heavy-duty pain meds including opioids - nothing has worked

[fisheye]

Originally Posted by guidoLaMoto

Some points about "pain killers"--

Narcotics, named after Narcos, the Greek god of Sleep, does not kill pain-- it makes you ignore pain. They do tests with subjects hooked up to a painful stimulus machine controlled by a light dimmer dial. They tell the guy to turn up the switch until it hurts (let's say that for this guy it's at "7.")..Then they give him a drug and repeat the test-- he still says it hurts at "7" but he says it with a "far out, Man" stupid smile on his face.

In the pain center of your brain, you have a receptor shaped like, say, a glove-- everyone is different. Maybe yours is a long opera glove, maybe a catchers mitt, maybe like a little white first communion glove....Each form of narcotic is shaped like a hand-- the better the fit, the better the effect of the drug...Everyone is different! (The socialists hate when I say that.)...So--a strong drug for you may be a weak one for me.

Complicating the picture is another effect of individual genetics-- one guy may absorb the drug faster or better than another, and one guy may metabolize it and clear it out more or less quickly than the next guy.

We can't tell you what's the best drug for you...You have to tell us, and you can figure that out only by trial and error.

Same principle works for NSAIDS & Tramadol-- but different sites of action than the narcotics.

One thing that our OP did not mention is the anesthesia that was used for the operation. I recently had a colonoscopy and I was thinking how much we have improved since I had either to have a tooth removed in the 1950s. I believe they used Propofol. All I know is I was watching the anesthesiologist hook me up and the next thing I remember is the recovery room. Plus I had no after-effects from the anesthesia. I hope our OP had the same kind of experience for her operation.

Maybe we are not doing a great job killing the pain after these operations. But we have made many advances in anesthetics during the operation. I still remember a very, very, painful hemorrhoid operation 30 years ago.

[karen_in_nh_2012]

Originally Posted by fisheye

One thing that our OP did not mention is the anesthesia that was used for the operation. I recently had a colonoscopy and I was thinking how much we have improved since I had either to have a tooth removed in the 1950s. I believe they used Propofol. All I know is I was watching the anesthesiologist hook me up and the next thing I remember is the recovery room. Plus I had no after-effects from the anesthesia. I hope our OP had the same kind of experience for her operation.

Maybe we are not doing a great job killing the pain after these operations. But we have made many advances in anesthetics during the operation. I still remember a very, very, painful hemorrhoid operation 30 years ago.

Interesting point. I definitely did NOT want general anesthesia for the surgeries, so they did a spinal with I THINK Versed for sedation. I remember being wheeled into the OR both times but basically nothing after that until I woke up in the recovery room. The first surgery, the spinal took longer to wear off (several hours), which was a freaky feeling -- they told me to wiggle my toes and I could see that I WAS but I couldn't feel it. The second surgery, the spinal wore off within an hour of me waking up, which I liked much better.

More RE: anesthesia, I had a very bad dental infection in a back tooth back in December -- I hadn't had a toothache in literally 30 years and had forgotten how painful they were! I got a local anesthetic while the dental tech did a deep cleaning of that one tooth, then I went on amoxicillin for a week I think, but by the next morning my face was back to normal (my cheek had blown up horribly due to that tooth). No more pain either, and no problems at all since (I think I got a tiny piece of food underneath the gum back there and it caused all the issues -- my dentist was amazed at my follow-up appointment a week later as the tooth looked totally normal again).

[Zymer]

Originally Posted by fisheye

One thing that our OP did not mention is the anesthesia that was used for the operation. I recently had a colonoscopy and I was thinking how much we have improved since I had either to have a tooth removed in the 1950s. I believe they used Propofol. All I know is I was watching the anesthesiologist hook me up and the next thing I remember is the recovery room. Plus I had no after-effects from the anesthesia. I hope our OP had the same kind of experience for her operation.

For my colonoscopies they used a combination of Versed and Fentanyl, it was great...except the first time- they didn't believe me when I told them I was very resistant to drugs and went too light, until I woke up in the middle of the procedure. The anesthetist was rather surprised when I started talking to her. I was watching her watching my heart rate on the monitor and said "Hey, did you know I can drop my heart rate to under 30?"

After she got over her surprise she said "Please don't do that."

She didn't seem to be in any hurry to do anything about me being awake and I was bored, so I started slowing it down. "Stop doing that!" When I hit 28 she cranked the juice and put me back under.

For the second one a year later, they made sure I didn't wake up.

I had scopolamine used on me for dental surgery once. That was some good [stuff] too. They shot me up in the waiting room, and the next thing I remember is being in the waiting room with my wife trying to give me a cup of coffee. "Coffee? Come on, how long is it going to be before we get this done?"

A nurse standing there said "We *are* done. We're trying to get you out of here now."

Yeah, baby, that's what *I'm* talking about. Best. Dentist. Visit. Ever.

Originally Posted by Ghaati

I'm thinking the reason these meds act differently in people is the tolerance to pain - rather than the tolerance to painkillers.

Some people have a higher sensitivity to pain than others. I have a fairly high tolerance. Meaning - I still feel the pain just like everyone else does, but for whatever reason, I'm able to endure it better than some folks can. I might feel pain at a level 5 (out of 10) and think - maybe I should sit down and relax a bit. And then when it hits 6, I might think I should take a tylenol. When it's at 7 I know something is "wrong" but still not convinced I need to "do" anything about it. By 8 I know it's time for something stronger than the usual.

With some people - they need something by the time they hit 3 or 4, even if it's just a tylenol.

This isn't simply a psychological thing. It's physiological. The body-mind-nerve connection is different for everyone. Same reason some people are ticklish and some aren't.

I think you are partially right, in that people have different pain tolerance levels. I know for a fact that I can tolerate some fairly high levels of pain and continue to function. In my military and other adventurous career choices I have suffered gunshot & stab wounds, been slashed, blown up, set on fire, and suffered multiple broken bones and kept on fighting. I was so shredded one time, that when I finally made my way back to the base the first soldier to get to me took one look and passed out cold. I've had to patch up my own gunshot, stab wounds and burns without the benefit of anesthetic and continued on...if you want to experience some *real* pain, try being set on fire with white phosphorus- you can't put it out (it makes its own oxygen), all you can do is either cut it out or wait until it burns out.

Earlier this year I managed to drive a 3" #2 Phillips bit through my thumb with a hammer-drill, it was pretty well shredded and the bosses wanted to take me to the hospital. I declined to go (it was March and Covid was ramping up). I cleaned it up with running water, slathered it with antiseptic burn gel, put a gauze pad on and taped it as tight as possible to stop the bleeding...and went back to work. No 'lost time' accident tagged to me.

On the other hand, different people *do* metabolize drugs differently. I can't do any of the opiods- morphine, oxycodone, oxymorphone, codeine, dilaudid (hydromorphone- a hydrogenated ketone of morphine), it doesn't matter if they are naturally or synthetically derived, they leave me curled up in a ball with a terrible pain in my guts while doing nothing for whatever other pain I have.

I have been living with chronic pain for more than 40 years. I generally don't use anything stronger than aspirin and alcohol except when it's *really* bad. My 'go to' used to be Darvocet...until it was pulled from the market due to an allegation of causing heart issues in some people. Now I use a combination of Tramadol and Tylenol (1/4 of my prescribed dose of Tramadol and a full dose of Tylenol, my own version of Ultracet). It doesn't 'kill' the pain, but it brings it down to a level where I can function and it doesn't screw up my head.

But I've seen other people who are barely scratched say it's a 'ten' on the silly pain chart (with the happy and sad faces) that the docs use these days. My wife gets a splinter and it's the end of the world, she's out of commission for days.

[melaniej65]

snip

Originally Posted by karen_in_nh_2012

I THINK that might have been one that my surgeon suggested as a possible alternative if the pain gets severe, so I will definitely keep it in mind for later (although the idea of hallucinating is absolutely terrifying to me -- Sydney, I hope yours were pleasant

end snip

Dilaudid worked spectacularly on my pain after abdominal surgery (IV on demand), but I had completely terrifying dreams; they were worse than anything hollywood could dream up.

I now have a pain pump and my Doc tried a light dose in my mix but we had to discontinue it and drain my pump completely because I still had scary dreams.

I think everyone is different, so you may not have any problems with dilaudid. I hope you find something that works for you.

[rstevens62]

Originally Posted by mcsangel2

I've never taken any illicit drugs, nor have I even ever tried marijuana or even cigarettes; and I drink (white wine) so rarely you could classify me as a non drinker, and oxycodone and hydrocodone also have no effect on me. Well, oxy had zero effect, hydro made me loopy but didn't kill the pain (following oral surgery).

My mother told me at the time that my dad was the exact same way (although he was also a heavy smoker and drinker). The only painkiller that works on me is ibuprofen. Not sure what I'm going to do if I ever have to have major surgery. Anyway, I think it's genetic. I hear we're rare, but out there.

How could Hydrocodone make you loopy, but Oxycodone not do anything? Oxycodone is a stronger opiate.