These comments are made for the purpose of discussion and should NOT be used as
recommendations for or against therapies or other treatments. An individual patient is
always advised to consult their own physician.
Addiction Concerns While Medicating
for Chronic Pain
Question: I have had 8 surgeries on my tmj’s. I have chronic pain. I had been
taking various narcotic pain medications for the past 3 years, Talwin, percocet, vicodin.
My doc switched me to oxycontin 40mg. I took the medication only 1 day per week so that I
could have 1 day of moderate pain relief. The oxycontin made me itch very badly, as well
as made it difficult to sleep. My Doc switched me to mscontin 30mg. This medication does
not cause me to itch. This medication only gives me 60-70% of the pain relief as the
oxycontin. Is there a formula that would determine what the equal dose of mscontin would
be to that of oxycontin? Also, due to tyhe public phobia of addiction, I am always worried
about getting addicted. I can truely say that in the many years of taking narcotic pain
medications I have very rarely experienced euphoria. My Doc would ok me to take the meds
daily. I have corresponded with many patients and doctors around the world. Most have told
me to take the meds if I am in pain. But I still have the fear of addiction. Which
medocation, oxycontin or mscontin, would be more likely to cause addiction? I am aware
that I will probably develope physical dependancy. I should note that I took Talwin NX 1-2
times a day for 3 years.I developed a tolerance to it and stopped taking it, cold turkey.
I did not experience any sort of withdrawls. Should I be so worried about addiction? I
have read many studies by the NIH and other institutions regarding pain management and
opiates. Many experts feel that true chronic pain patients will not become addicted. If
you could address myconcerns, I would be greatful. !
Answer: Addiction and dependence are defined as separate issues. Addiction has
an element of non-socialability(robbery, etc.). Dependence has no conotation of
anti-social behavior. You will become physically dependent, you will not become addicted.
Take the narcotics and use as much as necessary to keep the pain under control. Work to
change social attitudes, we need it.
Lortab & Ultram
Question: I need to know what physically happens when a person takes Lortab and
Ultram for a long period of time (2-3 years) ? How does long term use effect pain
tolerance and what happens to the nerve endings? Do you know where I can find out more
about the physical effects on the body.
Answer: I’m not aware of controlled studies using the two together. There is no
specific contraindication; but, in general pick one not two analgesics.
Physicians Concern
Question: Actually I have two questions. The first being, what is the difference
between an opiate and an opioid as well as, is Ultram an addictive pain medication? My
second question is a bit more complex, I have been taking Fiorinal w/Codeine for over 20
years, on and off, for Migraine headaches, back pain due to compressed Thoracic vertebrae,
and herniated lumbar disks’ as well as a host of other pains due to broken, fractured
bones. Why is it so hard for Physcians to understand that a patient is quite capable of
controlling their use of narcotic pain medications responsibly without becoming addicted?
I can understand that Physcians DO have problem patients that come to them for pain
medications “Just” to get High, but, I have NEVER taken medications unless I
have to. As a matter of fact, I HATE the feeling that I get from taking these medications,
therefore I have to suffer needless pain because “Most” physicians think that
ALL patients are subject addiction. I have stopped taking the Fiorinal w/codeine and have
never suffered any type of withdrawal symptoms or side effects. I also NEVER take any
medications without first consulting my PDR. The only things I am interested are the
adverse reactions and side effects, as well as how the medication is supposed to be taken.
I hope that someone can shed some light on this subject, because frankly I’m just to
darned aggravated by the situation. Thanks in advance for any information anyone can
provide.
Answer: An opiate contains a opium type drug; an opiate resembles an opiate. So
opiates are synthetic or structurally similar. Ultram does not currently appear addictive;
but, it is structurally similar enough that I suspect you will see physical addiction
reported in the future. The problem with physicians starts at a social level. The whole
social environment against drug use has permeated medical teaching and physician social
awareness. To change this you will need to change 40 years of general social propaganda.
It is beginning; but, just beginning.