Pain medication and addiction in Crohn's Disease

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I , personally, don't have a problem with it UnXmas but lets see what other folks say. I have not had any problems with addition so I wish I had suggestions for you. Hang in there.
 
Been a while since I last posted on this thread. I've had many codeine-free days recently, and my overall consumption is down quite a bit. The doctor's prescription now lasts me a month like it's supposed to. I still take it all at one time though, I don't take the 30 to 60 mg at a time like I'm supposed to, I take, at the moment, usually 180 to 240 mg in one go, though that's lower than my average dose was a couple of months ago. And I still take over the daily limit often. It's just not effective to take 30 to 60 mg at a time and never go over 240mg in a day. Much better to have 240mg in the morning followed by another similarly large dose later in the day and have a really good day. If I took 30mg and then a few hours later another 30mg and so on, it would just waste it because I'd still get through a lot of it but not feel any benefit other than staving off withdrawal.

And withdrawal is a funny thing. One thing I've found that's helped me to cut down is that sometimes I feel awful withdrawal and sometimes it's not that bad. (And the reverse is also true: sometimes a high dose makes me feel so much better, and other times only a bit better - but always at least a bit, it never fails to make me feel a bit better and I always feel better taking some than none.) So I try going without, and if the withdrawal's awful I take some, if it's not, I keep going without.

And I'm still using it in the way it's of most help: if I feel awful, physically, mentally, for reasons nothing to do with codeine withdrawal, a big dose will calm me down and steady me a bit.
 
Hi Unxmas

Have you considered Methadone? I have no idea about how withdrawal works but perhaps you can work with a withdrawal clinic but they would require you not to take your script. Just something I am throwing this out there for your thoughts.

Happy New Year.:dusty:
 
I don't think codeine is strong enough to warrant methadone. Codeine withdrawal just feels like having the flu, getting over-emotional, and really wanting to take some codeine even though I'm not quite sure why I want it. Taking methadone would cause more problems than carrying on taking codeine. Thanks for the suggestion though. :) Happy New Year to you too!
 
Unxmas

Are you in a state that offers medical marijuana? Again I am just racking my brain to help you. It is not offered in Virginia. Very conservative. Well, that is all I can think of at this point but I feel your frustration. Take care and thanks for a Happy New Year. They, being Christmas and New Years comes faster and faster the older I get...LOL
 
But don't worry about me, goofy. I don't intend to stop codeine completely. If I did want to do that, I'd just ask my GP to stop my prescriptions. You can't buy codeine here, you can only get it if you have a doctor's prescription (well, you can buy codeine in very small doses that also contain paracetamol. The reason for the paracetamol is that it makes you sick if you take too much, so you can't take any more than the very small amount of codeine - I know, I've tried it :p and I can't stand feeling nauseous, so I won't do that again!). If the GP stopped my codeine prescription, I'd go through a few days of feeling like I had bad flu, but it's not dangerous and it's not terrible - I've done it many times, voluntarily. But what I'm trying to do at the moment is cut my codeine use down, because it was getting out of hand, but not stop it.

Maybe it would help if I set myself definite limits to stick to. I have been cutting down, but when I feel bad I take more. Maybe if I set myself a specific number of pills to take, and maybe another specific number for when I feel very bad, it would be easier than just having the undefined idea of cutting down. Guess I could also ask my doctor to reduce my prescription? except I need to have control of it myself.

But anyway, codeine addiction and withdrawal are nothing compared to strong opioids, I'm sure other drug addicts would not be impressed by the amount of fuss I make about it. :p And codeine withdrawal isn't dangerous, which is another critical difference. When I was in hospital, I had oxycodone - I posted about it on this thread - and the withdrawal from that was something else - and I'd only been on it for a few days! That withdrawal was awful, and there was no way I could have done it by myself. I was begging the doctors and nurses for more.... if there'd been any way I could have got someone to sneak it into the hospital for me, I probably would have, I was that desperate for it.

A nurse told me that if you imagine a scale of the strength and withdrawal of opioids, heroin would be at the very top: the strongest effects and the most terrible withdrawal. She said oxycodone would be right up there just below heroin, though the withdrawal after just a few days of use shouldn't have been anywhere near as bad as it was for me. I think for some reason opioids just do it for me: something in my physiology just responds to them and taking them makes me feel so well, and my body just hates it when they're taken away. And the nurse said codeine is right down at the bottom of the scale. In fact, once I was off the oxycodone, the doctors were fine with letting me have doses of codeine higher than the recommended maximum. I think they felt that, compared to oxy, codeine addiction wasn't worth worrying about.

From that experience I learned never to try another opiate: pain is better than withdrawal. But also that codeine addiction isn't terrible.
 
Btw goofy - do you have pain? How do you manage it? (A lot better than I do obviously. :p ) I saw on your profile you have fibromyalgia, and am I right in remembering your take Elavil? I take it, but for pain but for sleep and as an antidepressant. Have you joined the support group for it?

http://www.crohnsforum.com/showthread.php?t=47926

(Elavil's a brand name for Amitriptyline.)
 
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I've read through this thread and I've noticed that a lot of you talk about taking Dilaudid. Are you taking it at home, in pill form? I've only ever gotten that in the ER by IV. When I need pain meds at home, I've only been given Tramadol (or a few days worth of Vicodin if I'm being discharged from the ER). I was just curious because I've never heard of docs prescribing Dilaudid pills for home (which would seem like a life changer!).
 
I pulled a muscle or something in my leg the other day. Codeine stopped the pain like magic. There are definitely benefits in continuing to take it.
 
Hi UnXmas. I didn't kow there was a group for fibro and those taking Elavil. It really does take the pain away at night time and helps me to rest. One a new note....I tried the new drug Entyvio approved by the FDA for Crohns and after the fourth does I had an anaphalysis response and off to the ER I went. I looked like a burn victim. It was all over, hurt like being a burn victim and had respiratory involvement. Now my GI guy is sending me to medical centers to see if they have any studies going on. The only thing I am on now is steriods and that aint cutting it. Hope all is well with you and hope others have more success with this new drug. It is a great hopeful drug for so many that struggle with remission.
 
Goofy! That sounds awful! Have you had reactions to other meds before?

Amitriptyline (Elavil) still works very well for me at night. I've been trying to find alternatives to codeine; my doctor prescribed me tramadol but I'm not sure the benefits were worth the side effects, so I'm still in the same situation with painkillers, trying to make my prescription last longer, but my doctor isn't concerned and tells me to take codeine if it makes me feel well, which it does.
 
Hi UnXmas. I have tried so many drugs including all the TNF drugs. I have had anaphylasis to liver failure. Some of them have latex in them or in the vials they are in and I am anaphylatic to latex as well. Sorry my spelling is not my forte. I do take narcotics for the pain and the doc tells me to take them but I don't have any problem with lowering the dosages or taking the full amount as perscribed without any addiction symptoms. My heart goes out to you. Crohn's is just so complicated in itself and then the meds with their side effects complicates things even more.
 
I am so blown away, hurt and angry!!! I've said before on this page that I've been on and off narcotics for years and with in the last 2yrs i've been able to stay off them. I'm having a bad spring (my crohns seems to flare in spring and fall), and needed some pain relief. I went to the ER, as I have been told to do in the past, and was denied pain meds unless I submitted myself to a CT scan and scads off other tests to see what was causing the pain. I told him I know what is causing the pain and I see my GI in two days and would rather have him call the tests due to expense. He told me due to having signed a substance agreement he cannot give me meds. I said this makes no sense, the contract is to make sure I stay within my Docs not ER, besides, I said, I have pain meds at home that are not working, I don't want to leave with any, just need a break from all this pain. He looked at me like I was an idiot and seeking out medications. I left AMA, crying for being accused of doing that! He was so cold and mean, and has no clue how to deal with a chronic pain patient. Sorry had to vent. I hate this disease!!!!!
 
I'm sorry long time crohnie. :( Do you have a copy of the contract? The hospital must have records of your ER visit, you could find out who this doctor was and get his superiors to educate him. If you don't have a copy, it sounds like it would be a useful thing to have should you ever need to go to the ER again.

Why on earth would a doctor only give you pain meds if you have a scan? If you were drug seeking (which is a possibility the ER doctor did have to consider), why would it then be ok to give you meds after the scan?! Or did he mean only if tests revealed a legitimate cause of your pain to prove you weren't just drug seeking? Did he not even offer you non-addictive pain meds? I know they're often useless, but things like paracetamol may have helped you a bit.

Again, I'm very sorry this happened to you. You're doing so well staying off pain meds, you don't deserve to be treated like this for something in your past when you've moved on.

Can I ask though, if you were to take painkillers again now, do you think it's possible you'd have difficulty getting off them again? If you're pretty confident it wouldn't be a problem, maybe your usual doctor could give you an emergency supply to keep at home so as to eliminate the need for ER visits.
 
UnXmas, Thanks for your reply and support. I cannot find my copy of the Controlled Substance Contract and have asked my doc for a copy. It is my understanding that you must sign this if you have been given any controlled substance within the ProHealth doctors. I signed one for my psych doc due to being on xanex for anxiety. It is standard practice. So yes, I do have an emergency supply, why one of the two contracts I've signed, for oxycondine. Unfortunately these meds were not helping, which is why I went to the ER. I explained what happened at my GI appt yesterday and my PA was appalled.

Im well aware of people drug seeking, which is why they implemented this contract. To ensure you stay within the providing physician and not dr hop. He meant that he would not give me any pain relief unless they found a problem via cat scan. My GI agreed that I should not have had to have one. He offered my nothing but accusations that I was a seeker. I haven't been to the ER for pain relief in 18mos!!

Re taking pain meds now, I try and not take them daily and if need be, only 1-2 a day. I know all too well how fast our bodies can become addicted, Ive cleaned my self up 2x in the past 20yrs (on my own knowledge of being on too many and not knowing my pain levels any more). I believe that addiction is a chronic issue w this shitty disease, and as long as I am open and honest to my docs and make sure they monitor me, I'll be ok. Thanks again
 
I believe that addiction is a chronic issue w this shitty disease, and as long as I am open and honest to my docs and make sure they monitor me, I'll be ok.
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This is how I think about it too. I know I'm addicted to painkillers, but I also know I have legitimate pain. But since secrecy is meant to be a major sign of an addict, I make a point of not keeping anything from my doctors, including telling them I'm addicted and that I take more medication than I should (which they know, since they prescribe it all).

I haven't heard of contracts before, maybe we don't have them in the UK or maybe they don't have them for codeine, which is the only addictive painkiller I take when not in hospital.

I hope your pain is better and you can avoid the ER and its less-than-helpful doctors.
 
So update on the pain med situation: I've fractured my spine. I think I probably fractured it over a year ago as that's how long I've been having lower back pain for, but I recently had an X ray confirming it. The background to this is that I've had osteoporosis since childhood (idiopathic juvenile osteoporosis) and the idiopathic childhood disease has been worsened by steroids, low weight and malnutrition to result in my bones being incredibly thin. So this fracture is undoubtedly going to be joined by more (it's amazing I haven't had other breaks by now) so more pain is in my future. And besides that there's the stomach pain of course, though I've been lucky that my Crohn's pain has not been chronic; I've had episodes of severe pain, and of course pain from surgeries, but I've always known there was an end in sight. And that's still the case. I get blockages and such, but normally my stomach is merely uncomfortable.

But anyway, my doctor has increased my opiate pain meds. I know I'm horribly addicted (I went through one of my opiate-free trials yesterday, just twenty-four hours, and I was beginning to get a bit desperate by this morning. I just took them half an hour ago and feel very relieved). But I would rather continue the addiction than give it up. My doctor and I have tried all sorts of non-opiate meds, and physiotherapy, but they don't touch the pain. (Though the physio has helped a lot with other issues.) The only other thing that's ever helped relieve pain for me is diazepam (used as a muscle relaxant), but that's addictive too! Amitriptyline is hugely beneficial as it allows me to sleep through my various pains and discomforts at night, but I've not yet become desperate enough to need to sleep through the days as well.

I don't think I really have a question to ask with this post, but any advice is welcome, even if it's to tell me that increasing my meds further isn't a good idea. If that is how anyone feels I'm open to discussing it.
 
Having been through the pain med/addiction/recovery road, I sympathize with you. Being in constant pain is awful. There aren't a lot of alternatives. It is a difficult situation, no getting around that.
 
I realize that this might be very late but I would like to point out that they do give you narcotics when you have pain because being in pain not just sore or discomfort but real Crohn's pain puts stress on your heart which if you are already dehydrated and having problems would be very bad now of course you should not be taking them like candy or on a constant basis but when used properly they work with little to no addiction problems it's a medication like any other one and can be dangerous like all medications so if you do what your doc says to do you will be alright now yes you can become dependant on them but that does not mean addict sometimes its because you are litterally in pain and without them your body will freak out that is why they are only used when pain is interfering with your daily life especially when eating or sleeping which are crucial to healing also no they don't like to prescribe then when you have obstruction and blockages but in the words of my old GI who was awesome what are you supposed to do be in pain all the time litterly there are not that many options as seeing the only over the counter a person with Crohn's can take is Tylenol and to be honest not does not even treat my constant headaches I hate when anyone says take tylenol it doesn't help but to each his own so it's not uncommon for Crohn's patients to be put on narcotics for pain it's just not what they want but they cannot keep you in pain at least any well-meaning caring physician should not do and if they refuse to do anything at all about the pain time to find one who will
 
Take a look at ondansetron. It's an anti-emetic. I was given it to get me off cyclizine, but it causes terrible migraines.

However! There are very promising studies showing ondansetron can mask the worst cold turkey withdrawal symptoms. This is why I've kept as many as I can - sooner or later I'm going to have to come off the codeine. Last time took weeks and was extremely uncomfortable.

Someone earlier mentioned methadone. This is foolish - if you're shooting up heroin every day then, yes! For codeine it would actually make you higher and re-enforce the physiological dependence.
 
I get bad insomnia and headaches that last 2 days when I take hydocodone or morphine. Does anyone else have theses issues with pain meds?
 
Trapper said:
Take a look at ondansetron. It's an anti-emetic. I was given it to get me off cyclizine, but it causes terrible migraines.

However! There are very promising studies showing ondansetron can mask the worst cold turkey withdrawal symptoms. This is why I've kept as many as I can - sooner or later I'm going to have to come off the codeine. Last time took weeks and was extremely uncomfortable.

Someone earlier mentioned methadone. This is foolish - if you're shooting up heroin every day then, yes! For codeine it would actually make you higher and re-enforce the physiological dependence.
Click to expand...

You're right about the methadone.

Does ondansetron help with any withdrawal symptoms besides nausea?
 
pfosterm1963 said:
I get bad insomnia and headaches that last 2 days when I take hydocodone or morphine. Does anyone else have theses issues with pain meds?
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I've not had that problem. I don't know about hydrocodone, but I've had morphine several times, and I've always found the side effects I do have to be very short-lived rather than continuing for days. I think morphine causes drowsiness rather than insomnia. But I've contradictory side effects from some meds, so I think it's perfectly possible that your insomnia and headaches are from hydrocone and morphine. Have you tried any other painkillers?
 
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I've tried Tramadol with the same problems. I have to be very sick in order to take a pain med. I am in a bad place with these issues. Thanks for your reply. 😀
 
A pain management Doctor once told me I should never feel guilty or ashamed because I have to take pain medication. Its a needed medication for some and one should never feel guilty or be made to feel like a addict because they are in constant pain from a health issue. You cannot help the fact that you are in pain and its not appropriate for anyone to call you a addict because you need these meds to function.

That being said I do take pain medication and I would say my body is addicted to them. But what exactly are you suppose to do? Am I suppose to curl up on the couch in pain all day? If it were not for these medications I would not be able to do much of anything. Between my Stomach and back I wouldn't be able to function on a daily basis. I'm certainly not saying you need them for every little twing that you feel as pain is the bodies way of letting you know there is something wrong. But when you know whats wrong and there is nothing that can be done. It is certainly not the humane thing to do to expect someone to experience debilitating pain.

People that have called me a "Pill head" are the same people that would rush there dog to the vet if they thought it was in pain, would do anything for the animal to help its pain. But yet a person in pain taking a prescribed medication is a drug addict. There is something wrong with the world today.

If you are in pain please do not feel bad about taking your medications. These people asking you why you need it are not the ones in the pain. They do not know your pain nor do they understand what its like to be in constant pain as we sometimes are.

I get asked what Crohn's pain feels like by people all the time. My reply: Go get a pair of vice grip pliers, grab your stomach with them and twist as many times as you can never letting go. This is the best way I have found to express the lvl of pain I experience with Crohn's. And I'm suppose to go without my meds no I think not.
 
All good points, pjm. What medication do you take, if you don't mind my asking? Do you find tolerance a problem? (You probably know the difference between physical tolerance and mental addiction, as you seem to know what you're talking about, but if not, tolerance to a pain med means you need to keep upping the dosage because you've used it often and your body has become tolerant to its pain-relieving effects.)
 
UnXmas said:
All good points, pjm. What medication do you take, if you don't mind my asking? Do you find tolerance a problem? (You probably know the difference between physical tolerance and mental addiction, as you seem to know what you're talking about, but if not, tolerance to a pain med means you need to keep upping the dosage because you've used it often and your body has become tolerant to its pain-relieving effects.)
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I take hydrocodone when its really bad I take percocet. My PM Doctor had me on Methadone at one time but it created a problem with constipation so he switched me to the Fentanyl Patch. I had to ask him to think about it for a minute. This medication is causing extreme constipation in someone with a narrowed ulcerated bowel which in turn is causing me pain which I come to you for help with. He took a minute to let it sink in and then changed me to the patch.

Yes I have a problem with resistance to pain medications. But I find that if I keep my GI DR informed on my pain medication lvl's and inform the ER dr's they will generally treat my pain correctly when I have to go to the ER or am hospitalized.

Its a shame that we have to go to a pain management dr to get the relieve we should be able to get from our GI Doctors. These recent laws they have created related to narcotics have caused more and more people that cannot afford 3 Doctor visits a month to have to turn to other means of pain relief. How is it that a Dr treating a extremely painful condition has to ignore one of the symptoms of the condition for fear of loosing his practice.
 
pfosterm1963 said:
I get bad insomnia and headaches that last 2 days when I take hydocodone or morphine. Does anyone else have theses issues with pain meds?
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Hydrocodone keeps me up at night when I have to use it. I find it helpful to take a melatonin tablet. Its a non addictive sleep aid found in the vitamin section of your pharmacy. It WORKS! :) As with any addition to your meds I would ask my GI DR if it was ok before taking it though.
 
After 7 years of being rx'd Hydromorphone, I'd become hopelessly addicted to opioids. Throughout those years my saving grace was a friend with a Buprenorphine prescription.
I now have my own RX for Suboxone and I think its safe to say that it has completely saved my life. Not to mention the constipating effect actually allows me to function without the fear and anxiety that comes with not being able to control my bowls.
I wonder if any of you can relate to this positive effect opioid constipation can have? Understandably some opioids cause more severe constipation then others, and believe me I've tried them all, but at the same time I've found that others allow me to function in life. Specifically (for me) Buprenorphine.
 
hi
A doctor treating a person for pain needs to look for potential risk factors for substance abuse, such as a personal or family history of other types of substance abuse or psychiatric disorders,


Thanks
 
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I've been on percocett for over 15 years and have not had any real problems. First off one has to respect the med as its very additive. The tendency is to want more as time goes on. I avoided that route and limit it to two tablets a day maximum. Often only half a tablet is enough to settle the pain. This painkiller does two things well. It provides that all important glow or feel good as it goes to work that other pain meds don't. This reduces stress and takes away ugly weight of cramps giving me a decent level of life quality. The other thing is it helps with watery stool and I have better formed bowel movements.
 
goofyrn2 said:
Hi UnXmas. I didn't kow there was a group for fibro and those taking Elavil. It really does take the pain away at night time and helps me to rest. One a new note....I tried the new drug Entyvio approved by the FDA for Crohns and after the fourth does I had an anaphalysis response and off to the ER I went. I looked like a burn victim. It was all over, hurt like being a burn victim and had respiratory involvement. Now my GI guy is sending me to medical centers to see if they have any studies going on. The only thing I am on now is steriods and that aint cutting it. Hope all is well with you and hope others have more success with this new drug. It is a great hopeful drug for so many that struggle with remission.
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Didn't your GI Rx Benedryl and/or prednisone bolus in your first month or so of a new biologic to PREVENT the anphaphalctic shock?
 
I have intermittent Crohn's symptoms. I was eventually prescribed Tramadol 50mg which I take when I've had enough of pain and want a break. On the plus side, 1 tablet takes about an hour to work and yet the effects usually last for 2-3 days.
As much as anything it gives me the confidence to know wherever I go I have a backup plan which will get me through the occasion should I need it.
I am very careful with Tramadol, I've given up smoking and drinking so I can recognise the signs of addiction easily and I can see how people get addicted to it. At most I use about 25 tablets per year.
Other than that I'm lucky that I don't need anything.
 
Spedley, thats great that tramadol helps you. It sounds like it helps the diarrhea as well as the pain. I was on tramadol as needed for many years, until I was put on medications that had interactions with it. Tramadol actually messes with the serotonin levels in your body as part of how it relieves pain, so make sure you don't take other meds that also mess with it.

Its also good that you are careful. The more careful you are, the slower your tolerance will rise.

I am currently on lyrica, cymbalta (antidepressant that can help pain) and hydrocodone 7.5mg for chronic abdominal pain. I was actually on morphine ER 15mg earlier this year after my insurance took me off butrans patches. I am glad I found that lyrica and cymbalta help.
 
Folks, here is a suggestion....discuss with ur GI, I have tried everything and finally using Zubsolv, a month supply I can titrate and lasts 4 months...If you have Short Bowel Syndrome, no need to worry about constipation or transit time....this works miracles for me...controls diarrhea, stomach pain and no high or NO euphoria, leg and arm pains and cramps....use it at night...
You need Pain Specialist-Anaesthesiologist to write this script.
good luck....
new studies 2 tylenol and 2 ibuprofen= better relief than any opiate...
Cheers...
 
MarchelloHUdson said:
Folks, here is a suggestion....discuss with ur GI, I have tried everything and finally using Zubsolv, a month supply I can titrate and lasts 4 months...If you have Short Bowel Syndrome, no need to worry about constipation or transit time....this works miracles for me...controls diarrhea, stomach pain and no high or NO euphoria, leg and arm pains and cramps....use it at night...
You need Pain Specialist-Anaesthesiologist to write this script.
good luck....
new studies 2 tylenol and 2 ibuprofen= better relief than any opiate...
Cheers...
Click to expand...
About the ibuprofen, be careful about nsaids. They can cause bleeding.
 

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