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pain meds

Posted by denise n on 5/18/01 at hrmin (048237)

I keep seeing the drug ULTRAM used as a pain medication for tarsal tunnel. I used this at one time for a wrist injury/ulnar neuropathy from work. I do know the Celebrex helps keep the pain down some, but would the ULTRAM help any more? It would be so nice to have less pain or (do I dare say it??) NO PAIN???

Denise N.

Re: pain meds

Lynn on 5/18/01 at 21:00 (048244)

Personally I found Ultram to be useless for pain after PF surgery. Just my experience.

Re: pain meds

Dr. Biehler on 5/18/01 at 21:08 (048245)

Ultram is a unique drug in the way it works. It is used for pain and for neuropathies. It is not as specific for pain as regular pain drugs, but as an example, it is used for breack through pain in cancer patients. Dr.B.

Re: pain meds

Pauline on 5/19/01 at 07:50 (048259)

Dr. Biehler,
Luckly I've never been in a situation that required heavy pain medication so I don't really understand 'break through pain'. If a person is in extreme pain and on heavy pain medication that is covering the pain when
does 'break through' medication come into play? Would this be used between dosing of the heavier medication? Is break through medication used basicly to control the number and increase in heavier narcotics?

Re: pain meds

Dr. Biehler on 5/19/01 at 10:46 (048272)

Break through pain can happen inbetween regular doses of pain medication ( such as for cancer patients ). Ultram can control pain but is not as effective as codine with tylenol. Ultram does have other properties that codine doe not have, this is what makes Ultram valuable. Dr. B.

Re: Breakthrough pain

wendyn on 5/19/01 at 11:12 (048278)

I had never heard of it till 3 years ago. Our friend with cancer (was in his bones/lungs/liver) was in A LOT of pain. He was on high doses of something similar to morphine, plus he had similar pills for 'breakthrough pain' - pain that was too much, and happened between the big doses.

Re: Breakthrough meds

BrianG on 5/19/01 at 18:30 (048311)

Hi Pauline,

Most people that take pain meds for chronic pain, whether it be for cancer of PF, will take a long acting opiate like Oxycontin or MS Contin. These pills are manufactured so they will release the codeine, or morphine, at a couple different times during the day. These pills are supposed to work for 12 hours a day, but frequently do not. Say you take your first pill at noon. About an hour later the outer coating of pill will wear off, releasing 50% the medicine. The rest of the pill will stay in your stomach / intestines until it releases the 2nd 50% of the medicine about 6 hours later. Now, most people in the know will tell you that a dose of codeine, or morphine will only last 3-4 hours. This gives you 1-2 hours of pain before the 2nd half of the pill kicks in. This is called breakthrough pain. If your not sleeping when this happens, you'll have a pain spike, and need a quicker acting med to get you through that 2 hour window.

If the manufactures would recommend taking the long acting pills three times a day, instead of two, there would be little need for breakthrogh meds, as you would have a constant supply of medcation in your system. At least this is the way it's been explained to me.

BCG

Re: To Brian Breakthrough meds

Pauline on 5/19/01 at 22:43 (048323)

Thanks Brian. I think doctors shy away from narcotic drugs because of government scrutiny more than addiction. I know pharmacies that won't even carry this type of drug. It would seem to me, if the doctors would prescribe to control pain, less total medication would be taken. I think the new Pain Law that went into effect might help, but I think it applies only to hospital patients, perhaps nursing homes and hospice as well.
Unfortunately I don't think homebound patients qualify. Thanks again for
your explaination.

Re: To Brian Breakthrough meds

BrianG on 5/20/01 at 12:07 (048363)

Hi Pauline,

Actually anyone in chronic pain qualifies for long acting pain meds. I am one. Some states have stricter laws than others, but it is not against the law, in any state, for a physician to prescribe long term opiates for his chronic pain patients. If your interested, I think I can find a page with the guidelines for each state. Thank god for compassionate doctors who refuse to let the DEA intimadate them. Pain meds are not for everyone, but it some cases they can literly be lifesavers.

BCG

PS You are right about the new Pain Guidelines. They were developed by the institution that accredits, hospitals, nursing homes, etc.

Re: To Brian Breakthrough meds

bg cped on 5/20/01 at 13:02 (048372)

Pain and strong medications like vic, oxycontin, etc. is a tough thing from a Doctors standpoint. They want to help, and there are many patients that need it. I used to be in an office with a pain manag/phyisiatrist. He did a wonderful job and patients loved him. A big problem is patients that are drug shoppers. Last I heard a vic tablet is worth about $4 on the street.
One thing I found odd is that every Monday morning when the receptionist would play the answering machine there would be several calls about getting script re-filled before time.

It was always, my dog ate the bottle, it fell out of my shirt pocket and went into the lake, my bf took them, my kids put them down the toilet, etc. What is even more strange it was ALWAYS the pain meds that got 'lost' never was it anti-inflam meds. Most Doctors are concerned about the patient. Most patients are honest. A Doctor needs to cover hi/her behind because obtaining prescription pain meds under false pretense is a cottage industry

The Doctor had to change script pads from a patient stealing them. My script pads have no DEA number, yet 2 times some ninny stole one out of the room, wrote a script, and tried to use it at the pharmacy.

Re: Help is available

BrianG on 5/21/01 at hrmin (048460)

You actually make some good points, and yes there will always be people who will try to divert pain meds. Does this mean the legitimate person with chronic pain must go without. I would hope not. Each state has guidelines that take all these things into consideration. Unfortunatly most doctors are concerned about covering their behinds, than of helping the patient. If a doctor follows the guidelines, there should be no trouble. It just makes me sick that people are lying at home in agony because their doctor is afraid the prescribe. Do we even want to get into how many people commit suicide because of chronic pain? I know of one such person myself. In fact we may all know of someone, it's just that the true facts hardly ever come out. My doctor told me that he had 4 hours of pain management in med school. Four measley hours!!! Pain management should be right up there with every other type of service the doctors offer. The outlaws cannot be allowed to win this battle. There are many websites available to help anyone that cannot deal with the pain anymore. I'm talking about legal, compassionate help, nothing underground. I'll be glad to point anyone in the right direction.

BCG

Re: pain meds

Lynn on 5/18/01 at 21:00 (048244)

Personally I found Ultram to be useless for pain after PF surgery. Just my experience.

Re: pain meds

Dr. Biehler on 5/18/01 at 21:08 (048245)

Ultram is a unique drug in the way it works. It is used for pain and for neuropathies. It is not as specific for pain as regular pain drugs, but as an example, it is used for breack through pain in cancer patients. Dr.B.

Re: pain meds

Pauline on 5/19/01 at 07:50 (048259)

Dr. Biehler,
Luckly I've never been in a situation that required heavy pain medication so I don't really understand 'break through pain'. If a person is in extreme pain and on heavy pain medication that is covering the pain when
does 'break through' medication come into play? Would this be used between dosing of the heavier medication? Is break through medication used basicly to control the number and increase in heavier narcotics?

Re: pain meds

Dr. Biehler on 5/19/01 at 10:46 (048272)

Break through pain can happen inbetween regular doses of pain medication ( such as for cancer patients ). Ultram can control pain but is not as effective as codine with tylenol. Ultram does have other properties that codine doe not have, this is what makes Ultram valuable. Dr. B.

Re: Breakthrough pain

wendyn on 5/19/01 at 11:12 (048278)

I had never heard of it till 3 years ago. Our friend with cancer (was in his bones/lungs/liver) was in A LOT of pain. He was on high doses of something similar to morphine, plus he had similar pills for 'breakthrough pain' - pain that was too much, and happened between the big doses.

Re: Breakthrough meds

BrianG on 5/19/01 at 18:30 (048311)

Hi Pauline,

Most people that take pain meds for chronic pain, whether it be for cancer of PF, will take a long acting opiate like Oxycontin or MS Contin. These pills are manufactured so they will release the codeine, or morphine, at a couple different times during the day. These pills are supposed to work for 12 hours a day, but frequently do not. Say you take your first pill at noon. About an hour later the outer coating of pill will wear off, releasing 50% the medicine. The rest of the pill will stay in your stomach / intestines until it releases the 2nd 50% of the medicine about 6 hours later. Now, most people in the know will tell you that a dose of codeine, or morphine will only last 3-4 hours. This gives you 1-2 hours of pain before the 2nd half of the pill kicks in. This is called breakthrough pain. If your not sleeping when this happens, you'll have a pain spike, and need a quicker acting med to get you through that 2 hour window.

If the manufactures would recommend taking the long acting pills three times a day, instead of two, there would be little need for breakthrogh meds, as you would have a constant supply of medcation in your system. At least this is the way it's been explained to me.

BCG

Re: To Brian Breakthrough meds

Pauline on 5/19/01 at 22:43 (048323)

Thanks Brian. I think doctors shy away from narcotic drugs because of government scrutiny more than addiction. I know pharmacies that won't even carry this type of drug. It would seem to me, if the doctors would prescribe to control pain, less total medication would be taken. I think the new Pain Law that went into effect might help, but I think it applies only to hospital patients, perhaps nursing homes and hospice as well.
Unfortunately I don't think homebound patients qualify. Thanks again for
your explaination.

Re: To Brian Breakthrough meds

BrianG on 5/20/01 at 12:07 (048363)

Hi Pauline,

Actually anyone in chronic pain qualifies for long acting pain meds. I am one. Some states have stricter laws than others, but it is not against the law, in any state, for a physician to prescribe long term opiates for his chronic pain patients. If your interested, I think I can find a page with the guidelines for each state. Thank god for compassionate doctors who refuse to let the DEA intimadate them. Pain meds are not for everyone, but it some cases they can literly be lifesavers.

BCG

PS You are right about the new Pain Guidelines. They were developed by the institution that accredits, hospitals, nursing homes, etc.

Re: To Brian Breakthrough meds

bg cped on 5/20/01 at 13:02 (048372)

Pain and strong medications like vic, oxycontin, etc. is a tough thing from a Doctors standpoint. They want to help, and there are many patients that need it. I used to be in an office with a pain manag/phyisiatrist. He did a wonderful job and patients loved him. A big problem is patients that are drug shoppers. Last I heard a vic tablet is worth about $4 on the street.
One thing I found odd is that every Monday morning when the receptionist would play the answering machine there would be several calls about getting script re-filled before time.

It was always, my dog ate the bottle, it fell out of my shirt pocket and went into the lake, my bf took them, my kids put them down the toilet, etc. What is even more strange it was ALWAYS the pain meds that got 'lost' never was it anti-inflam meds. Most Doctors are concerned about the patient. Most patients are honest. A Doctor needs to cover hi/her behind because obtaining prescription pain meds under false pretense is a cottage industry

The Doctor had to change script pads from a patient stealing them. My script pads have no DEA number, yet 2 times some ninny stole one out of the room, wrote a script, and tried to use it at the pharmacy.

Re: Help is available

BrianG on 5/21/01 at hrmin (048460)

You actually make some good points, and yes there will always be people who will try to divert pain meds. Does this mean the legitimate person with chronic pain must go without. I would hope not. Each state has guidelines that take all these things into consideration. Unfortunatly most doctors are concerned about covering their behinds, than of helping the patient. If a doctor follows the guidelines, there should be no trouble. It just makes me sick that people are lying at home in agony because their doctor is afraid the prescribe. Do we even want to get into how many people commit suicide because of chronic pain? I know of one such person myself. In fact we may all know of someone, it's just that the true facts hardly ever come out. My doctor told me that he had 4 hours of pain management in med school. Four measley hours!!! Pain management should be right up there with every other type of service the doctors offer. The outlaws cannot be allowed to win this battle. There are many websites available to help anyone that cannot deal with the pain anymore. I'm talking about legal, compassionate help, nothing underground. I'll be glad to point anyone in the right direction.

BCG