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Long term opiate use...

KrisKKris Posts: 12
edited 06/11/2012 - 8:30 AM in Pain Medications
My pain dr has discussed with me before about long term opiate use can cause increased sensitivity to pain (hyperalgesia). For the last 18 months I have failed at reducing my pain through PT, injections, etc. I have been Opana ER for over a year, and have taken Norco for the last two and half years. I have had to increase the Opana by 20 mg in the last year, and sometimes the Norco doesn't help me at all, but my problems with my back and feet have worsened also. Because it has been difficult for my drs to pin point the exact cause of my pain, inconclusive tests,etc., I am now tapering off the Opana because I am desperate to getting to the bottom of my pain, and don't want to "mask" something with the Opana especailly, and do question whether my pain could be exacerbated by the pain medication. I wanted to know if anyone has had decreased pain just by coming off of or decreasing opiates, especially the extended release opiates. It has only been a week since I started decreasing the Opana and my pain has doubled but don't want to give up too soon.
Thanks for any feedback


  • Why you are choosing the Opana to discontinue? I would suggest that perhaps you would want to stop the Norco since you say you do not notice it doing anything any longer.

    There is indeed, or seems to me, an increased sensitivity to pain when on narcotics. The human body seems to stop making its own pain suppresion when narcotics are taken. Some days I have noticed this effect myself. I can't say if it is in my head or not. I have felt pain increase in about 30-45 minutes after taking my Norco, then it drops off as the Norco works in about and hour. Could be all in my head! (shoulder actually)

    It is a vicous circle, I as you seem to be, have often looked for a way out. I have failed miserably on my attempts. We all have to do what we have to do. I commend you for trying this and wish you success!
  • You said that there is ongoing /increasing problems, which may actually be the cause of the increased pain that you are experiencing. Even with you going off of/lowering the dosage of the opiate pain meds, is no guarantee that you will locate the problem.
    Hyperalgesia does happen, but not nearly enough as it is touted by some doctors.
    It may simply be that your body became acclimated to the old dosage, and you needed an adjustment in meds, which is perfectly acceptable and normal when being treated for chronic or acute pain.
    The body does decrease the amount of endorphins that it produces because of taking opiates, but after you stop taking them, you are going to experience an increase in pain levels, both because of the increasing problems you are having, and secondly because the body needs some time to begin reproducing its own endorphins again. Even when it does, it may not be enough to keep your pain levels under control.
    Oh, and for the tests, there are tons of people who do not get a pinpoint of what is causing increasing pain, for what ever reasons. MRI, CT scans, are pictures of a moment in time. They do not capture all of the problems or it may be that the new problem is revealed only when you are standing or sitting, versus laying down as you are for those tests. EMG's should be done at least 1 month after onset of new symptoms, since it takes that long for them to begin showing on emg testing.
    Best of luck to you, I hope that you can find out the answers you are looking for.
  • What tests have you had for your pain? I hope that you're tapering off the Opana with your doctor's help so you'll avoid withdrawals. I agree with Sandi that hyperalgesia is a controversial issue and you should talk with your doctor about what is going on. They may have to do further testing, but unfortunately the exact cause of pain can remain elusive no matter how they look. Maybe there is a new problem going on, and I believe they will find it without you having to stop meds in fear of masking it. Take care
  • I've also wondered about this. I know, for a fact, that I feel pain more intensely now than I did years ago. For example, when I hit myself or stub a toe or something of the sort, it hurts a heck of a lot more than it should (or ever did).

    Recently, I took part in a research study on this very subject. The clinician used hot and cold sensors to measure the pain tolerance of patients on long term opiates and the tolerance of patient who aren't on LTO therapy (and compared these results with a control group). I'm interested to read about the final results when they come out.

    Like the others, I'm also worried about whether you are tapering off these meds with a doctor's help. Be careful!

    Have you ever tried anything like nortriptyline for pain? I was on it and it was tremendously helpful for the pain..as much as the opiates, in fact. I had to come off of it because of a rare side effect but if it weren't for that, I'd still be taking it. Just wanted to mention it....

  • When a CP patients body and mind are accustomed to being in pain they can become overly sensitive to things that cause s very low amount of pain. For instance if you arent paying attention and someone pokes you from behind on the back with a pencil you may jump up because to your mind it feels like youre being stabbed with a knife. I think it's mostly a mental thing. Many doctors will recommend counseling to CP patients to help them with this type of problem but I believe we will always have this problem to some extent.

    But I dont know how much it has to do with narcotic medication, what you describe sounds sort of more like tolerance to me. Longterm opiate using patients are going to gain some tolerance of the medication they use and sometimes the med's will work great at the start and then a couple months later after youve grown a tolerance to them you find yourself in more pain again.
  • I have heard that there are quacks out there that are pushing this idea and telling patients to stop their pain meds and deal with the pain so that their endorphins can kick in and take care of it. I do think this is extreme and I feel that it should be left up to patients and doctors to decide how they should address their chronic pain. There are patients that take the same dose of pain medication for years and they still get relief from it. Not everyone will require higher and higher doses.
  • Have you tried a different time release med? Opana is really not the best med out there, and in my honest opinion, it is absolute junk. If you haven't already, I would HIGHLY recommend talking with your PM doc about switching meds; time release morphine, oxycodone, fentanyl, or even methadone are all perfectly reasonable alternatives to the Opana, and I'd put my money on it that you get better pain relief. Why has your doc wasted a year and a half on Opana? If they do change your meds, make sure they don't start you on a high dose; the manufacturer of Opana would lead you to believe it is twice as strong as Oxycontin, but this is not true. (only true when both are administered via IV, which is obviously not the case). If you are taking 40mg Opana 2 or 3 times a day, then starting on 10mg oxycontin 3 times a day or 20mg twice is the highest dose, being close to equivalent. Most docs are oblivious to the topic of bioavailability and will Rx 80mg oxycontin 2-3 times per day, which is a HUGE no no. If they do change your meds just make sure they know about bioavailability of Opana; search the pain med forums for some detailed rants of mine with factual numbers and references; it's important stuff.

    I highly recommend trying a new med vs dropping your meds altogether. Although it can be very beneficial to lower your meds and get used to a bit more pain, to sort of 'reset' your pain threshold, it sounds like your pain is intense and needs controlling. Good luck in whatever you decide on!


  • I'm sorry for getting back to everyone's feedback so late. I had a crazy last week with tests/dr's appt. and feeling bad.
    To answer some questions above, my pain dr has me on a tapering schedule, which I am now on 10mg in am and 10mg in pm (I was on 20mg am and pm). If I don't take Norco every 6 hrs my pain is worse most days, but I have had a couple of days that it is tolerable, but these are the days I don't leave the house,do housework,etc. I expressed concern about Opana because it is hydromorphone, but I also have read that it is not all that is marketed to be. I requested to come off because my pain has not changed that much since being on it. I didn't know if this contributed to the Norco not working at all somedays, or not that well, because it use to. I was also concerned about being on the opiates because when I have had steroid injections before last year,2007, (when I was on Tramadol), I did well with the sedation they gave me, but last year when I got it, it didn't work AT ALL (example,I didn't remember much of the procedure in 2007 from the Versed, but last year I barely noticed that I received any sedation and remembered everything), so I wondered if this has to do with the meds.

    In regards to changing medication, they have suggested before Avinza and methadone. I have tried Fentanyl but the patch caused a rash so I stopped it. I have tolerated ER Tramadol before my pain in my feet/back/hip increased last year and then was put on Opana. My doctor will ABSOLUTELY will not prescribe Oycontin stating that they had problems with previous patients taking it. They really pushed the Opana/Avinza, they say they are better for you.
    I have also have tried Neurontin, Topamax, Cymbalta, Lyrica and just recently was on Zonegran (I'm off Zonegran right now). I only had relief from Zonegran, and also didn't have the side effects like the others for me. I stopped it while in PT to see if the nerve pain in my calf/feet would improve just from the PT, which it didn't.
    My history is a T-12-L2 fusion 15 years ago (car accident), and then I had a work injury resulting in a L5-S1 annular tear. My MRI's show buldges at L4-S1 (small), hip bursitis/arthritis, and degernative disc/facet disease. My pain is in my lower back, SI, hip, (right greater than left), radiating leg pain (both but R>L), heel/foot and ankle pain.My fusion is stable and I have never had problems with my back until the annular tear. Starting 12/07 I started having debilitaing foot/heel/ankle pain, and it has not gotten any better after all the conservative treatments performed (I mean everything). So for the last year they have been questioning if the pain in my feet is correlated to my back. I have had a positive discogram for L4-S1 but the CT was negative, a negative MRI except for the small buldges, and just had my 2nd myelogram last week which is negative(except for DDD). I did have a positive EMG for tarsal tunnel syndrome and radiculopathy. So the ortho surg. I saw this morning who is my third opinion, said that my foot pain is not related to my back, that it is a seperate issue, and that there is nothing from a surgical point going on in my back to help the pain. My pain dr/and one of the other ortho surg. said that my pain is coming from the discs, but this this morning said that it could but removing the discs would not help me??? So I am now going to a ortho surg. specializing in foot/ankle problems to get a second opinion (I am seeing a podiatrist right now). I do hope that if someone can help my feet problems, I would not walk with a limp,etc. and that my back pain would at least get better.
    Sorry for the long explaination but what has been going on is so complicated and getting very frustrating.
  • Danimal,
    Please update on how your trial was. I am interested in hearing about how that went. I have not tried Nortriptyline, however, I am concerned about taking it because of the side effects,etc. with MAOI's. It may be something to consider although, especially hearing that it worked so well for you.
    Thanks for your feedback.
  • ive never ever heard of anyone decreasing pain by getting off pain killers. usually its the opposite pain killers decrease the pain, hence the name pain killers. good luck.
  • I agree with the other posters who are thinking this is most likely a tolerance issue as opposed to hyperalgesia. Also, good for you for being so proactive with your healthcare. Getting a second opinion from a doctor whos speciality is foot/ankle problems is a step in the right direction. (no pun intended)Good luck,and keep us updated.

    Take Care
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