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? about chronic pain meds

felicidadffelicidad Posts: 2
edited 06/11/2012 - 8:41 AM in Pain Medications
Hello fellow pain sufferers--Sorry so this is so long! I welcome all & any comments/advice :) I exploring my options before discussing a med change with my doctor in 2 days. My pcp & I agree that I need opiate type medication to manage my pain at this time--that is not in debate. Can anyone help the following info?

1) Are there any other schedule III narcotic type medications (besides tramadol) that can be used long-term that do not have tylenol/NSAID's in them? and 2) What are some of the NSAID/opiate drugs that could be used for chronic pain, & are they available in extended release form and appropriate for long-term (1-2 yrs) use? *I most likely will need to go on schedule II drug in the near future, but would like to postpone it if at all possible--most of all, I want to be able to travel internationally for more than 30 days at a time., so for that reason I would like to avoid schedule II drugs if possible FOR NOW.

*see below for quick background* Lack of $, job and insurance is a big factor in mine & my doctors decision making. For that reason I've been taking methadone for the past 3 weeks now . . . no side effects, but no pain relief either (due to extra low dose no doubt). He started me on 5 mg/24 hr, then last 10 days 5 mg/2 x day. I understand the caution and slow titration. I'm also taking voltaren 150-200mg /day, which used to help, although not sure anymore my doctor wants me to continue with it for now. I've since read up more on methadone and while I feel it may help and be an excellent choice for me long term, I don't want the ball & chain that comes with it right now (having to have hard copy script every 30 days, mostly) because I want to travel during the next few years, before my mobility becomes more of an issue. I just hope I'm not asking for terrible physical withdrawl even though its only been 3 weeks of a low dose. Does anyone know if I'd have trouble making a switch? Maybe dropping the voltaren and taking something like vicoprofen (extended release if there is one?) I'm not trying to obtain huge pain relief, only enough to be semi-productive, which is hard to do without any meds.

Quick background: chronic pain for many years (spinal injury/lots of degeneration/bone spurs/stenosis,ect...now dealing with thoracic outlet syndrome as well). Only in the last year have I decided to try managing pain with daily meds to help improve my (and in turn, my husband's) quality of life. Pain can get quite bad at times, but it's the losing battle of not being able to perform ADL's & get around that is most devestating. When I'm in a bad flare, it's a real challange to even get out of bed, much less shower and do basic chores without medication. I would also like to return to work--I'm currently trying to find something that won't cause more flares. **In reality, I've been in complete denial of my physical condition for years now and somehow thought through PT and other therapies that I may be able to reabilitate myself (even though my doc said otherwise)**For this reason, I'm only now considering daily opoids for chronic pain management.

Of course, my first choice of tx would be PT, massage & accupunture instead of drugs, but I cannot afford it, am unemployed & don't have insurance. I know accupuncture helps me because I did it while I could afford to. I used to be totally opposed to taking medication . . . Fast forward-Sept 2009-I ask my pcp about pain management. We try voltaren (which I had success with in the past) and tramadol. (I'm aware that some say tramadol is no better than aspirin, but it does work wonders for some--we are all different. It did for me, it just didn't last). After 2 weeks of taking this I was actually receiving enough pain relief to greatly improve my life (got up to 2, 50mg tabs 2x day--problem was, if I took tramadol after 3pm or so, I had trouble sleeping--like I drank too much coffee), so I was able to be more productive during the day & took it easy in the afternoon/eve. Of course, after Christmas I wasn't getting the same pain relief or maybe my pain just worsened. . . I returned to my doctor 3 weeks ago telling him I was having increasing pain. He thinks with my issues (based on my films, ect...) that I most likely will need long-term opiod therapy. Said he'd like to try me on oxycontin, but because of the cost he wanted me to try methadone instead (I have taken opioids in the past off & on, there's really no issue of abuse or addiction concerns & they have been effective--more so, I'm concerned with side effects and pain relief). It's also a community/low-cost clinic, so there's probably more red tape/limitations on what & how he can prescribe as well.

Our health care system is in a real sad state, when people who need strong opiods are forced to go without due to abusers, while others are forced to rely on strong opiods instead of possibly taking something milder & receiving additional pain relief through natural therapies like accupunture, massage & physical therapy because of lack of insurance &/or $.

Thanks to all for reading this and I wish you happy painfree (or at least painLESS) days.



  • It's rough you've had chronic pain for so long. I heard others have relief from Methadone as a pain med but you need to be followed up with any heart problems and with bloodwork. I started at low dose MS Contin and now take Oxycontin. I usually get by on only 2 pilla a day as opposed to 3 my Dr. ordered.

    As for PT and acupuncture, is there any University based hospitals in your area? Maybe that would be an option for you. I don't live in the USA but have enough problems with our Health care system. Without Insurance I wouldn't know how to get by paying for meds. Usually low dose ER meds are the way to go to stop addiction which I'm not worried about really just need pain control right now. I hope you find the med that works for you to help you tolerate the pain so you can excercise walk or swim if you can.
    If I had no Insurance through long term disability I would be on medicare or social welfare to get the treatment needed. I hope you find some pain relief soon. It sounds like your Dr. is very understanding. 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
  • Temgesic (sublingual buprenorphine 0.2mg) is a Schedule 3 strong opioid analgesic that I've personally found to be very helpful, and suitable for long-term use. I'm prescribed twelve tablets a day (plus tramadol and muscle relaxants) and I've found that it usually gets my pain under control pretty well (0.8 - 1mg in the morning, when my pain is really bad, helps a lot, and I can usually get by on less later on in the day).

    Unfortunately I don't think its use for pain relief has caught on yet in the States, where it's used for opioid addiction/withdrawal treatment in doses far higher than those recommended for analgesia. It has been used in pain management for about thirty years in other countries, and is being used increasingly as an alternative to morphine, oxycodone, fentanyl and the other strong opioids (in Europe the transdermal formulation, similar to the fentanyl patch, is now preferred for chronic pain, with the tablets being used more for breakthrough pain). It's listed as a Schedule 3 drug due to its excellent safety profile, and it's certainly been my experience that it causes fewer negative side effects than other opioids (I've never had a problem with itching or constipation, for example, and over the years I've been treated with it my tolerance has remained remarkably steady).
  • Have you tried Lyrica (actually Neurontin if you're being money concious)? It has really done wonders for my daily pain, although I still get a lot of breakthrough.

    There is another med like Tramadol that was recently approved, but I don't think it's available yet.


    I can't help you with the NSAIDS, I haven't found one I can take yet.
  • I'm just horrified by how limited our options are in the US compared to other countries. Is our drug system really safer?

    I was checking overseas pharmacies and finding out what's available OTC to others that doctors don't even want to prescribe here for fear we'll all become drooling homeless addicts. Sigh.

  • in the decision making process. This will be short (I usually tend to ramble) due to extra numbness/tingling in hands/arms today--I need to stay away from the computer, but will check back next week.

    I need to familiarize myself with this forum, or rather with this whole website--it looks like it could be very helpful and it's always great to connect with others who can relate.
    Wish you all the best,

  • I've been on several different painkillers like Fentanyl patches, Ms Contin, Oxycontin, and currently take Methadone. All of them require that you have to go back for a new script every month- Schedule II's that is; Vicodin is refillable.

    Are you asking which one of these will work for you? The most affordable ones are Methadone of course and generic Morphine ER (MS Contin). The rest are very costly and really hard to take on a regular basis if you don't have insurance. It's hard to say which ER med will help and I am currently weaning down my Methadone dose and so far I haven't had any withdrawal symptoms. I am able to do this with the help of my PM doctor and you should consult your doctor about any concerns you have about changing meds. Take care
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