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My crazy cousin
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<blockquote data-quote="Marguerite" data-source="post: 239757" data-attributes="member: 1991"><p>Terry, I was thinking about this in regards to myself, your post made me think about it again.</p><p></p><p>The trouble with strong paind medications, is that you can get addicted. And even if you don't, you can get habituated. I started taking pain medications because I was in pain. (duh) The trouble was, the pain wasn't going away quickly. When it became obvious that the pain was chronic, we had to shift into a different gear to manage it.</p><p></p><p>For short-term pain, you throw at it what it needs. You don't worry about long-term effects or problems because your main aim is to get pain relief fast and hang te consequences. But longer term you need a different approach. Your body responds differently to pain and even a mild pain that you could put up with in the short-term can be like water torture as the days, weeks and months wear on.</p><p></p><p>So in order to properly manage long-term pain, you should get yourself under the care of a pain specialist. Even though I'm young and not suffering from a terminal illness, I took myself to a palliative care clinic. It needed a referral from my GP but since it took the heat and responsibility off him for prescribing the strong medications I'd worked my way up to, he was happy to do it.</p><p></p><p>Now, when you begin taking opiates, it takes time to get ther dosage justright. In my case I was taking more than I needed and was finding it sedated me and gave me a bit of a buzz. Since I didn't like that feeling, I avoided taking the opiates unless the pain was really bad. However, after a few weeks the buzz effect was gone and I was no longer quite so sleepy.</p><p></p><p>Over time, either the pain has slowly got worse or the tolerance to opiates has increased, or both. As a result, the dose needed to knock the pain has increased. However, it has been important for me to never fully knock out the pain because to do so, it rapidly increases the rate of tolerance build-up. And the faster tolerance builds up, the faster you run out of medications and the sooner you get to that nasty point beyond which it is too dangerous to go; the point at which any further increase could be fatal.</p><p></p><p>So if you take opiates to deal with pain, and one day you wake up and the pain is gone, you should be able to stop the opiates without problem because you were'nt addicted. However, there can be some side effecgts (withdrawal) simply because your body has adapted to the opiates and stopping them means your body's adaptation swings back the other way. For example, opiates cause constipation. But if your body is used to them, then the constipation eases and things function normally. However, stop the opiates and your body's personal adjustment suddenly becomes obvious and you get diarrhoea. Only for a day or so (depending on what form you took the opiate in) but for someone with chronic pain, a bit of diarrhoea is no big deal.</p><p>When I was pregnant with difficult child 3, the pregnancy had the fringe benefit of greatly reducing my pain. As a result, I was able to stop all opaites for six months. However, as soon as he was born the pain was back. The dose I needed was almost as high as it had been six months earlier, it really hadn't done much for my tolerance levels.</p><p></p><p>However, if the person is in pain PLUS they're addicted, if they're taking the medications not only to knock out the pain entirely but to also enjoy a nice relax and snooze, then you have problems They will have a bigger problems with withdrawal, coupled with a return of pain.</p><p></p><p>An addict who is desperate for their next fix is bad enough; a person in pain who is anxious that they won't have enough medications to knock their pain to a tolerable level, is also pretty bad. Putthe two together and it's not pretty. Just as a heroin addict on the street will lie, cheat and steal to get their supply, a patient with chronic pain who has abused their medication will be even more anxious and frantic.</p><p></p><p>Getting off the medications - for an addict (such as a heroin addict on the streets) this only can work if they WANT to get off the heroin, and because they don't also have chronic pain. To get off heroin, the naltrexone route is the most effective. But they have to have the mindset and motivation to really work on this, because they go through the withdrawal process under sedation. After the sedation is finished, the patient then has to continue to stay off the opiates. It takes a lot longer than a few days to lose the high tolerance. After all, I didn't lose any tolerance in six months.</p><p></p><p>So for your cousin - unless her pain is now gone, you won't succeed. If there is another non-addicvtive pain medication that would suffice then you could try switching from one to the other. However, if such a medication existed, I'd be on it. There are other options she could try - TENS, acupuncture (which could promote healing also), a morphine pump that trickles analgesia into the spine - but if she's already abusing her pain medications, then chances are other methods would be doomed to fail.</p><p></p><p>If she's abusing her medications then a month's supply will be running out in much less than a month. So how is she getting more? Does she have several doctors prescribing, who don't know about each other? That wouldn't be possible here in Australia without multiple IDs which would be difficult to arrange.</p><p></p><p>What is needed is to make sure her doctor knows just how much she is taking, and to assess whether the dose is correct and whether there is anything else tat could be done to alleviate her pain more safely. Again, she would have to be cooperative. If she's taking medications primarily for the pain, then you would expect her to cooperate. But if she is getting a buzz out of it, she is likely to resist more controlled options.</p><p></p><p>At her age, it could be a case of shrugging your shoulders and letting her have what she wants.</p><p></p><p>If it's any consolation, opiates taken appropriately are probably the safest things she could be taking, in terms of long-term health issues. I know a lot of people find this hard to believe.</p><p></p><p>She's your cousin - if you can't get her to see a palliative care specialist, then you can't do anything more for her. Certainly you need to be careful to not get caught up in her manipulation (which is what it sounds like to me).</p><p></p><p>Marg</p></blockquote><p></p>
[QUOTE="Marguerite, post: 239757, member: 1991"] Terry, I was thinking about this in regards to myself, your post made me think about it again. The trouble with strong paind medications, is that you can get addicted. And even if you don't, you can get habituated. I started taking pain medications because I was in pain. (duh) The trouble was, the pain wasn't going away quickly. When it became obvious that the pain was chronic, we had to shift into a different gear to manage it. For short-term pain, you throw at it what it needs. You don't worry about long-term effects or problems because your main aim is to get pain relief fast and hang te consequences. But longer term you need a different approach. Your body responds differently to pain and even a mild pain that you could put up with in the short-term can be like water torture as the days, weeks and months wear on. So in order to properly manage long-term pain, you should get yourself under the care of a pain specialist. Even though I'm young and not suffering from a terminal illness, I took myself to a palliative care clinic. It needed a referral from my GP but since it took the heat and responsibility off him for prescribing the strong medications I'd worked my way up to, he was happy to do it. Now, when you begin taking opiates, it takes time to get ther dosage justright. In my case I was taking more than I needed and was finding it sedated me and gave me a bit of a buzz. Since I didn't like that feeling, I avoided taking the opiates unless the pain was really bad. However, after a few weeks the buzz effect was gone and I was no longer quite so sleepy. Over time, either the pain has slowly got worse or the tolerance to opiates has increased, or both. As a result, the dose needed to knock the pain has increased. However, it has been important for me to never fully knock out the pain because to do so, it rapidly increases the rate of tolerance build-up. And the faster tolerance builds up, the faster you run out of medications and the sooner you get to that nasty point beyond which it is too dangerous to go; the point at which any further increase could be fatal. So if you take opiates to deal with pain, and one day you wake up and the pain is gone, you should be able to stop the opiates without problem because you were'nt addicted. However, there can be some side effecgts (withdrawal) simply because your body has adapted to the opiates and stopping them means your body's adaptation swings back the other way. For example, opiates cause constipation. But if your body is used to them, then the constipation eases and things function normally. However, stop the opiates and your body's personal adjustment suddenly becomes obvious and you get diarrhoea. Only for a day or so (depending on what form you took the opiate in) but for someone with chronic pain, a bit of diarrhoea is no big deal. When I was pregnant with difficult child 3, the pregnancy had the fringe benefit of greatly reducing my pain. As a result, I was able to stop all opaites for six months. However, as soon as he was born the pain was back. The dose I needed was almost as high as it had been six months earlier, it really hadn't done much for my tolerance levels. However, if the person is in pain PLUS they're addicted, if they're taking the medications not only to knock out the pain entirely but to also enjoy a nice relax and snooze, then you have problems They will have a bigger problems with withdrawal, coupled with a return of pain. An addict who is desperate for their next fix is bad enough; a person in pain who is anxious that they won't have enough medications to knock their pain to a tolerable level, is also pretty bad. Putthe two together and it's not pretty. Just as a heroin addict on the street will lie, cheat and steal to get their supply, a patient with chronic pain who has abused their medication will be even more anxious and frantic. Getting off the medications - for an addict (such as a heroin addict on the streets) this only can work if they WANT to get off the heroin, and because they don't also have chronic pain. To get off heroin, the naltrexone route is the most effective. But they have to have the mindset and motivation to really work on this, because they go through the withdrawal process under sedation. After the sedation is finished, the patient then has to continue to stay off the opiates. It takes a lot longer than a few days to lose the high tolerance. After all, I didn't lose any tolerance in six months. So for your cousin - unless her pain is now gone, you won't succeed. If there is another non-addicvtive pain medication that would suffice then you could try switching from one to the other. However, if such a medication existed, I'd be on it. There are other options she could try - TENS, acupuncture (which could promote healing also), a morphine pump that trickles analgesia into the spine - but if she's already abusing her pain medications, then chances are other methods would be doomed to fail. If she's abusing her medications then a month's supply will be running out in much less than a month. So how is she getting more? Does she have several doctors prescribing, who don't know about each other? That wouldn't be possible here in Australia without multiple IDs which would be difficult to arrange. What is needed is to make sure her doctor knows just how much she is taking, and to assess whether the dose is correct and whether there is anything else tat could be done to alleviate her pain more safely. Again, she would have to be cooperative. If she's taking medications primarily for the pain, then you would expect her to cooperate. But if she is getting a buzz out of it, she is likely to resist more controlled options. At her age, it could be a case of shrugging your shoulders and letting her have what she wants. If it's any consolation, opiates taken appropriately are probably the safest things she could be taking, in terms of long-term health issues. I know a lot of people find this hard to believe. She's your cousin - if you can't get her to see a palliative care specialist, then you can't do anything more for her. Certainly you need to be careful to not get caught up in her manipulation (which is what it sounds like to me). Marg [/QUOTE]
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