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  • Opioid Pain Relievers Can Make Pain Worse in Some Patients

    (Editors Note - This explains why some doctors are VERY RELUCTANT to prescribe opiates. Just worth knowing about. - Jill)

    Newswise — Opioid medications are essential for helping to relieve all types of serious pain. However, relatively recent evidence suggests that in some patients they can paradoxically worsen the pain.

    “Actually, this possible negative effect of opioids, such as morphine, to cause increased sensitivity to pain was observed in the 19th Century,” says Peggy Compton, RN, PhD. “Today, we call this opioid-induced hyperalgesia, or OIH.”

    Compton is an Associate Professor of Nursing at the UCLA School of Nursing, Los Angeles, and a well-known researcher and author in the pain management field. Her extensive review of the clinical evidence on OIH, exclusively for Pain Treatment Topics and published at the Pain-Topics.org website, is titled “The OIH Paradox: Can Opioids Make Pain Worse?”

    The evidence-based document can be accessed at:
    http://pain-topics.org/clinical_conc...php#ComptonOIH.

    Fortunately, it seems that OIH does not arise in the majority of patients taking opioid analgesics, but when it does occur it can be difficult to manage. In addition to OIH, pain increasing during opioid therapy can indicate several other conditions that must be considered, including: 1) worsening pain-causing disease, 2) tolerance to opioid effects, 3) opioid withdrawal symptoms, or 4) pseudoaddiction (opioid-seeking due to unrelieved pain). For these conditions, increasing the opioid dose usually helps relieve pain.

    A patient who is addicted to opioids may complain of worsening pain but may not be helped by increasing the opioid dose. In fact, signs of addiction may emerge further, such as difficulty controlling opioid use, a preoccupation with obtaining opioids, or other misbehavior.

    In the case of OIH, increasing the opioid dose will actually make the pain worse. Often, the pain is difficult for the patient to describe and can spread beyond the original point of pain. According to Compton’s review, several strategies may help prevent OIH or to deal with OIH if it occurs:

    >> The opioid dose should be kept as low as is clinically effective for managing pain.

    >> Additional medications can be used to help minimize the need for opioids, such as COX-2 inhibitors, dextromethorphan, and others.

    >> Long-acting opioids are preferred over shorter-acting formulations for chronic pain.

    >> If a particular opioid becomes ineffective, it is often helpful to rotate to a completely different opioid drug (methadone is especially useful for opioid rotation).

    >> New research suggests combining low-doses of opioid antagonists (eg, naltrexone) with opioid therapy to counteract development of OIH.

    Compton observes that there are still many unanswered questions about OIH, and research investigations are ongoing. Meanwhile, it is essential for healthcare providers to carefully monitor patients’ responses to opioid therapy and recognize that several opioid-related responses other than OIH can lessen opioid-analgesic effectiveness. In some cases, higher dosing is needed; however, if OIH occurs, other strategies should be employed to provide patients the pain relief they need and deserve.

    Pain Treatment Topics and the associated Pain-Topics.org website provide open and free access to noncommercial, evidence-based clinical news, information, research, and education on the causes and effective treatment of the many types of pain conditions. It is independently produced and currently supported by an unrestricted educational grant from Covidien/Mallinckrodt Inc., St. Louis, MO, a leading manufacturer of generic opioid analgesic products.
    Would you like to talk with someone about your IC struggles? The ICN now offers personal coaching sessions that include myself, Julie Beyer RD on the diet and Dr. Heather Howard on Sexuality. http://www.icnsales.com/icn-personal-coaching/

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  • #2
    Very interesting Jill, thanks for the update.

    Comment


    • #3
      heya

      its also good to note that you can have increased depression on opiate painkillers....(it is one of the side effects and yes i know its a catch-22, your depressed because of the pain so painkillers should help....but thats with all meds, theres always side effects....)
      http://chealth.canoe.ca/drug_info_de...=723&page_no=2

      quote---'Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

      * constipation
      * dizziness, lightheadedness, or feeling faint
      * drowsiness
      * nausea or vomiting
      * sweating
      * itching
      * headache
      * dry mouth
      * weakness

      Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

      Check with your doctor as soon as possible if any of the following side effects occur:

      * depression or other mood or mental changes
      * difficulty urinating
      * fast, slow, or pounding heartbeat
      * feelings of disassociation from reality
      * hallucinations
      * hives or skin rash
      * redness or flushing of face
      * trembling or uncontrolled muscle movements
      * unusual excitement or restlessness (especially in children)'

      i just wish there was one set drug for us all and that it worked and no side effects....i guess i am hoping for a dreamworld or something
      hope all are doing good today though....
      we need more good days....(i sure do... )
      Have dealt with chronic pain and gerd/ibs since '98 endometriosis, vulvodynia diagnosed 2000, ic diagnosed around 2004, chronic epstein barr-like virus 2011
      Hysterectomy/oophorectomy 2014 endo had destroyed everything
      Now dealing with recurrence and menopause in late 30s
      Other things--migraines, chronic hives, eczema, raynauds, congenital scoliosis, broke 3 vertebrae in middle of back when i was 16, heart defect (ventrical septal defect)

      Comment


      • #4
        Originally posted by icnmgrjill View Post
        (Editors Note - This explains why some doctors are VERY RELUCTANT to prescribe opiates. Just worth knowing about. - Jill)

        Newswise — Opioid medications are essential for helping to relieve all types of serious pain. However, relatively recent evidence suggests that in some patients they can paradoxically worsen the pain.

        “Actually, this possible negative effect of opioids, such as morphine, to cause increased sensitivity to pain was observed in the 19th Century,” says Peggy Compton, RN, PhD. “Today, we call this opioid-induced hyperalgesia, or OIH.”

        Compton is an Associate Professor of Nursing at the UCLA School of Nursing, Los Angeles, and a well-known researcher and author in the pain management field. Her extensive review of the clinical evidence on OIH, exclusively for Pain Treatment Topics and published at the Pain-Topics.org website, is titled “The OIH Paradox: Can Opioids Make Pain Worse?”

        The evidence-based document can be accessed at:
        http://pain-topics.org/clinical_conc...php#ComptonOIH.

        Fortunately, it seems that OIH does not arise in the majority of patients taking opioid analgesics, but when it does occur it can be difficult to manage. In addition to OIH, pain increasing during opioid therapy can indicate several other conditions that must be considered, including: 1) worsening pain-causing disease, 2) tolerance to opioid effects, 3) opioid withdrawal symptoms, or 4) pseudoaddiction (opioid-seeking due to unrelieved pain). For these conditions, increasing the opioid dose usually helps relieve pain.

        A patient who is addicted to opioids may complain of worsening pain but may not be helped by increasing the opioid dose. In fact, signs of addiction may emerge further, such as difficulty controlling opioid use, a preoccupation with obtaining opioids, or other misbehavior.

        In the case of OIH, increasing the opioid dose will actually make the pain worse. Often, the pain is difficult for the patient to describe and can spread beyond the original point of pain. According to Compton’s review, several strategies may help prevent OIH or to deal with OIH if it occurs:

        >> The opioid dose should be kept as low as is clinically effective for managing pain.

        >> Additional medications can be used to help minimize the need for opioids, such as COX-2 inhibitors, dextromethorphan, and others.

        >> Long-acting opioids are preferred over shorter-acting formulations for chronic pain.

        >> If a particular opioid becomes ineffective, it is often helpful to rotate to a completely different opioid drug (methadone is especially useful for opioid rotation).

        >> New research suggests combining low-doses of opioid antagonists (eg, naltrexone) with opioid therapy to counteract development of OIH.

        Compton observes that there are still many unanswered questions about OIH, and research investigations are ongoing. Meanwhile, it is essential for healthcare providers to carefully monitor patients’ responses to opioid therapy and recognize that several opioid-related responses other than OIH can lessen opioid-analgesic effectiveness. In some cases, higher dosing is needed; however, if OIH occurs, other strategies should be employed to provide patients the pain relief they need and deserve.

        Pain Treatment Topics and the associated Pain-Topics.org website provide open and free access to noncommercial, evidence-based clinical news, information, research, and education on the causes and effective treatment of the many types of pain conditions. It is independently produced and currently supported by an unrestricted educational grant from Covidien/Mallinckrodt Inc., St. Louis, MO, a leading manufacturer of generic opioid analgesic products.
        my friend who is a nurse practioner told me this after she went to a pain IC lecture by one of the famous icons in IC specialists today. He doesn't give his patients narcotics and he is tops in IC. Vicky

        Comment


        • #5
          How do I start my first thread?

          Hi Jill,

          I'm not sure where to click when I log on to start a conversation?

          Esteva

          Comment


          • #6
            I found the article to be very interesting, but again shows that as IC patients again we don't follow the norm.

            Vicky, he wouldn't be a top IC doctor for me if he didn't prescribe pain meds. Not that I feel every IC patient needs narcotics. If there is a way to function without them, go for it, but if a patient does need them, it is so unfair to allow a patient to live in misery because of pain. I know that there are alot of "top" doctors out there that treat IC, but what makes them "top" in my world is when they take their time to keep your life as normal as possible. A "top" doctor is one that does his best to be available when you need him/her.

            I could certainly handle life much better now than back during my pre interstim days when all I knew was pain, no sleep and the constant need to find a bathroom. I can't imagine so many people on here that go without pain management when they obviously need it and can't get it at all or get just enough to let them see what pain relief is really like then have it taken away. Yes, I know that opioids are pretty much a catch 22, but I have been on the same pain med for well over a decade now and I feel fairly normal. Pain meds and now Prosed DS are pretty much the only meds I don't have to switch back and forth on. They work, so I don't have to try something different.

            I tried a couple long-acting pain meds years ago prior to my interstim implant and couldn't handle the side effects and I had to work, plus I loved my job and doing things with my family and friends so my doctor and I worked very hard in finding the right pain med that allowed me to keep working as much as I could. Now that I am on a good combo of meds most of the time and I am taking fewer Lortabs than I have had in years. I still have my bad days when I am stressed or in need of an adjustment on my interstim (like now).

            I am very tickled when people can deal with their IC symptoms without narcotics, but there are those of us out there that do what they can to deal with each day. I don't know if my body is just used to the Lortab, or if the supplements I take counteract some of the side effects. But I never have many of the usual side effects. I do have a skin rash, but I have always had chronic Eczema growing up and it didn't start back up until this year since my early 20s, so that is 20 years plus. Dermos and I are still trying to figure that out! I am always cold natured. My mom heard me say that I couldn't wait until I hit menapause and she looked at me like I had 2 heads! I was sitting on a porch swing with everyone walking on the deck with me wearing shorts and summer tops and there I was with my usual sweater that has become my "blankie". I am not even enemic anymore, so I can't blame it on that.

            I am very grateful that I do have a doctor that wants me to see him every 2 months. I just graduated from every month! Because he does watch everything that is going on, so I feel safe.

            Comment


            • #7
              I have a local urologist I've seen for 27yrs. I started seeing him when I was 4 I'm 31 now! And, I have a Uro Specialist that is top notch! I see them both, they both know I see them both, because my specialist is 3 hrs away and my local uro is 25 minutes away. The specialist keeps up with the big stuff like my pelvic floor dysfunction, vulvodynia, of course my IC, my fibro etc and my local helps mainly keep my IC in under control since he's right here! But, the two of them have two totally different fews when it comes to pain medicine! And, then dr armstrong disgrees with one of the meds he put me on but he said he's the specialist and i'm sure he probably knows something I don't!
              Dr Armstrong (local) believes in pain med's as long as he is watching over me and making sure i'm taking as prescribed. He's says when your bladder is as bad as yours as a doctor I feel it's unfair for me to let you stay in pain when I know I can do something about as long as i monitor you!! And, I've known you long enough to know you will obey my orders! And, I do!!
              Now, Dr. Evans (specialist) the first time i went to him he talks so fast and he mentioned neurotin and lyrica and I know they block out pain and I thought he was going to start me on either one of those as well. So, when I looked at the prescriptions I said meaning about the neurotin or lyrica, what about for pain? And, he whirled around and said did you come down here for pain meds? And, I said NO!! I misunderstood, about the neurotin or lyrica I thought you were going to start me on one of those and he said OH well lets see how these go and will talk in 3 months!!
              So, I know my specialist isn't a fan, but also he hasn't known me 4 27 yrs and known the pain and been inside my body like my local doctor!! My local doc knows everything i've been thru since I was 4 and he knows I would never and have never abused my pain meds and he feels I need them from time to time to have alittle bit of a normal life when I have the days when I'm in so much pain!!
              I guess the doctors are on the fence about it, but I'm so forunate that my local doc has knowm me for so long and knows my pain. I have know idea what I'll do if he ever retires. Which i'm sure will be in a few yrs!!

              Comment


              • #8
                Originally posted by Claredale View Post
                I found the article to be very interesting, but again shows that as IC patients again we don't follow the norm.

                Vicky, he wouldn't be a top IC doctor for me if he didn't prescribe pain meds. Not that I feel every IC patient needs narcotics. If there is a way to function without them, go for it, but if a patient does need them, it is so unfair to allow a patient to live in misery because of pain. I know that there are alot of "top" doctors out there that treat IC, but what makes them "top" in my world is when they take their time to keep your life as normal as possible. A "top" doctor is one that does his best to be available when you need him/her. I

                can't imagine so many people on here that go without pain management when they obviously need it and can't get it at all or get just enough to let them see what pain relief is really like then have it taken away. Yes, I know that opioids are pretty much a catch 22, but I have been on the same pain med for well over a decade now and I feel fairly normal. Pain meds and now Prosed DS are pretty much the only meds I don't have to switch back and forth on. They work, so I don't have to try something different.

                I tried a couple long-acting pain meds years ago prior to my interstim implant and couldn't handle the side effects and I had to work, plus I loved my job and doing things with my family and friends so my doctor and I worked very hard in finding the right pain med that allowed me to keep working as much as I could. Now that I am on a good combo of meds most of the time and I am taking fewer Lortabs than I have had in years. I still have my bad days when I am stressed or in need of an adjustment on my interstim (like now).

                I am very tickled when people can deal with their IC symptoms without narcotics, but there are those of us out there that do what they can to deal with each day.
                I agree with everything you wrote! I have no respect for any Dr that rules out pain meds for an entire group of people who are suffering. I think it is downright immoral and out to be criminal to deny pain relief to people who are suffering!

                I have seen DRs like this before, back when I didnt know any better. But, never again! Pain meds gave me back my life and gave my children back their mother, and my husband back his wife! They allow me to get out of bed, sleep better, do some household chores, excersize, take care of my kids, have sex with my husband, go to church, and live as normal of a life as possible under the circumstances. It angers me beyond beleif that Drs like that one even exist, but that they profess to be "IC experts" and spread this venom to other DRs, nurses, and health care workers in meetings like they know what they are talking about and have these other people believeing them and then MIStreating their OWN patients based on this misinformation, is downright sickening!

                (I know you dont believe in that Drs view anymore than we do, Vickie, since you also have to take pain meds. So, please dont think I am going off on you! It is just Drs like that one that set my blood boiling! GRRR! I feel so sorry for his patients and the patients of those professionals attending his workshops that leave them "learning" not treat IC pain either, since HE doesnt believe in it and professes to be an "expert". GRRRRR!!!

                Thank God there ARE Drs out there that DO belive in pain control for people with chronic IC pain when patients have not responded to other treatments. (I understand not giving them only as a last resort, after the patient has tried everything else and is still in pain, but NO ONE should have to suffer with this forever with no hope of ever being out of pain! Like I said, it is not only immoral but ought to be criminal!

                I wish we knew the name of this Dr so we could send him ACCURATE information and research about IC pain and copies of the numerous studies done that show that chronic, unrelieved pain can has been linked to depression, nerve damage, lowered quality of life, trouble sleeping, inactivity (as well as weight gain and loss of muscle tone resulting from the inactivity), and a host of other issues! This guy needs a REAL education from the REAL IC experts....IC patients!
                Last edited by amaranthe; 08-25-2008, 05:48 PM. Reason: added last paragraph
                I am not a medical professional. I do not give medical advice. In all cases, I urge you to talk to your Dr. about your treatment options.

                D/Xed 2003 with IC. Also have the co-existing condtions of VV, Vulvadynia, Lupus, Fibro, GERD, CPP, Endo, & Adhesions, and Depression

                Meds: Estrogel (due to total Hyster)
                The meds r/xed by my Pain Dr. from the Pain Clinic are as follows: Morphine ER and IR, Baclofen, and Lyrica and Seroquel (used off-label as a sleeping pill, but it also helps with depression)


                (I listed my meds in case someone reading this has been told like so many ICers that Drs dont r/x pain meds for IC.) I want you to know that there ARE tons of us who are also dealing w/this disease and the pain and many of us ARE on pain meds.)


                John 3:16 For God so loved the world that he gave his only begotten son, that whoever believes in him shall not perish but have everlasting life.

                Comment


                • #9
                  I agree with both of your posts claredele and amaranthe. I never said I agreed with this md's practice. I always gave my patients in the recovery room pain medicine till comfortable. The anesthesiologists called me the queen on narcotics. I gave a lot of narcotics to my pateints I Know what it is like to wake up on the other side of the cart in pain. It's terrible. I always pray I get a good recovery room RN .

                  For me the pain clinic is new in the last year. But before that I had such terrible pain. The pain clinic or atleast has helped me more then my family md did.

                  Oh I agree with both of you. I could not believe this md gave this information to all nurse practioners and gyn mds at a conference on IC just a few months ago.

                  Vicky

                  Comment


                  • #10
                    the best!

                    You two are amazing! I think I want to print out your responses just to give to people that do not understand!!! I agree that he could not possibly be a top doctor if he is that close minded!! Who said he was a top IC doctor anyway? Thank you big time for great responses! Ginny

                    Comment


                    • #11
                      Originally posted by malone View Post
                      You two are amazing! I think I want to print out your responses just to give to people that do not understand!!! I agree that he could not possibly be a top doctor if he is that close minded!! Who said he was a top IC doctor anyway? Thank you big time for great responses! Ginny
                      He is rated as an IC specialist here on this IC board when you look up where to find md's in different states. That is how I knew. Why do I feel like I am being picked on. I did not say I agree with the article or this Dr. IC. I am sorry I even posted anything. I feel bad now that I did and yes I do feel that I am being picked on . VIcky

                      Comment


                      • #12
                        Yes I can believe it, and I think maybe sleeping pills may be the same way.

                        Trish

                        Comment


                        • #13
                          I just read some feedback on what was written. Don't get me wrong I believe as IC'er we do need pain killers and other medicine to survive this disease but do listen to your body if things begin to change. These medicine
                          can be a life saver but also can change on you. Don't know why, but listen
                          to your body, you alone only can tell something is wrong.

                          Trish

                          Comment


                          • #14
                            I just wanted to give you a virtual hug Vicky! I am sorry that you felt you were being picked on, I don't think that is how anyone meant it to be but I know that it still hurts.

                            I understand you don't think he is a top doctor! I have heard you complain about him before. We love you here and hope you still can post and feel comfortable.

                            BIG HUGS
                            Sarah
                            Current meds; , effexor 37.5 mg 2 times a day, and lyrica 100 mg 3 times a day, lots of reading and snuggling with the pets!

                            Comment


                            • #15
                              Originally posted by IC SARAH-CPP View Post
                              I just wanted to give you a virtual hug Vicky! I am sorry that you felt you were being picked on, I don't think that is how anyone meant it to be but I know that it still hurts.

                              I understand you don't think he is a top doctor! I have heard you complain about him before. We love you here and hope you still can post and feel comfortable.

                              BIG HUGS
                              Sarah
                              thanks for your support sarah. No it is not my uro i was referring to.
                              Actually, it is a uro listed ic specialist by this board in state of California not my uro he is like almost retired. Thank you I am a sensitive person- . VICKY

                              Comment

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