Narcotics and pain meds

New to this site..so if this is a repeat, bear with me.
I have been suffering from headaches all my life and the last 17 yrs. specifically with migraines! Started out in a dark room, unable to function every three days! Went to numerous dr., neuros, headache clinics and have been on a boatload of medication. 17yrs. later I am not on a preventative but work with a naturopathic dr. in getting overall healthy...learning alot about foods and affects on headaches and health. I function very well. I work part time and i have a total of 7-10 days of headache (but not all day) in a month. I use maxalt which works well 50percent of the time..actually maxalt takes care of the headaches and narcotics take care of the pain. I go from starting to feel a headache to full blown pain in 15 mins. so I don't have a large window to work with. Hydrocodone works and when I am too nauseous demerol injection with anti nausea meds. work. Bear in mind I have been doing this regimine of pain relief for almost 10 yrs.
Now..the NP I see wants me to not use narcotics at all! She claims the receptors in my brain get "coated" from the narcotics and prevent anything from working well-maxalt in particular. I am all for getting off all meds...but I am highly skeptical at this point of my life that I can not use narcotics because I have used them for sooo long. I feel that thru what I learn from foods/ naturopathic dr. eventually I can be the best I can be....the NP says to get off narcotics is to not use them and in 8 months or so my brain will be cleared of them...what do I do for pain in the meantime? go to the emg. room.! One--can't afford financially to do this Two--this is an awful thing to do to my body Three--won't be able to keep my job doing this!

So...wondering if anyone out there has either gone thru a similar situation..or knows some resources that I can read up on what these "coated receptors" are in the brain/body so I can understand more.
there was a time early in my treatment that my dr. had me go thru all the available non-narcotic pain relievers and NONE worked! so I am so torn about this
I don't want to be a 60 yrs old woman on narcs the rest of my life, but I do want my life and I like the one I have so far....compared to alot of people whose lives I read about on these forums mine is a piece of cake...but no doctor seems to like narcotics and migraines. Your feedback is greatly appreciated.
Thanks

Scobby you story is very close to mine.

I've had migraines and CDH's longer than I can remember. I've had blood tests, Xrays, CT's, MRI's, MRA's, Cortisone shots, a laundry basket of different drugs and nothing works. Nothing except narcotics. Oh I had one doctor tell me all of my headaches are rebound headaches, and if a got off of all drugs the headaches will stop. I also tried Biofeedback (mind-over-matter crap).

I've been taking various forms of Vicodin for years now. I've never heard about this "coating effect" your doctor is telling you about. The only time I've heard of this is with meth abuse. I have a very good PCP who has prescribed narcotics to me, but In a restricted amount. I'm sure by now I'm dependent on them. I depend on them to let be live a normal life.

Hi and welcome!

I have had chronic intractable migraine/New Daily Persistent Headache for 13 years now. Mine began at age 17, now 3O.

I have been through the whole on pain meds/narcotics and off them. On occasion, I have had to be on longer acting opiates. In your situation, I am not sure exactly what the benefits/risks would be for you. If you are on daily pain meds, and haven't been off them in a while, then I would think twice and make sure you have a plan. You may need to go down slowly, if you do decide to go off them. I have heard of rebound or that your body gets used to pain meds, but not the explanation your dr. mentioned.

I got off all the mong-acting pain April and started using tylenol 3 as needed. This was my choice, though.

Pain free days,
sailingm

yes been there and had to go through the detox to clean your body out, over here the neuro offer to admit you to hosp for the first 2 weeks if you want but will sign you off work for a month. after the first 2 weeks the pain starts to spread out and you get breaks in the pain which was great after 18 years of migs, i manage mine now with occipital nerve blocks and triptans as i need them but you can only know what true pain you get just from migraine once youre cleaned out of drugs.

A long time ago an orthopedic surgeon refused my request for narcotics for chronic back pain because, according to him, after awhile my body's natural endorphins wouldn't kick in when needed and I would become dependent on them. He said occasional or short term use is okay, but I would start using them every day and it would lead to problems. I didn't believe him and I thought there were other reasons why he wouldn't give them to me. Much later I moved to country where codeine (with tylenol) was available OTC and I started out using it twice a week, but ended up taking a small dose almost every day. I already had manageable migraines at the time I started using it, but during this time the migraines really got out of control. I believe NSAIDS have the same effect on me.
I would ask the NP for some literature or links describing the "coating effect".
Also, if you do decide to reduce or eliminate the pain meds, massage can be very helpful. Especially the deep tissue type. I tried acupuncture, too, but it didn't work for me.

thanks for the feedback..it is very interesting.... I don't use the pain meds daily..that's what is so ironic? I have found fighting a virus gives me migraines..I asked the naturopathic dr. if that is because my head is the "weakest" point? I can go weeks without needing anything but then I get "whammed" and it could be a few days in a row..but I don't feel like I am missing out on anything in my life. I may miss a meeting or church once in a while but I am not down and out for days. So I don't think I have to worry about withdrawl in a sense of daily useage but I will consider what y'all wrote..thanks

Many doctors are leary of prescribing narcotics. None of my doctors will. I am given nothing stronger than imitrex and maxalt. Once in a great while I can get a shot of demerol in the ER...but that is rare.

I've been told it's because studies show narcotics don't have any effect on migraine pain (I don't know who they studied, but it wasn't me! Demerol is very effective on my migraines). I've also been told narcotics cause rebound headaches (I will give them some leaway on this because I've experience rebound with vicodin when I had kidney stones...but I don't think it's true for every body or every narcotic).

Personally I think they are scared to prescribe them. A nurse once told me that the DEA watches doctors very closely. They get in big trouble if the presribe opiate based meds too often. It's sad....

I would ask the nuero what she plans to prescribe in the mean time if you go that route. If it's nothing, I'd start looking for a new nuero. This over concern about rebounds and chronic pain med use is leading to a 'let them suffer" mentality, which doesn't do us any good for trying to maintain any type of a life. I just can't afford to be out of action for days at a time. If they are sure that narcotics are a problem, let them come up with a decent substitute first.

I've been put on two daily medications, Verapamil and Propronolol....and I think both made me worse. (I take the triptans, and those work occasionally...but they don't make me worse!)

Both of the above-mentioned drugs gave me horrible horrible side effects...most notably, headaches/migraines, sleeplessness, and wore me out.

I just got off propranolol and stopped taking ALL of the vitamins that I have been taking for years. Honestly, the last 7 days have been the best I've felt in years...and the longest streak I've gone without a migraine in probably two years...

I'm sure another one is lurking in the shadows, ready to pounce, but I'm going to enjoy this feeling as long as I can!

I think you get probably the best answers to your questions from Dr Robbins who visits us here from time to time, and kindly explains such issues.

If you have long pain free periods, it sounds as if you have your migraines reasonably well under control. This is what most of us here aim for, since we know that migraine is not curable, so we can not eliminate it altogether, just make it more bearable by getting as few days of pain, as we can, by better pain management. This means trying to find what works best, and sticking to it. It often means changes in our lifestyle, or changes of docotrs, as well as elimintain any possible triggers which cause migraines.

Weo know that certain medicines can cause rebound:
the more often you take them, the more frequent you headache becomes since your brain chemistry begins to get use to them and start expecting more (I think this is what was meant by "coating") and then your head protests, by giving you more head pain often causing daily or chronic pain.

This can be caused by ordinary over the counter (OTC) headache medicines.
Narcotics will ceratinly lead very quickly to dependency, as they are more powerful and very addictive.

BTW Scooby, I just wanted to mention that Maxalt is definitly NOT a narcotic, but it belongs to the group of medicines called triptants which act in completely different way to narcotics.

However, if taken frequently triptans can aslo cause rebound - so the more often you take it, the more chance of a rebound.
Maybe this is what your doctor was trying to prevent.
BTW welcome to our forum, Scooby.

I've always heard about the rebound effect when taking analgesics and triptans, but (at least in my case) I don't believe I experience that as the pattern of migraines never change.

I once stopped EVERYTHING for two months. Two months of hell I might add. Nothing changed; the time of onset, the ramping up, the peak. Nothing changed except my sanity.

Thank god my PCP agreed and put me back on my regular script.

Scooby,

I'd look for another doctor. If you were on daily pain meds, that's another story but things seem to be relatively well managed with your current plan. There are some doctors out there that don't believe in pain meds at all - I've heard that crap about it stopping working. I was there without adequate meds, with a neuro that refused to prescribe them and I was at a level 9 pain. I asked what was I supposed to do? Go to the ER? He didn't have an answer.

You know what works for you and if someone is wanting you to do something you feel will only end in disaster - DON'T DO IT. Life is too short to be that miserable because of 1 person's theory.

Narcotics will ceratinly lead very quickly to dependency, as they are more powerful and very addictive.

Not certainly, and not very quickly, not even just "quickly" if the doctor's directions are being followed to a "t".

One just have to be truthful, vigilant and careful while taking narcotic pain relief, any drugs for that matter.

It's true that with this type of medication caution is needed, but sometimes there is nothing else that helps
but narcotic pain relief.

Risa

I take narcotics along with an abortive and have never had rebound or dependency problems. I get migraines a couple of times a week. Mine are almost 100% manageable. I'll be darn if I'm going to stop something that works. Life is too short.

I am struggling Linda. Triptans not working as well as they can...not every one, just some.
Cant figure why this is, what the difference might be.

But I have no place to go.
I have nothing else, and even if it was rebound/moh which the neuro said it is not (it is me), just 3 weeks ago.
Then what can I do. Sit and look at a drug that might get me out of 12/10 pain and not take it?
I might not be living right now, but I am not living in less pain with than without the Triptan...

Pen - how does your doctor feel about a narcotic? to at least block out the pain? At our age I only worry about
pain management for the day, not about dependency, MOH, etc. etc. I have successfully been able to live normal because of this. Hopefully some day I will no longer need to take anything, but until then, I keep my "wasted days" to a minimum.

Well after 2 mornings in a row of waking up to an ugodly throbbing have to hold my head so it doesn't burst migraines I called my Neurologist NP. I tried her regimine of maxalt and then ketorolac and then reglan. Didn't even touch the pain! or headache so I took a hydrocodone.

I told her nurse that and she said I was to repeat the non narcotic regimine every 6 hrs.
So, I said, "So, that can take care of the headache, what about the pain?!"
she then went into the classic "mantra" of you are experiencing withdrawl/rebound headaches and until you are totally off narcotics this is what you will go thru.

I replied, "But I have a job to go to! I can't sit home and go thru the pain for a day!" The nurse replied it get's worse before it's better...but there is light at the end of the tunnel. You have to ride it out.

I went nuts! Crying mess. I told her I felt I did have a quality of life with narcotics. I could go a week or 10 days and no headaches. She sounded surprized...she said you mean you can go that long and not have a headache and I said yes!

her only reply was that if I insisted on being on narcotics I would have to find a different provider because this one was done perscribing them!

So now I am left trying to decide to I go thru hell for 8 months (that is what the NP said how long it takes to clean out your system from narcotics) or try to find a dr. that may percribe narcotics - which there are not any. so I am home from work...sitting here trying to decide and having a good cry while doing it.

Scobby - How much narcotic do you take? That may be the problem with your doctor.

estre004 wrote:Pen - how does your doctor feel about a narcotic? to at least block out the pain? At our age I only worry about
pain management for the day, not about dependency, MOH, etc. etc. I have successfully been able to live normal because of this. Hopefully some day I will no longer need to take anything, but until then, I keep my "wasted days" to a minimum.

It has never been offered. We dont seem to endorse their use here for migraines.
I am not sure why, but unless any Brits here can say otherwise, that seems to be it.

P

02R96 wrote:I've always heard about the rebound effect when taking analgesics and triptans, but (at least in my case) I don't believe I experience that as the pattern of migraines never change.

I once stopped EVERYTHING for two months. Two months of hell I might add. Nothing changed; the time of onset, the ramping up, the peak. Nothing changed except my sanity.

Thank god my PCP agreed and put me back on my regular script.

I logged in to create a new topic called "NO PILLS FOR 30 DAYS!" when I saw this thread and realized it's been done. I saw my doctor yesterday and she wants me to "detox" my system for at least 30 days before I the neurologist again (my appointment is January 18, 41 days from now). I don't know how I'm going to survive, I'm 44 years old and have been on some pain killers almost daily since i was about 15. (although I did go a week once when the barometric pressure was low and steady the whole time!)

Apparently the 'detox' thing is the big thing in the medical community at the moment, it gives them a clean start so to speak.

I had gone in anticipating that I'd tell her that I have learned that there is no "magic cure" and I'll stop seeking advice, but she tells me that my blood work came back 'bad' and I'm apparently killing my liver with all the OTC pills. Darn. So after my 30 days of hell we'll talk other options as apparently I haven't tried several of the biggies. All I've ever tried is Calcium Channel blockers and beta blockers.

Here comes 30 days of hell!

I just spoke with a friend of mine. He's 68 and suffers from diabetic neuropathy. Some day's his legs and back throb so bad he can hardly walk. Monday he called to get his Lortab script refilled and got the "lecture". They denied him a refill and did not offer him an alternative. FYI Lortab is hydrocodone with a big blast of APAP.

He's 68 for gods sake. What do they thing is going to happen? Now's he's in pain and has nothing for it. Damn these doctors.

He called again today. We'll see what happens.

02R96 - I agree. I suppose we should be mad at the abusers. If nobody abused these drugs, there wouldn't be a problem.
Doctors can monitor that though. In the state I live in, they passed a law that makes it hard to get enough prescription drugs to abuse them.

estre004 wrote:02R96 - I agree. I suppose we should be mad at the abusers. If nobody abused these drugs, there wouldn't be a problem.
Doctors can monitor that though. In the state I live in, they passed a law that makes it hard to get enough prescription drugs to abuse them.

Exactly! So many abusers and the media makes a huge deal of it.

And you're right...the doctors can monitor their patients. With electronic records they can easily check pharmacy records. And I'll pee in a cup anytime they want. Doctors should stand up and not be so afraid to treat their patients!

Scobby

Sounds like it is time for a new doctor. If they want to leave you in pain for the next 8 months just to test the latest fad, they are not worthy of being called doctors. Sorry. That is just totally unacceptable.

Earlier today I was at a pain level of 7 which had been rising steadily over about a 4 hour period. It wasn't going away. I could only keep one eye open and felt like a pirate. Simple decisions were taking forever so I couldn't stay at work no matter how hard I tried. You know the feeling. After taking an Oxycodone, the pain is down to a 2-3, my eye is open again, and while I'm not great, at least I'm functional. I can get work done. If they can't cure migraine, the least they can do is provide some relief and let us live our lives. 10 mg of Oxy about every 2 weeks is not drug addiction. It's not causing MOH. It's just keeping people functioning. If your doctor doesn't get that, he/she is a lousy doctor.

I tried her regimine of maxalt and then ketorolac and then reglan. Didn't even touch the pain! or headache so I took a hydrocodone.

Hey, they invented Treximet because triptans taken at once with pain relief works so much better than either separately.
I think you'd fare so much better if you were given at least maxalt and ketorolac together,
unless it is not supposed to be done.


That's why I always take my Maxalt together with Percocet. It works WAY better than either one alone.
Neither Maxalt nor P works for me if taken on its own. Or rather - hardly ever.

Talk to your neuro, and ask for that, maybe he/she will be OK with that
and my guess is will sooner Rx P than Hydrocodone? unless you preffer H.

Good luck sweetie.

Risa