shifted me from Ultram to Kadian. For time-release meds, he doesn't like oxycontin. He said he would prescribe it if the Kadian doesn't work out, but he finds that patients need it every 8hrs vs 12hrs as labeled. That causes an issue with prescribing, given that it is a schedule II drug (maybe there are state issues too?). He also said that too much tends to get released in the stomach vs. intestines which often causes patients nausea. There's also Opana ER and a time release dilaudid, I believe. But I've tried the IR versions of them and they didn't agree with me.

So, we tried a low dose of Kadian. As a once-a-day pill it has an advantage over MS contin. I forget the dose now, but it was equivalent to the Ultram dose per the equivalence tables. But as I couldn't deal with the side effects, I stopped using it.

White Beard and Resty brought up my opioid reticence. I'm in my 40's and I probably have 30-40 years left. Assuming nothing changes, I'll probably need opioid medication for the rest of my life and so the less I take now, the more effective in future decades.

In addition, my pain levels are usually 2-6. 2 when I wake up, within a few hours, 4, a few hours later 5 or 6. Opioids can bring a 5 down to a 3, but often at the expense of my concentration.... yet the pain too would interfere with concentration. So, either way, it gets harder to work. Thus, the pursuit of an alternative strategy made sense. If I can find something whose primary role is to improve concentration, then whether or not I take an opioid too, my main goal would be accomplished: to be able to work despite the pain.

After researching the medications, and trying a few, I now see Provigil as the next one worth attempting. My PM appointment is in about 2 weeks and I'll see what he thinks.