Opiates and lower back pain

Posted by in Doctor X files, Drugs and diseases

Been thinking about asking this, so here goes.

I’m a 55 year old male who, over the course of about 35 years has had 3 lower back laminectomys and finally, about 18 years ago, a lower back fusion. Now don’t get me wrong, that lower back fusion was one of the best things I’ve ever done. It allowed me to go back to work full time as an automotive mechanic for 15 years. However, a few years ago, the lower back pain started getting progressively worse to the point where I could no longer work. I am now in constant chronic pain and am able to control it fairly well with opioids. Usually Percocet or vicodin, and the like.

My problem is where I live there is currently a big push in the medical community, backed by the goverment, to stop the prescribing of any type of opioid or narcotic pain killers. It’s getting harder and harder to find a doctor or pain clinic that will prescribe them or even see chronic pain patients as they are somewhat afraid to prescribe the meds anymore.

I currently am prescribed Percocet 5/325. 1 or 2, 4 times a day along with Flexeril. This only barely works. I’ve been going to the emergency room once a week or so because the pain gets unbearable. They give me a shot, usually Diluadid,   to break the pain and then send me home. I cannot get the current doc to prescribe anything stronger, so I’ve recently taken matters into my own hands and searched out stronger stuff. I am currently, on occasion, able to buy some morphine sulphate er 60mg tablets. When I can get these, about 4 tablets, 240mg, spread out through 24 hours, keeps me pretty much completely out of pain and able to function as a normal human being. (Yes, I am quite opioid tolerant.) I do not take any other meds with the morphine and I don’t drive anymore because of my back anyway, so that is not a concern.

My question is about switching medications. I will not be able to get the morphine for very long and the supply is expensive and erratic. I was considering going to opium. Either making opium tea or using the paste-like stuff that is captured from the pods that they used to make all opioid narcotics. Considering it contains all the opioid alkaloids, I was wondering if it might be a lower-cost alternative?

The only other option offered by the medical community is a “”spinal cord stimulator”” implant. It’s extremely expensive, I would have to have government help to pay for it and even then I doubt if I could afford the part I would have to pay. Several specialists have told me they wouldn’t do another surgery on me for any reason because it would just further aggravate the situation. One of the larger medical universities in the area are the ones who want to put the spinal cord stimulator in and even then, they cannot guarantee the results. The surgeon that did my fusion warned me repeatedly before he did it that I would never be able to have another back surgery after the fusion. To be honest, I don’t really want to have another surgery. I know they can’t really see what’s wrong because every time they send me for imaging (xray, MRI, ect) the radiologist always complains that the metal in my back whites out everything and they can’t see any detail.

 

It is very difficult to assess only through Internet in a case like this but I will give you my opinion. Opiates are one of the best available option for treatment of  pain that not responds to other treatments (analgesics, NSAID…). Its efficacy is well stablished in the case of short time pain, but not so clear in long-time pain. Risk of dependence but also pharmacological tolerance are the limitations of opioids. I also agree with you that moral prejudices are a important part, and sometimes life  with dependence than life with pain. Depending on the characteristics of pain some other treatments (amytriptiline, gabapentine…) can be very useful, although I can´t reccomend them only based in Internet information.

ER morphine sulphate should be used each 12 hours. It is better to use a higher dosage twice a day than four dosages during the day. Morphine and fentanyl are, among all prescription opiates, the ones with proved efficacy in control of long-time pain (more than 6 months). The proofs of efficacy of oxicodone or hydrocodone are much more limited in this sense.

Opium contains morphine and other analgesic alkaloids. Using it for control of long-time pain would have two specific problems added to general opiate risks: morphine would act ast “”fast release”” (intense effects but short time) and contain of morphine in opium could have big differences between different plants.

Cannabinoids could help to improve opiates analgesic effects but I don´t think should be enough in this case by themselves.

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