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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 3 to 27 of 27. Go back in thread:
Posted by lunesta on April 10, 2005, at 19:57:50
In reply to Re: The Duragesic Patch (fentanyl) Xyrem=Happiness, posted by Phillipa on April 10, 2005, at 17:15:59
i am in chronic pain and suffer chronic sleep problems, these have benfited me a lot. I dont abuse them at all and my doctors take this very seriously.
-
Posted by Phillipa on April 10, 2005, at 20:35:39
In reply to Re: The Duragesic Patch (fentanyl) Xyrem=Happiness » Phillipa, posted by lunesta on April 10, 2005, at 19:57:50
Lunesta, I wasn't in any refering to you or the patch. I'm sorry I wasn't more specific in my post. What I meant was that I heard they breath it in or inject it or whatever they do with it to help induce anesthesia. I know the patches are used in chronic pain and I would never let anyone suffer with pain. The effects of pain are the worse things a person can do to his body and emotional state. I'm so sorry if I offended you. Sometimes I just write before I think. Thanks for picking this up for me. Fondly, Phillipa
Posted by mattw84 on April 10, 2005, at 23:53:12
In reply to Re: The Duragesic Patch (fentanyl) Xyrem=Happiness » lunesta, posted by Phillipa on April 10, 2005, at 20:35:39
Lunesta,
I haven't been following this board very frequently, let alone your case, none-the-less it is good to hear that you have found a suitable cocktail.
I must say however, that the combination sounds rather haphazard in terms of long term risks vs. benefits. The combination of three CNS depressant drugs is almost unheard of, not to mention that all of the forementioned are likely the most potent of each class. I hope that you will soon find a less health hazardly combination that still provides adequate relief of your symptoms. I would imagine it must be difficult to function without them, but I also suspect that it must be hard to function alike with so many narcotics used concurrently.
I hope you don't take this too lightly -- I am not trying to burst your bubble or deprive you of the relief you need. Yet I find it astounding that one can take such a combination in an outpatient setting. I'll have to ask my attending tomorrow, but the combination just flat out seems unwise, not to mention the unavoidable dependence and potentially fatal withdrawal. You have my sympathy, and I only am pointing this out to encourage you to consider the facts at hand.
Best wishes,
Matt
Posted by ed_uk on April 11, 2005, at 11:24:05
In reply to The Duragesic Patch (fentanyl) Xyrem=Happiness, posted by lunesta on April 10, 2005, at 11:50:40
Hello :-)
>I am now both floating on the air.....
Lunesta, you do sound rather euphoric, it sounds like one or more of your doses may be too high.
I have to disagree with certain things that Matt said. I do believe that fentanyl can be safely combined with other sedating drugs under certain *specific* circumstances.
If an opioid-naive patient was given fentanyl in combination with another respiratory depressant drug, respiratory depression or even apnea would be likely. However, tolerance to the respiratory depressant activity of opioids is rapid and profound, palliative care patients frequently take huge doses of opioids in combination with benzodiazepines and other 'sedatives' while breathing quite normally. It would be very dangerous to initiate treatment with GHB and fentanyl in an outpatient *at the same time*. Nevertheless, it is not unusual to prescribe 'sedatives' such as lorazepam to outpatients who are already established on long-term opioid treatment.
>I must say however, that the combination sounds rather haphazard in terms of long term risks vs. benefits.
Long-term use of opioid/gabapentin combinations is frequenly useful in the treatment of chronic severe pain, I would guess that the same would also be true of the opioid/pregabalin combination. I don't know much about the long-term efficacy of GHB.
>I also suspect that it must be hard to function alike with so many narcotics used concurrently.
Lunesta, do you feel euphoric? If you do, your doses are too high. A carefully titrated dose of fentanyl should not be euphoric. In the short term, opioids are often quite sedating, making it difficult to function. Many patients who suffer from chronic pain eventually reach a stable dose of fentanyl on which they are not sedated. Tolerance to the sedative properties of opioids often develops quite quickly, tolerance to the analgesic properties tends to develop more slowly or sometimes not at all.
>not to mention that all of the forementioned are likely the most potent of each class......
Although transdermal fentanyl is more potent than oral morphine, it is no more likely to cause sedation or respiratory depression. Potency is important only in the sense that it influences the dose which is given. The word 'potent' is often misused; fentanyl is one of the most potent opioids yet it is no more effective in the treatment of chronic pain than less potent opioids such as morphine. We say it is 'potent' only because it is effective at lower doses than other opioids- it's maximal efficacy is the same. It is more potent because it has a higher affinity for opioid receptors; other opioids could produce the same analgesic effects at higher doses.
AFAIK, the side effects of gabapentin and pregabalin are similar, but the dose of pregabalin is lower.
>unavoidable dependence and potentially fatal withdrawal.......
Long-term opioid treatment almost inevitably results in physical dependence ie. withdrawal symptoms will occur if the medication is abruptly discontinued, the same could be said of many drugs used in psychiatry- although pdocs may deny it! True opioid 'addiction' only occurs in people who take excessive doses of their medication in order to get 'high'. If you're euphoric- the dose is too high. I hope that Lunesta will be careful. Be careful Lunesta! Euphoria leads to bad things!
The withdrawal would not be fatal unless the drugs were withdrawn abruptly. The taper must be flexible- taking the patient's symptoms into account. It is very important that people on long-term opioid treatment do not run out of their medication!!!
Regards,
Ed.
Posted by Paulbwell on April 11, 2005, at 12:28:51
In reply to Opioid combinations: to Matt and Lunesta, posted by ed_uk on April 11, 2005, at 11:24:05
Hi Ed
Are you really only 20?-I read you were born 1984?
Your knowledge is increadable
Posted by The_Resistance on April 11, 2005, at 13:07:05
In reply to Opioid combinations: to Matt and Lunesta, posted by ed_uk on April 11, 2005, at 11:24:05
Personaly I would not prescribed Pregabalin or GHB as Narcotics, it seems like a pejorative term anyway.
GHB alone does not cause respiritory depression, it can apparently be combined with diazapines, so I imagine it could be combined with an opiate at a reasonable dose.
GHB does eventualy loose its euphoric effect and becomes merely sedating.
I found that Pregabalin quickly lost its euphoric effects.
Posted by ed_uk on April 11, 2005, at 13:27:02
In reply to Re: Opioid combinations: to Matt and Lunesta, posted by Paulbwell on April 11, 2005, at 12:28:51
Hi P!
>Are you really only 20?
Yes, I'm 21 in June :-)
Ed.
Posted by ed_uk on April 11, 2005, at 13:35:09
In reply to Re: Opioid combinations: to Matt and Lunesta, posted by The_Resistance on April 11, 2005, at 13:07:05
Hi!
>Narcotics.....
I hate the term 'narcotics'- it reinforces the stigma which is unfortunately associated with the use of opioids for the treatment of severe pain. Opioids should be referred to as opioids- because that's what they are LOL!
Kind regards,
Ed.
Posted by mattw84 on April 11, 2005, at 16:04:31
In reply to Re: Opioid combinations » The_Resistance, posted by ed_uk on April 11, 2005, at 13:35:09
Nice ed! I turn 21 in June as well! =)
On lunch so I have to be brief... Sorry to have offended anyone with the term 'narcotic,' I do recognize the significant role opiates play in managing chronic pain. Especially those like fentanyl which have been made accessable to those like lunesta -- which at not to long ago would have been unheard of. (Though opiates were once a treatment for depression... and even still at times today!)
The first thread by lunesta aroused my initial concern, the thread seemed to convey a sense of drug-induced stupor. (I don't mean stupid when I say that -- so please don't be offended!)
All I know is that many times patients are prescribed medications from different doctors without the knowledge of what other medications are already in use. This can put the patient in potential jeopardy, so I only wanted to express my concern considering what had been presented. I do not know the whole story -- and am merely making statements based on what I can surmise from the original post. Gotta Run!
Regards,
Matt
Posted by Spriggy on April 11, 2005, at 16:20:19
In reply to Re: Opioid combinations » ed_uk, posted by mattw84 on April 11, 2005, at 16:04:31
Posted by Phillipa on April 11, 2005, at 16:49:57
In reply to Re: Opioid combinations » ed_uk, posted by mattw84 on April 11, 2005, at 16:04:31
Matt84, So glad you take the time to post on this Board with your grueling schedule. 4pm and it's lunch time? When do you get to sleep? It's great to hear there are so many doctors in training who are as knowledeable as you are. I remember when working as an RN in a teaching hospital, Residents would see a pt with foam coming of their mouth and turn to the nurse and say "What should I do?" Give them IV lasix we'd say. I don't know what the drugs of choice are now for PE, but lasix was what was used then. On a regular medical floor. Fondly, Phillipa
Posted by The_Resistance on April 11, 2005, at 16:56:28
In reply to Re: Opioid combinations » ed_uk, posted by mattw84 on April 11, 2005, at 16:04:31
Sorry Matt
I didn't mean to jump down your throat in response to your origonal post.
I get a bit deffensive with GHB, because there's so much misinfermation about it.I don't really know much about opiates at all
Posted by jerrympls on April 11, 2005, at 18:38:19
In reply to Re: The Duragesic Patch (fentanyl) Xyrem=Happiness, posted by Phillipa on April 10, 2005, at 17:15:59
> I heard fentanyl was the most abused drug by anesthesiologists and those with access to it. It must be good for all those professionals to risk losing their license over. Fondly, Phillipa
This was one of the opiates my pdoc put me on at first. He wanted to use an opiate that was in a form that didn't require me to take it so often and so he tried the fentanyl patch - 0.25. Didn't do anything for me. I read that there are barely any effects at .25mg and that .5 was usual for most chronic pain patients. However, he would have kept me on it it if it helped as much as the hydrocodone I'm on now helps. Unfortunately there is no long-acting version of hydrocodone so I have to take it 4x daily.
Again- and I'll say this to the day I die: the opioid receptors are vastly overlooked in psychiatry. They have SO much to do with serotonin, NE, and dopamine and our emotion centers within our brains. Psychic pain has a lot in common with physical pain - at least in the brain.
Jerry
Posted by jerrympls on April 11, 2005, at 18:52:52
In reply to Opioid combinations: to Matt and Lunesta, posted by ed_uk on April 11, 2005, at 11:24:05
>
> Long-term opioid treatment almost inevitably results in physical dependence ie. withdrawal symptoms will occur if the medication is abruptly discontinued, the same could be said of many drugs used in psychiatry- although pdocs may deny it! True opioid 'addiction' only occurs in people who take excessive doses of their medication in order to get 'high'. If you're euphoric- the dose is too high.
>
> Regards,
> Ed.Ed shows his knowledge very well in this post (as well in other posts). I clipped out this specific section of his post because it's something I brought up when talking to my pdoc about using an opiate for my depression. I said to him: "How is an opiate any different than the stimulants or benzos you prescribe? They all have abuse potential as well as potentially bad withdrawl - what makes an opiate different?"
I also went on to tell him that I've been on and off amphetamines (prescribed) and benzos (prescribed) for 13 years for my depression and have never abused them nor have had problems with withdrawl - in fact, then ONLY meds that ever gave me terrible withdrawl were SSRIs and Nardil - and to combat the withdrawl I had to up the dosage and taper more slowly. Tell me that's not different that what some people experience from stimulants and benzos (I said to him).
I'm proof that opiates CAN be used effectively for use in depression. I also take Dexedrine as well. Do I feel drugged? nope. High? nope. Close to normal? Yup. I never run out of my Rx early and I don't take more than what's prescribed daily.
I wish I could open more doctors' minds about the use of opiates - but I am only one person. Perhaps I can get my pdoc to write in to a journal or something?
Now of course - one can be VERY high on opiates and still feel relieved of thei depression - which Lunesta may or maynot be? I think the big thing that scares doctors from using these meds is that they make you feel better almost instantly - which is reason for caution. But it doesn't mean they shouldn't be used.
Just my 2 cents
Jerry :-)
Posted by jerrympls on April 11, 2005, at 18:53:53
In reply to Re: Opioid combinations » Paulbwell, posted by ed_uk on April 11, 2005, at 13:27:02
> Hi P!
>
> >Are you really only 20?
>
> Yes, I'm 21 in June :-)
>
> Ed.Not even 21!! Impressive!!
Posted by jerrympls on April 11, 2005, at 18:56:23
In reply to Re: Opioid combinations » The_Resistance, posted by ed_uk on April 11, 2005, at 13:35:09
> Hi!
>
> >Narcotics.....
>
> I hate the term 'narcotics'- it reinforces the stigma which is unfortunately associated with the use of opioids for the treatment of severe pain. Opioids should be referred to as opioids- because that's what they are LOL!
>
> Kind regards,
> Ed.HI Ed!
Correct me if I'm wrong - but I believe Codeine and Morphine are "opioids" whereas synthetic versions like fentanyl and hydrocodone are "opiates?"
I whole heartedly agree with you Ed that the term "narcotics" reinforces negative stereotypes. Thanks for your post!
Jerry
Posted by Phillipa on April 11, 2005, at 19:00:30
In reply to Re: Opioid combinations » ed_uk, posted by jerrympls on April 11, 2005, at 18:53:53
I totally agree with everything you say about benzos, AD's , etc. I wonder why we are so afraid of pain meds? And is Lunesta considered an opiod? I've been on tylenol #3 for my facial surgery. I've been on it about l0days. When complications set in I was told I could continue it [after first 3days], and I've been taking it at night to help me sleep along with the l0mg of valium. I'm so worried about my surgery that I want to insure a good nights sleep so my body can heal. Do you think I am becoming addicted? I admit I'm scared of pain meds and this is the first time I've ever taken any. Is codeine hard to stop? Fondly, Phillipa
Posted by jerrympls on April 11, 2005, at 19:05:00
In reply to Re: Opioid combinations, posted by Phillipa on April 11, 2005, at 19:00:30
> I totally agree with everything you say about benzos, AD's , etc. I wonder why we are so afraid of pain meds? And is Lunesta considered an opiod? I've been on tylenol #3 for my facial surgery. I've been on it about l0days. When complications set in I was told I could continue it [after first 3days], and I've been taking it at night to help me sleep along with the l0mg of valium. I'm so worried about my surgery that I want to insure a good nights sleep so my body can heal. Do you think I am becoming addicted? I admit I'm scared of pain meds and this is the first time I've ever taken any. Is codeine hard to stop? Fondly, Phillipa
Hi Phillipa-
I think we were referring to the original poster of this thread whose board name is "Lunesta" - not the drug. But as far as becoming addicted to codeine - it's hard to say really from just knowing you through this board. You can become mentally dependant on it - thinking you won't sleep or won't feel good without it, etc. Just something you have to monitor. WHen all else fails, talk to your doc or therapist about how you're feeling. Have you had trouble in the past abusing meds? or other drugs?
Hope you are well...
Jerry
Posted by Phillipa on April 11, 2005, at 20:23:47
In reply to Re: Opioid combinations » Phillipa, posted by jerrympls on April 11, 2005, at 19:05:00
I keep forgetting about Lunesta, sorry Lunesta I love your name and now of course you're famous! To answer your question, no I have no hx of abusing meds. But you may be right about thinking it will make me sleep. I'm very suggestive. You could probably give me a placebo to sleep and I would. I don't know that for a fact. Just a guess. Fondly, Phillipa
Posted by ed_uk on April 12, 2005, at 11:19:47
In reply to Re: Opioid combinations » ed_uk, posted by jerrympls on April 11, 2005, at 18:56:23
Hi Jerry!
I think you should ask your pdoc to write a case report about you in a medical journal. I think it's a good idea :-)
>Not even 21!!
Did you say you were 34 or was that someone else? Perhaps I imagined it :-S
>Correct me if I'm wrong - but I believe Codeine and Morphine are "opioids" whereas synthetic versions like fentanyl and hydrocodone are "opiates?"
Opiates = one of the analgesic compounds present in opium eg. morphine, codeine etc.
Opioid = any drug with morphine-like effects eg. codeine, morphine, diamorphine, oxycodone, hydrocodone, fentanyl, methadone etc. 'Opioid' can be used to refer to naturally-occurring opiates such as morphine as well as synthetic drugs like fentanyl and semi-synthetic drugs like oxycodone.
Kind regards,
Ed.
Posted by jerrympls on April 12, 2005, at 19:43:34
In reply to Re: Opioid combinations » jerrympls, posted by ed_uk on April 12, 2005, at 11:19:47
> Hi Jerry!
>
> I think you should ask your pdoc to write a case report about you in a medical journal. I think it's a good idea :-)
>
> >Not even 21!!
>
> Did you say you were 34 or was that someone else? Perhaps I imagined it :-S
>
> >Correct me if I'm wrong - but I believe Codeine and Morphine are "opioids" whereas synthetic versions like fentanyl and hydrocodone are "opiates?"
>
> Opiates = one of the analgesic compounds present in opium eg. morphine, codeine etc.
>
> Opioid = any drug with morphine-like effects eg. codeine, morphine, diamorphine, oxycodone, hydrocodone, fentanyl, methadone etc. 'Opioid' can be used to refer to naturally-occurring opiates such as morphine as well as synthetic drugs like fentanyl and semi-synthetic drugs like oxycodone.
>
> Kind regards,
> Ed.Yes I am 33 (I used to be 21 too! LOL). Thanks for clarifying the opiate/opioid thing.
Jerry :-)
Posted by paulbwell on April 12, 2005, at 20:53:59
In reply to Re: The Duragesic Patch (fentanyl) Xyrem=Happiness » Phillipa, posted by jerrympls on April 11, 2005, at 18:38:19
> > I heard fentanyl was the most abused drug by anesthesiologists and those with access to it. It must be good for all those professionals to risk losing their license over. Fondly, Phillipa
>
> This was one of the opiates my pdoc put me on at first. He wanted to use an opiate that was in a form that didn't require me to take it so often and so he tried the fentanyl patch - 0.25. Didn't do anything for me. I read that there are barely any effects at .25mg and that .5 was usual for most chronic pain patients. However, he would have kept me on it it if it helped as much as the hydrocodone I'm on now helps. Unfortunately there is no long-acting version of hydrocodone so I have to take it 4x daily.
>
> Again- and I'll say this to the day I die: the opioid receptors are vastly overlooked in psychiatry. They have SO much to do with serotonin, NE, and dopamine and our emotion centers within our brains. Psychic pain has a lot in common with physical pain - at least in the brain.
>
> Jerry
>
Hi Jer,I'l say that too
Thou in past decades, Amphetamines were used to get people off Opi's, and MethylAmphetamine proved rather effective in helping withdrawal.
Trading one substance for another, I guess, but theres evidence that the body in pain DOES produce it's own powerfull painkillers, Endorphins, think hard out exercise, and the high that produces.
Did you start on 3 15mg Dex Spans right off?
Hydro 20mgs day stil going well?Cheers dude,
Posted by jerrympls on April 13, 2005, at 0:15:55
In reply to Jerry, posted by paulbwell on April 12, 2005, at 20:53:59
> > > I heard fentanyl was the most abused drug by anesthesiologists and those with access to it. It must be good for all those professionals to risk losing their license over. Fondly, Phillipa
> >
> > This was one of the opiates my pdoc put me on at first. He wanted to use an opiate that was in a form that didn't require me to take it so often and so he tried the fentanyl patch - 0.25. Didn't do anything for me. I read that there are barely any effects at .25mg and that .5 was usual for most chronic pain patients. However, he would have kept me on it it if it helped as much as the hydrocodone I'm on now helps. Unfortunately there is no long-acting version of hydrocodone so I have to take it 4x daily.
> >
> > Again- and I'll say this to the day I die: the opioid receptors are vastly overlooked in psychiatry. They have SO much to do with serotonin, NE, and dopamine and our emotion centers within our brains. Psychic pain has a lot in common with physical pain - at least in the brain.
> >
> > Jerry
> >
> Hi Jer,
>
> I'l say that too
>
> Thou in past decades, Amphetamines were used to get people off Opi's, and MethylAmphetamine proved rather effective in helping withdrawal.
>
> Trading one substance for another, I guess, but theres evidence that the body in pain DOES produce it's own powerfull painkillers, Endorphins, think hard out exercise, and the high that produces.
>
> Did you start on 3 15mg Dex Spans right off?
> Hydro 20mgs day stil going well?
>
> Cheers dude,
>
>Hey Paul-
Interesting that amphetamines were/are? useful for opiate withdrawl. I agree about the body producing its own endorphins. I excercise (walking right now - trying to ease back into it) and it helps my energy and mood. Trust me when I say I wish I didn't have to substitute my endogenous opiates for synthetic ones - same with the stimulant. However, I may have sleep apnea which may count for the chronic daytime fatigue. I'm having a sleep study done at the end of this month. If I DO have apnea, I'm hoping either CPAP or surgery will help and allow me to stop the stimulants - maybe even reduce the opiate..? We'll see.
As for my dosage of Dexedrine - believe it or not but my pdoc had me on 20mg CR 4xdaily = 80mg!!! And I was still depressed and tired!! Asz I've said in posts before - I've been on and off Dexedrine for the past 10 years or so. Right now I wouldn't be able to hold my job if I didn't have it - even with the opiate. When I restarted Dexedrine this time - which was many months ago - I was switching from Concerta and yes, I did start at 15mg (spansules) 3x daily. I haven't had to increase at all and many weekends I take a stimulant holiday. Without the stim I'm so apathetic it's painful. The opiate is actually stimulating in its own right - but in a different way. It helps tremendously with apathy and motivation - but I still need the stimulant.
So right now I'm takeing 20mg Lexapro, 20mg hydrocodone (5mg 4x daily) and Dexedrine 15mg span 3x daily. Also, I can take up to 4 mg of Klonopin throughout the day - although I find I mostly need it at night (weird ehh??). I get most anxious at night before bed - which doesn't help with the chronic insomnia!! So, I take 15mg Remeron for sleep but am going to try Lunesta for a while.
LOL-almost every med I'm on is a controlled substance - but I don't see it that way of course. They're jsutmy meds - ya know?
One of my BIG problems is getting anxious at night. It's more of an anticipation of the next day I think. But I have the WORSt problem getting my mind to shut up and get to sleep. I used to be on Seroquel - which totally shut me down - but gave me the worst hangover (I was missing work, sleeping in and getting to work late, etc). Also the Seroquel caused me to gain 80pounds over a year! Since being off it - I''ve lost 25 poounds thank God!
Anyway- about sleeping - I can't even sleep in my bed - I usually sleep on my couch. My therapis and I are trying to figure it out. When I get in my bed I start to focus too much on TRYING to get to sleep whereas on my couch I just fall asleep watching TV (takes my mind off of ME). Hopefully I can get this straightened out.
Anyway, I hope this answered your questions - maybe too much info? Thanks for being there!
Your friend- Jerry
Posted by paulbwell on April 13, 2005, at 3:58:33
In reply to Re: Jerry » paulbwell, posted by jerrympls on April 13, 2005, at 0:15:55
Thanks Mate,
Not too mch info, we are so much alike, everything you stated Is a part of me and my life too!
we are the same age 1 year dif, controlled pills, wishing we dign't have to rely on outside(exodgenous) endorphines, brain energy, (stims), I ran out few days ago, and was a 3 claw sloath-slow-and sick, going to bed where you know you should sleep and your inner voice, screams BEDTIME-here we go!, stupid AD weight gain yuck!man I'm all with ya! jealous somewhat of your better treatments, but ya gotta keep in the game ha? and whatever does it for ya?
Your PB-soul bud,
Paul
Cheers
Posted by ed_uk on April 13, 2005, at 8:56:38
In reply to Re: Jerry » paulbwell, posted by jerrympls on April 13, 2005, at 0:15:55
Hi Jerry!
>>Are you 34?
>Yes I am 33...Oops I added a year!
Ed.
This is the end of the thread.
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