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Best Short acting narcotics?

JEMJJEM Posts: 32
edited 06/11/2012 - 8:24 AM in Pain Medications
I currently take Oxycontin, with Oxycodone for BT. My doctor is getting cold feet lately. She upped my Oxycontin (60mg, 3x day), but took away my BT meds. It's not working on my pain.

I'm starting to think that Oxycontin isn't for me, and I'd like to take just short acting meds instead. The immediate relief works better for me. I don't mind taking meds every four hours either. I don't know how to present this to my doctor. What dosages could she prescribe for me so it doesn't add up to too many pills, and is Oxycodone the best short acting med?

Any and all advice is appreciated. Thank you.
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Comments

  • JEM,

    Sorry that you are having a hard time getting good pain control from the Oxycontin. How long has it been since you sat down and discussed with your doc how your meds are or are not working and in what fashion? Are you tracking the effectiveness in a timeline each day? I found that by tracking my pain levels vs the times and effectiveness of my pain meds and presenting that information to the doc, helped him better tailor a pain management schedule for me.

    It's quite a delicate balance sometimes, between the half-life of the drug, the rate your body metabolizes and other drugs you may be taking at the same time. Medicating someone isn't an exact science, but the more data a doctor has to go from, the more accuracy they can achieve for you.

    My doctor had me taking several different narcotic pain medications until he was able to figure out what worked best for my body. Once that was figured out, I had better pain control. It took a concerted effort between myself and the doc in order to get everything figured out though.

    "C"
  • :) i am not sure how you would approach this to a doctor. it is not the preferred way to take medication. there are no short acting meds that you would only take 3 of a day. since you need them every 4 to 6 hours you would need 6 a day at the least. short acting meds really aren't made for long time use as your primary souce of medication. perhaps another long term medication would be better. maybe you need to give the new dosage a chance. following the doctors plan for awhile might be your best bet. if it really doesn't work for you, be honest! tell your doctor what you told us. good luck and i hope you have the pain treatment you need soon. Jenny :)
  • Thank you for the replies, C and Jenny. I saw my doctor last week, and told her that using only Oxycontin, even at 60 mg, 3x day just wasn't cutting my pain. My neck pain is out of this world. The Fibro pain, I can handle, and the Lyrica is helping with that, but the neck/upper back spasms are awful. She told me that she's not comfortable going beyond 180 mg a day.

    Before this change, I was taking 40mg, 3xday, but I had BT meds. I had six, 5 mg Oxycodone. The Oxycontin just isn't working. Due to insurance, I tried Methadone earlier this year. It helped with my pain, but made me feel weird. Finally, my insurance company covered the Oxycontin.

    I seem to be one of those people who responds better to short acting meds. My doctor isn't too flexible, and always seems one step away from cutting me down. When she increased the Oxycontin, she took away the BT, so that was no help. I told her that just three BT a day would work with the 60mg Oxycontin, but she didn't want to hear it.

    I'm trying to think of a way to stay within her 160 mg comfort level. I just don't know. This is all so tiring. Trying to make my case, and all I want is pain relief.
  • it may be that the doc would rather have you on the long acting meds because they do less harm to your organs than the short acting meds. I am on methadone and am on percocet for bt pain but my doc has told me that he would rather up my methadone than increase my percocet because of the fact that it is safer for my body. I think that docs would like to keep you on the safest meds especially if you are looking at taking them long term. have you tried morphine? The methadone made me feel weird at first but now I feel perfectly normal just with less pain. Good luck finding a solution.
  • painintheback said:
    it may be that the doc would rather have you on the long acting meds because they do less harm to your organs than the short acting meds. I am on methadone and am on percocet for bt pain but my doc has told me that he would rather up my methadone than increase my percocet because of the fact that it is safer for my body. I think that docs would like to keep you on the safest meds especially if you are looking at taking them long term. have you tried morphine? The methadone made me feel weird at first but now I feel perfectly normal just with less pain. Good luck finding a solution.
    That's probably what it is. Have you ever tried Oxycontin? I ask because I'm wondering what worked better for you, the Oxy or the Methadone? I should know better, but Methadone scares me. Morphine made me sick, and I had to stop on fourth day. I would really appreciate to hear of your experience with Methadone.
  • I totally know where you're coming from. I've been taking MS contin 30mg twice a day and I told my Dr. I'm taking one percocet at night from leftover pills I've had and she seemed fine with it. She also said she wouldn't increase my meds. My pain clinic Dr. thinks he can get me off the narcotics with the pain and epidural shots. I doubt it. I think I need surgery. Although the leg pain is dissapating, my back pain is still bad. When I see my ortho second opinion in January perhaps he will recommend surgery. I need to go back to work as they can only hold my job for so long. Long term meds is what the Drs like to use as it's less habit forming. But I understand what you mean. Sometimes BTP meds are needed. Hope you find some relief. I may mention the fentanyl patch next time too. Sorry to talk about me so much it just brought up questions I'm wondering too. Take care Charry
    DDD of lumbar spine with sciatica to left hip,leg and foot. L4-L5 posterior disc bulge with prominent facets, L5-S1 prominent facets with a posterior osteocartilaginous bar. Mild bilateral foraminal narrowing c-spine c4-c7 RN
  • You cannot ask or force a doctor to prescribe past a point where they are comfortable. I respect your doc for telling you that she has reached her comfort level. Shows that she cares enough to do what she could until she reached that point.

    The thing to keep in mind though, is that if the 60mg of Oxycontin three times a day is not controlling your pain, then throwing a few mg of BT meds in there isn't going to do much and if it does, then not for long.

    "C"
  • charry said:
    I totally know where you're coming from. I've been taking MS contin 30mg twice a day and I told my Dr. I'm taking one percocet at night from leftover pills I've had and she seemed fine with it. She also said she wouldn't increase my meds. My pain clinic Dr. thinks he can get me off the narcotics with the pain and epidural shots. I doubt it. I think I need surgery. Although the leg pain is dissapating, my back pain is still bad. When I see my ortho second opinion in January perhaps he will recommend surgery. I need to go back to work as they can only hold my job for so long. Long term meds is what the Drs like to use as it's less habit forming. But I understand what you mean. Sometimes BTP meds are needed. Hope you find some relief. I may mention the fentanyl patch next time too. Sorry to talk about me so much it just brought up questions I'm wondering too. Take care Charry
    I'm glad you understand, and don't worry about talking about your experiences. That's how we learn, from each other. You're right. There are many times when BT pains are needed. In fact, on my insurance website, it's posted that's how opiate therapy works, a long-acting med, and if necessary a BT med. I read about BT meds everywhere. Good luck with your back pain. :)))
  • To me, I just see this: your doctor took away 30mg's of immediate release oxycodone per day, and gave you 60mg's more, which should VERY adequately compensate for not having the BT meds. If you took one every 4 hours as prescribed, then you are actually getting MORE of the medicine now. Just being totally honest, I think you are bordering getting labeled as an abuser/addict by your doc, just because of your request. You got TWICE the breakthrough meds, and are asking for more; I know where you are coming from, and if your motivations are valid then I'm sorry it's so hard for you, but there ARE many people in your situation who have been upped from 40 to 60mgs, 2 or 3 a day, and they DO get a high from it even if taken 'usually' as prescribed, and DO get a high from the BT meds, and doctors know this. Some people save up 3 days of BT meds and take them all in one day, or abuse them in other ways. Ultimately if you go from 180mg a day to 30mgs (breakthrough only) you are going to be VERY, very, unhappy. You are at a dosage right now that is reserved for BAD pain, and will definitely bring on withdrawals if your doc makes that change.

    You are more likely to get a change back to 40mgs 3/daily, and bring back the breakthrough. However, if you ask for that, again it just shows that you prefer the fast release oxy, over the higer milligrams of constant relief, and doesn't look good.

    I'm gonna suggest you ask the doctor to supply you with their medicine of choice for breakthrough, if they are uncomfortable with Rx'ing the oxycodone, I think it's the only way. Would you be fine with your current Oxycontin and say, 6 Norco/Vicodin per day? What kind of doctor are you seeing?
  • It sounds to me like what you have said-either your pain is worse,or your tolerant to your meds now.I hope that you can find some relief from your pain.

    I've never taken Oxycontin or Oxycodone,but it seems as though if the dosage were raised and it is not helping that perhaps you became tolerant to the BT medications.

    Lately I've been reading a lot about pain getting worse-and my pain is substantially worse.The chill in the air makes me tighten up and in turn causes more muscle spasms/headaches/stiff neck.I take 10mg lortab 4x's a day(every 6 hrs)and let me tell you~it's not enough lately.I almost regret telling my Dr that I didn't ever want to go higher,but I really don't.He has never mentioned long acting medication to me and I worry about the tylenol in my lortab.As it is I'm getting 2000mg a day because they are 10/500,and I've been on the lortab for over a year.Even at 5/500,and 7.5/500-still the same amount of tylenol-which I know helps with my pain.

    I've never brought up long term meds with him either,and it's my responsibility to do so if I'm concerned.I suppose I'm resistant to change.

    Anyway~Just thought I'd share my 2 cents.I do hope that you find relief from your pain.It gets tiring I know.
  • JWM said:
    To me, I just see this: your doctor took away 30mg's of immediate release oxycodone per day, and gave you 60mg's more, which should VERY adequately compensate for not having the BT meds. If you took one every 4 hours as prescribed, then you are actually getting MORE of the medicine now. Just being totally honest, I think you are bordering getting labeled as an abuser/addict by your doc, just because of your request. You got TWICE the breakthrough meds, and are asking for more; I know where you are coming from, and if your motivations are valid then I'm sorry it's so hard for you, but there ARE many people in your situation who have been upped from 40 to 60mgs, 2 or 3 a day, and they DO get a high from it even if taken 'usually' as prescribed, and DO get a high from the BT meds, and doctors know this. Some people save up 3 days of BT meds and take them all in one day, or abuse them in other ways. Ultimately if you go from 180mg a day to 30mgs (breakthrough only) you are going to be VERY, very, unhappy. You are at a dosage right now that is reserved for BAD pain, and will definitely bring on withdrawals if your doc makes that change.

    You are more likely to get a change back to 40mgs 3/daily, and bring back the breakthrough. However, if you ask for that, again it just shows that you prefer the fast release oxy, over the higer milligrams of constant relief, and doesn't look good.

    I'm gonna suggest you ask the doctor to supply you with their medicine of choice for breakthrough, if they are uncomfortable with Rx'ing the oxycodone, I think it's the only way. Would you be fine with your current Oxycontin and say, 6 Norco/Vicodin per day? What kind of doctor are you seeing?
    I didn't get TWICE the amount of BT meds. I got the BT meds taken away. There is a world of difference between long and short acting narcotics, and I'm learning that the hard way. The long acting ones alone don't work for me. Everyone's pain is unique to them, so unless you manage to spend a day with me, please don't tell me what "should VERY adequately compensate for not having the BT meds". I'm saying it's not, so it's not.

    I'm suffering. I was suffering before the change in meds. At least before, when I was having neck/upper back spasms that send me to hell and back, I could take the BT to somewhat take the edge off the pain, immediately (not get high). If my motives are valid? I'm 50 years old, don't drink, smoke and I didn't take my first narcotic until I was 49. I have no substance abuse issues.

    My doctor doesn't give BT with that amount of Oxycontin (180 mg). She told me to think about it, and I can go back to my other regime (120 mg Oxy, 30 mg BT). She's not labeling me as anything. She wouldn't give me an aspirin if she didn't trust me. When I was taking Methadone, she gave me BT meds and said she would again. She's my PCP and has been for 13 years. When I spoke with her last week, she told me that she would refer me to anywhere I want to go, any Pain Clinic. Said she'll go along with whatever a specialist suggests. I live in Boston, so good hospitals and doctors are not hard to find.

    My doctor told me that she doesn't have a high level of training in pain management. This is when she refers to her comfort level. I think her comfort level was reached a while ago, but she believes me, feels bad for me. She's even told me that she has to "be careful". We've discussed the issue of the DEA's "War on Pain." It bothers her. She's told me that most any doctor can be fooled by a patient, then went on and gave examples of red flags. She's not suspicious of me because I give her no reason to be. She believes me when I tell her that having no BT meds is making it so I can barely get out of bed. She believes me because she just arranged to have a shower chair and a cane delivered to my home. She knows I'm using meals-on-wheels. Speaking of wheels, we recently discussed a wheelchair for me, but my Fibro is fortunately being managed by Lyrica, so hopefully that continues and a wheelchair won't be necessary. Two weeks ago, I was holding onto the walls to walk. She listens when I tell her that in addition to the blinding, mind-numbing neck/upper back spasms, there are times when I can't lift my head off the pillow because it LITERALLY feels like my head is going to fall off. Like it's going to fall off.

    I know MANY people DO save up drugs, but I DON'T. I know some people DO get high from BT meds, but I DON'T. I thought this site was for people helping others, and to believe each other, unless given reason to think otherwise. Even my doctor believes me.

    I'm simply looking for some ideas here. I'm still sort of new to the narcotic world. I'm not a doctor or a pharmacist, so I didn't know that stopping the Oxy and taking pills for immediate relief was a big deal. That's how I used to take it, before my doctor suggested the Oxy. When you have nothing to hide, you speak freely and assume what you say will be taken at face value. I do know that taking an ER with BT is normal. My doctor isn't comfortable prescribing it (at this dose), but will be okay if a PM does. She knows I'm the real deal, with BAD pain.
  • It sounds like your pain management has gotten to the point where as your PCP has said, it's beyond her comfort zone, and you might want to seriously consider taking her up on the offer to refer you to a Pain Clinic.

    If you are that miserable, then are you possibly doing a disservice to yourself and to your PCP by trying to get her to continue to handle it?

    I understand completely what it is like to have a long term relationship with a doctor, one who you trust and one who you know trusts you. It is difficult to take that leap of faith and strike out into new territory. I am so glad that I did when it came to pain management, otherwise I wouldn't be able to sit here and read posts or write posts, let alone have any kind of life.

    Are you being fair to yourself? Are you being fair to your PCP?

    "C"
  • First off - it hurts my heart to hear about your situation - expecially the "being new" part. If you're anything like I was, you want to be taken seriously, you want your pain to stop, and you don't want to come across as a drug addict.

    Each and every one of us here can sympathize, certainly empathize with you because we have all 'been there, done that'.

    After being dismissed by one doctor (a rheumatologist who was treating me for connective tissue disease) because he thought it was my auto-immune disorder and my weight that was causing the pain, and so refused to do anything, basically, I did find a doctor who took the initiative and ordered MRIs - I was hoping to rule out anything more than I was trying to prove I had problems (silly me!).

    Once we realized my pain control was out of his hands, he referred me to Pain Management. What a life saving experience that has turned out to be! After some initial trials (medication, epidural shots, surgery, more epidurals, radio-frequency lesioning, more epidurals, more medication - you get the picture) we have finally settled on a combination of long-acting and short-acting medication. My biggest problem was actually feeling like I was "doing something" when it came to pain control. If I hurt, I took something. Whether it be pain meds or Advil - the act of hand to mouth made me feel as though I was being proactive in my pain control. Once I finally made myself understand it needn't be that way I was able to take the long acting 3 times a day, with maybe 3 (sometimes 4)breakthrough meds in a day's time. My pain levels will never be a 1 or 2 again, but I am learning to make do with the plan I am on currently. I'm thinking I will settle for the pain level of about 4-5 on a good day to 7-8 during my busy periods when I have no choice but to overdo. It's better than where I was about 2 years ago. So, I'm thinking this will have to satisfy me.

    My wish for you is that you can find some level of relief to where it's not the only thing you think about. Having physical problems are bad enough, but to add the Fibro in to the mix - good grief! At least your doctor believes in you and is willing to refer you to someone who can take your pain management to a whole new level.

    Good Luck, hon. Keep us posted. Okay?

    Jeaux
  • No oxycontin did not work for myself either.
    I agree with some postings. At first reading all the posts I thought you were already in pain managment. As it far few and between around here that a pcp would even RX a long acting medication.

    I was on methadone. I felt weird at first to But after a few weeks it was a life saver and cheaper then any other medication.

    The patch also helped.

    I'm on my way back to find a pain managment dr or suck it up and go back to my old one. His dept refuses to give BT meds. Just their policy.

    I feel your pain I live it everyday.
    What other treatments have you tried??? As in injections etc.
    Stenosis depending on the degree can be very painful for alot of people. Surgery is usually a huge option (in my ortho's office anyway) Are you under the care of a neurosurgeon or orthopedic surgeon at the time???
    Has surgery ever been a option for your neck issues.
    Just curious.
    As I know surgery is a last resort and not a option for alot of people due to the degree of their injury.

    Hang in there. I would defintly get in a pain managment clinic. And go from there.

    Pcp's are really out of their comfort zone RXing meds for a long period of time. The DEA checks them out all the time.

    GOOD LUCK in your journey to finding the right treatment.
    Terri ;) O:)
  • Sorry, in my long post I left out a little detail. I know you weren't given twice the breakthrough meds, you were given twice the MILLIGRAMS per day(60) of your BT meds (30), which as I described, averaged out to something that should really have controlled your pain. You no longer had BT meds, but as I described, if you took 5mg every 4 hours, then the 10mg(extra from changing to 60s) every 4 hours being delivered by your stronger dose should have, (in the perfect world theory) covered your pain. *shrug* Yep, rules about how things should work with pain meds don't always apply.

    I pretty much only asked you two questions: are you willing to let her decide which breakthrough med you take, instead of sticking to oxycodone? And; what kind of doctor is she?

    You gave some decent detail about her experience, which tells us she very likely does not have any specialty or subspecialty certification in pain management. Actually, you said she's not a PM doc I believe. That's good to know, and I think you're getting TONS of meds from a internist/PCP or whatever she is, and I personally think you'd be VERY happy if you transfer your pain care over to a PM doc. Just call around, and make sure to find one (ask!) that is not anti-opiates; the aids, nurses, etc that answer the phones, as I found, are almost always willing to very specifically answer those questions. You don't want to go to a PM and be suddenly taken off of Oxycontin and put through physical therapy and myriad other alternate methods before being given a choice.

    As for the breakthrough meds, and this is just my opinion, I really think you might find pain relief by using the 40 or 60mg oxycontin, but with something other than oxycodone for the breakthrough. There are arguments for either way, but it's absolutely worth trying.

    Lastly, I wasn't trying to be rude or label you as an abuser, I never said you were. I assumed your Dr. was a regular-ish doc, and that at your doses, I honestly think she might question your use. I believe you, which is why I asked you questions. I never said you abused. My replies are only in your best interest and I am trying to help; I'm sorry if you read it differently.

    Good luck, and go to a PM doc!

    JWM
  • JWM said:
    Lastly, I wasn't trying to be rude or label you as an abuser, I never said you were. I assumed your Dr. was a regular-ish doc, and that at your doses, I honestly think she might question your use. I believe you, which is why I asked you questions. I never said you abused. My replies are only in your best interest and I am trying to help; I'm sorry if you read it differently.

    Good luck, and go to a PM doc!

    JWM
    What bothered me was, "If your motivations are valid..." I'm of the mindset that we're all telling the truth here. I know I am. I get enough of the raised eyebrow bs with specialists who meet me for the first time. Last week, I saw a new doc for a routine eye exam, and he commented when he looked at my meds which I was asked to list on the form. I know these specialists walk on water and all, but something tells me that half of them would jump out the window after living in my body for a week. It's so hard out there. I didn't ask for this nightmare, but I sure got it.

    The Oxy isn't cutting it. When I'm having a bad neck flare (3 to 4 times a day), and I have nothing to reach for, it's a terrible feeling. If we're adding MGs, I got an increase of 30 mg. Keep in mind that I was in excruciating pain before the increase, so that's not a whopping amount. As I stated, there's a huge difference between ER and BT meds. I can't go without either one. It's common practice to give BT with ER. I do understand my doctor, but I don't want to find myself sitting across from a narcotic drill sergeant.

    Thanks for replying. We're good. Life's too short, and painful, lol.

    Jem
  • TerriJV said:
    Pcp's are really out of their comfort zone RXing meds for a long period of time. The DEA checks them out all the time.

    GOOD LUCK in your journey to finding the right treatment.
    Terri ;) O:)
    We really have a lot in common, with our experiences with Oxy and Methadone. I answered your questions in another reply. Thank you for your kind reply and concern, Terri. And good luck to you too!

    Jem :)
  • for me the primary care physician, and my surgeon, were the narcotic drill sergeants and the Pain Management doc has been my life-saver.. It'll take you a while to get into a pain clinic, but let us know how it goes when you do. Cheers
  • jeauxbert said:
    First off - it hurts my heart to hear about your situation - expecially the "being new" part. If you're anything like I was, you want to be taken seriously, you want your pain to stop, and you don't want to come across as a drug addict. Jeaux
    Thank you for your kind words. Unfortunately, there are some people who love to point fingers. It's very sad when a person is dealing with debilitating pain, only to be accused of drug abuse. If the day ever comes when I can never take another pain pill, it will be one of the best days of my life.
  • Robin said:
    It sounds to me like what you have said-either your pain is worse,or your tolerant to your meds now.I hope that you can find some relief from your pain.

    I've never taken Oxycontin or Oxycodone,but it seems as though if the dosage were raised and it is not helping that perhaps you became tolerant to the BT medications.

    Lately I've been reading a lot about pain getting worse-and my pain is substantially worse.The chill in the air makes me tighten up and in turn causes more muscle spasms/headaches/stiff neck.I take 10mg lortab 4x's a day(every 6 hrs)and let me tell you~it's not enough lately.I almost regret telling my Dr that I didn't ever want to go higher,but I really don't.He has never mentioned long acting medication to me and I worry about the tylenol in my lortab.As it is I'm getting 2000mg a day because they are 10/500,and I've been on the lortab for over a year.Even at 5/500,and 7.5/500-still the same amount of tylenol-which I know helps with my pain.

    I've never brought up long term meds with him either,and it's my responsibility to do so if I'm concerned.I suppose I'm resistant to change.

    Anyway~Just thought I'd share my 2 cents.I do hope that you find relief from your pain.It gets tiring I know.
    I'm resistant to change myself. I still can't believe I'm in this "new world" of meds. I never thought I'd find myself here. I lived so clean. I'm 50 years old. I quit smoking in my 20s, never cared for alcohol, even gave up the sun worshipping in my early 30s (didn't want wrinkles, lol). All that for what, to get sick at 49, and heading for being bedridden if things don't change.

    I know you're hesitant, but perhaps a small dosage of a long-lasting med might help you, or a small increase in your lortab. It's something to consider. You want to be comfortable. Good luck with whatever you decide.
  • My heart goes out to you. I too am living in the 24/7 pain world. I understand completely what you are saying. I am currently on oxycontin er and percocet for BT pain. I don't know what I would do without the BT meds. Just a thought and my all means I have no medical background just alot of pain. I don't know if your body is tolerant to the oxycontin or if taking the BT meds would help. But perhaps your dr. would be comfortable giving you 40mgs oxy 3 x a day and 10/325 percocet 4 times a day. That would be you at her comfort level and perhaps help.
    I currently take 40mg ext release oxy two times a day and 10/325 percocet 4-5 times a day. My dr is very comfortable with this. Can I say my pain levels are good, well not really but I also know I will not be pain free just hopefully enough to take the edge off. Also, just wondered as I have an appt. in two weeks, have they considered a pain pump. I am very scared and leary about this but will of course listen to what they have to say. I know I have to be pro-active in my own pain relief. I am 49 also and would love to have a better quality of life. It is very frustrating when we have documented test and test proving our disabilities yet everyone is treated as though we have the potential of being drug seekers. However, I understand dr.'s have to be strict as there are so many who have made it bad for the truly disabled people in pain. It just seems that no one should have to live like with all the technology around.
    I wish you the best of luck and hopefully you and your doctor can get our pain somewhat controlled in the very near future.
    Jan
  • JEM,
    It is counter productive to give patients increasing levels of medication pertinent to individual expectations and improvements they think they will have, it must come a balancing point where the benefits of volume medication make us feel worse overall. Many here have gone to the max, only to discover that this is just existing rather than living and reduced the volume as a consequence.

    PM management is not just about medication in isolation, so no amount will provided satisfactory quality of life and manage the pain simultaneously. C is correct in saying that medication attempts to manage those peaks and if we can get a smoother existence then we may have reached our optimum strategy. Many here live with daily pain that is unreasonable in the knowledge that this is preferable to those periodic spikes of pain that are intolerable. I always have some sympathy with those who have pain that is not managed effectively and although we expect satisfactory outcomes it is rare that this is achieved over the long term.

    Sustainable PM is less about medication and more about thoughts, feelings and emotions, what ratio these are in the whole scheme is harder to determine and it is suggested that a multifaceted approach is more effective in managing pain than only one entity. We all have to work within known parameters; any deviation from those norms infers us as the problem, rather than the pain itself.

    It is questionable if any genuine patients is being tainted from the provision of medication for alternative motives and most practitioners are aware of that distinction between both groups and treat them as individuals. Even with medication I live with pain every day, if we perceive that all our pain or even the majority at times can be eased, that in itself is an expectation that is rarely achievable, irrespective of its noble aspiration.

    The best is to find what works for you as an individual, even after 20 years that continues to be my objective, our daily pain as for everyone is not easy.

    Take care.

    John




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