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Part III: Pain Relief
Almost everyone hurts somewhere. Whether it be their back, shoulders, neck, or elsewhere. Your pain may be greater than what OTC pain relievers can handle. You may have a condition known as chronic pain.
It should be noted that this section may be the easiest or hardest, depending on the situation. You're not going to get morphine or oxycodone due to a headache. You're not going to get either one of those because you sprained your ankle once in gym class back in 93' either. So with that being said...
Let's see what chronic pain is.
Chronic Pain:
Chronic pain has several different meanings in medicine. Traditionally, the distinction between acute and chronic pain has relied upon an arbitrary interval of time from onset; the two most commonly used markers being 3 months and 6 months since the initiation of pain, though some theorists and researchers have placed the transition from acute to chronic pain at 12 months. Others apply acute to pain that lasts less than 30 days, chronic to pain of more than six months duration, and subacute to pain that lasts from one to six months. A popular alternative definition of chronic pain, involving no arbitrarily fixed durations is "pain that extends beyond the expected period of healing."
Let's see how it's treated with the most common (narcotic) medications
Tramadol
Tramadol hydrochloride (Ultram, Tramal) is a centrally acting opioid analgesic, used in treating moderate to severe pain. The drug has a wide range of applications, including treatment for restless legs syndrome and fibromyalgia. It was developed by the pharmaceutical company Grünenthal GmbH in the late 1970s.
Tramadol possesses weak agonist actions at the μ-opioid receptor, releases serotonin, and inhibits the reuptake of norepinephrine.
Tramadol is a synthetic analog of the phenanthrene alkaloid codeine and, as such, is an opioid and also a prodrug (codeine is metabolized to morphine, tramadol is converted to O-desmethyltramadol). Opioids are chemical compounds which act upon one or more of the human opiate receptors. The euphoria and respiratory depression are mainly caused by the μ1 and μ2 receptors; the addictive nature of the drug is due to these effects as well as its serotonergic/noradrenergic effects[citation needed] . The opioid agonistic effect of tramadol and its major metabolite(s) are almost exclusively mediated by the substance's action at the μ-opioid receptor. This characteristic distinguishes tramadol from many other substances (including morphine) of the opioid drug class, which generally do not possess tramadol's degree of subtype selectivity.
For more:
http://en.wikipedia.org/wiki/Tramadol Codeine:
Codeine or 3-methylmorphine (a natural isomer of methylated morphine, the other being the semi-synthetic 6-methylmorphine) is an opiate used for its analgesic, antitussive, and antidiarrheal properties. Codeine is the second-most predominant alkaloid in opium, at up to 3 percent; it is much more prevalent in the Iranian poppy (Papaver bractreatum), and codeine is extracted from this species in some places although the below-mentioned morphine methylation process is still much more common. It is considered the prototype of the weak to midrange opioids.
For more:
http://en.wikipedia.org/wiki/Codeine Morphine:
Morphine is the most abundant alkaloid found in opium, the dried sap (latex) derived from shallowly slicing the unripe seedpods of the opium, or common and/or edible, poppy, Papaver somniferum. Morphine was the first active principle purified from a plant source and is one of at least 50 alkaloids of several different types present in opium, Poppy Straw Concentrate, and other poppy derivatives.
For more:
http://en.wikipedia.org/wiki/Morphine Oxycodone:
Oxycodone (OxyContin and other brand names) is an opioid analgesic medication synthesized from opium-derived thebaine. It was developed in 1916 in Germany, as one of several new semi-synthetic opioids in an attempt to improve on the existing opioids: morphine, diacetylmorphine (heroin), and codeine.
For more:
http://en.wikipedia.org/wiki/Oxycodone Methadone:
Methadone (also known as Symoron, Dolophine, Amidone, Methadose, Physeptone, Heptadon, Phy and many other names) is a synthetic opioid, used medically as an analgesic and a maintenance anti-addictive for use in patients with opioid dependency. It was developed in Germany in 1937. Although chemically unlike morphine or heroin, methadone acts on the same opioid receptors as these drugs, and thus has many of the same effects. Methadone is also used in managing severe chronic pain, owing to its long duration of action, extremely powerful effects, and very low cost. Methadone was introduced into the United States in 1947 by Eli Lilly and Company.
For more:
http://en.wikipedia.org/wiki/Methadone Hydromorphone:
Hydromorphone, a more common synonym for dihydromorphinone, commonly a hydrochloride (trade names Palladone, Dilaudid, and numerous others) is a very potent centrally-acting analgesic drug of the opioid class. It is a derivative of morphine, to be specific, a hydrogenated ketone thereof and, therefore, a semi-synthetic drug. It is, in medical terms, an opioid analgesic and, in legal terms, a narcotic.
For more:
http://en.wikipedia.org/wiki/Hydromorphone Oxymorphone:
Oxymorphone (Opana, Numorphan, Numorphone) or 14-Hydroxydihydromorphinone is a powerful semi-synthetic opioid analgesic first developed in Germany circa 1914, patented in the USA by Endo Pharmaceuticals in 1955[3] and introduced to the United States market in January 1959 and other countries around the same time. It (along with hydromorphone) was designed to have less incidence of side effects than morphine and heroin. It was a success as it differs from morphine and heroin in its effects in that it generates less euphoria, sedation, itching and other histamine effects at equianalgesic doses. This also means a lower dependence liability.
For more:
http://en.wikipedia.org/wiki/Oxymorphone Fentanyl:
Fentanyl (also known as fentanil, brand names Sublimaze, Actiq, Durogesic, Duragesic, Fentora, Onsolis, Instanyl, Abstral, and others) is a potent synthetic narcotic analgesic with a rapid onset and short duration of action. It is a strong agonist at the μ-opioid receptors. Historically it has been used to treat chronic breakthrough pain and is commonly used in pre-procedures as a pain reliever as well as an anesthetic in combination with a benzodiazepine.
For more:
http://en.wikipedia.org/wiki/FentanylThis area of this guide is subjective and situational. I tried to order them from weakest to strongest. Obviously, the higher up you're aiming for, the more serious of a case you'll need to present to your doctor.
Methadone, Hydromorphone, Oxymorphone, and Fentanyl will be the hardest for you to get unless you have a disease such as Rheumatoid Arthritis, Multiple Sclerosis, Cancer, or some other high-pain causing illness.
(NOTE: Methadone can be obtained from a Methadone clinic, however, one must test positive for opiates to start Methadone treatment and after 60 days of constant treatment, take-home doses are usually allowed for up to a month's worth of medication)
Similarly, you could temporarily get these medications for a serious accident or injury.
In rare cases, these medications are prescribed for persistent pain that does not respond well to the other narcotic medications.
Typical lower back/neck/body pain can be treated with everything from Tramadol to Oxycodone, depending on the severity of your pain.
Some things to tell the doctor:
Quote:
"In the mornings, I can't even get out of bed. I have to have my girlfriend help me up out of bed. I can't live like this. I've been missing work/school."
Quote:
"The pain is terrible. Oftentimes, I'll get a sudden stabbing back in my back that makes me go to my knees."
Quote:
"I don't know what to do. I've been taking almost three times the recommended amount of naproxen sodium to get rid of this pain. I know that's bad, but I have to go to work! It's the only way I can get out of bed!"
Quote:
"I lay awake at night due to the pain. Here lately, it's been causing me to cry sometimes. I don't cry very easily, but this pain in my _________ just hurts so bad...."
Become familiar with types of pain (shooting, stabbing, dull, aching, etc.)
Also become familiar with the pain scale. You'll be asked this almost every visit:
When your doctor asks what is your level of pain, don't be a jackass and say 10. 10 is where your leg just snapped in two and the bone is sticking out of your leg. A good rule of thumb is you stay at a constant 4 or 5, but in the mornings and evenings, you're easily a 7 or 8.
Do not get discouraged if it takes you years to get where you want to be at. I started out on Ultram and after 4 years, I got to my target of Dilaudid. Just keep at it. You will eventually get what you're looking for.
