Need pain med advice. GP Doc finally put me on Percocet -- which is way too weak to do much good. Have bone mets for almost 2 years from femurs to neck, and sometimes excruciating pain. Starting Hospice soon as my MO discharged me. (Have Braca 2 gene, and last med -- Lynparza -- lost its effectiveness. ) What is recommended, after quitting most all meds except a couple for my heart? Denosumab (Prolia)? Alendronate (Fosamax)? Tanezumab? Straight oxycodone? ...
Thanks for your suggestions. Bob Graham, Tallahassee, FL
PS "Bobby has no arms. " Knock , knock. Who's there?? NOT Bobby!
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bloodyveinpoke
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Well of course it’s only anecdotal, since it’s just his case, but I have to disagree at least for him. He’s pretty much been on the same dose for years. If what you said was true, he would be needing more and more and more to relieve the same pain.I get that you are anti-opioids. But some people actually need them. And as I am familiar with the signs of addiction, I can safely say he is not addicted. But again, I speak only for his case. Not trying to impose my ideas on other people.
Humans have such a wide range of response to all medications and treatments, anything could be possible.
But it would be quite unexpected for someone not to acclimate to long term medication by opioid.
The only way to tell with an individual patient is to rotate different pain relievers for periods of time.
I recollect there were some recent studies that found that some non-addictive pain killers were materially more effective than opioids, at least for long term chronic pain.
Yes. CBD oil from commercial hemp really helps MY pain, then helps anxiety, and then greatly helps sleep. 100-200mg per day.THC lozenges helps MY head pain.
Search this site with your specific judgement of cause.
Hospice will be able to sort it out. You may want to do palliative radium 223 (Xofigo). At your stage I would not worry about “addiction”. Will you get tolerant to opiates? Yes but who cares? There is no ceiling dose for opiates. I would also talk about a long acting opiates like an extended release morphine or fentanyl patches. Opiates are good for bone pain but not so much for nerve pain. Steroids can help also. Good luck but be your own advocate. You should be comfortable especially on hospice.
You sound like you have much more experience than I do.
But the traditional path to addiction has been
1. being given an option prescription for pain
2. The doc declining to renew at some point because you aren't in hospice and they risk their license by not bringing it to an end at some point.
3. The patient then desperately seeks opioids out from sources that don't require a prescription.
I am certain that opioids are a complex subject. But my understanding is that what I said is the modern conservative approach to opioid use. And after so so so many deaths has been gaining acceptance.
My understanding is that after a few weeks you need it to return to the prior pain levels.
If the opioids are maintaining your husband with 0 pain you are right. If he is still in pain while taking opioids, then you don't know which of us is right without referring to clinical trials.
Being heavily sedated by opioids isn't pain relief.
Docs are coming under increasing pressure to withold renewals of opioid prescriptions. Not such a wise thing to become dependant on it.
Personally, I am not going to touch it until I am in hospice, and I know they won't pull it.
In any case, opioids are something to be treated with care and circumspection.
By the way, I recollect reading about some recent studies that have shown that some non-addictive pain killers work more effectively than opioids when you are measuring pain over longer time periods.
"The medical profession has become gun-shy about prescribing opioid pain medication, to the detriment of people who need pain management for chronic & terminal illness. "
Yes, that is a problem. Exacerbated by Purdue Pharma's bad-boy behavior.
"who are incurable and thus "terminal."
If you are talking about hospice. that is one thing. 5 -10 years on opioids is another.
As I said earlier, in controlled trials, many people who get addicted to opioids want and need it for many years. They suffer great pain when it is withdrawn. That can give the impression that it has been removing pain, even if the opioid is the cause of the pain. The only way to tell is clinical trials. Anecdotal experience can't. How can it?
There are safer pain killers than opioids. But not any near as addictive.
The evidence you discuss is as consistent with (a) your conjecture, as it is with (b) mine.
I submit that your proselytizing of opiates is statistically way way way more dangerous than what I am saying ("exercise great care, it can sneak up on you and do a lot of damage").
And the medical profession over the last 20 years has been proven, by all objective standards, to have overprescribed opiates. The reason why it has is too complicated for texting back and forth here..... but:
"Purdue Pharma pleads guilty, will pay billions for role in opioid epidemic"
"The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy"
"In 2017 HHS declared a public health emergency and announced a 5-Point Strategy To Combat the Opioid Crisis"
"From 1999–2018, almost 450,000 people died from an overdose involving any opioid, including prescription and illicit opioids.1" (most of these addicts started with lawful opioid prescriptions)
No one has been criminally indicted for urging caution with opioids.
But a number of people have actually been criminally indicted for over-promoting it.
You can just do any of the searches above to learn more.
The other alternative is that you may be in error, and if that is so, you possibly accept the consequences of that error.
Opioids are dangerous and should be used with caution.
We have a 20 year documented history of the destruction and damage done by over prescription of opioids.
Facts are facts.
Sorry
+++++++++++++++++
"Purdue Pharma pleads guilty, will pay billions for role in opioid epidemic"
"The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy"
"In 2017 HHS declared a public health emergency and announced a 5-Point Strategy To Combat the Opioid Crisis"
"From 1999–2018, almost 450,000 people died from an overdose involving any opioid, including prescription and illicit opioids.1" (most of these addicts started with lawful opioid prescriptions)
"Doc finally put me on Percocet -- which is way too weak"
I just provided facts that loading up on heavier opioids may be going down a dangerous path unless you are in hospice. Maybe even then the choice of opioids vs other pain relievers is a dead-end road.
Percocet is Oxycodone, a commonly abused opioid.
I think anyone thinking about opioid pain control needs to get some second opinions. They are dangerous. To the extent that they can sensitize one to pain, they could even be dangerous in Hospice.
This was well within the topic of the post.
The KGB (now FSB) would administer a 2-week course of opioids as a pain sensitizing agent for pain receptors prior to administering platypus venom to torture people. The platypus venom wouldn't kill, it would just generate huge levels of pain.
I will address your off-topic ad hominem attack on me in private messaging. Where you should have placed it in the first place.
Thank you
There are doctors who specialize in pain management. You should ask your Medical Oncologist or Radiation Oncologist for a referral.I'm sure they know some in that area of medicine.
Sorry to hear of your situation.
I'll keep you in my prayers.
Good luck.
I’m caregiver for a man with stage four highly metastasized prostate cancer. He’s had horrible pain from the beginning. The only thing that has kept it in check is a fentanyl patch with oxycodone for breakthrough pain. Yes, opioids were overused and handed out like Chiclets in the past. But the pendulum has swung so far to the other side that people who really need opioids struggle to get them. It’s a constant struggle to keep his pain at bay and he lives in terror that his doctors, scared of the new opioid police, will pull his meds. I’m just not that concerned with people getting addicted if it gives them a better quality of life. Thanks to his meds he’s been able to travel some and see his family. (Pre pandemic) None of that would’ve been possible without opioids. He uses a pain clinic through his hospital.
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