Vicodin addiction/withdrawal

Factual Questions
21

[QUOTE=Qadgop the Mercotan]
Many, many folks with chronic pain who end up on opiates tend to end up on massive doses of opiates and still report just as much pain as they used to have, along with mild to moderate sedation and severe constipation. So opiates are not good for your basic long-term chronic pain treatment.
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Just to add my opinion: everything the good doctor says here is true, and in general if somebody says they can only obtain pain relief by opiates, it’s almost certain they’re just after a quick fix.

But it’s not ALWAYS the case. I know several people that do get chronic pain relief from opiates, who use them on a regular basis but are not addicted. (Of course, definitions of “addiction” vary, but I consider addiction psychological, the “wanting with all their heart and mind and spirit” you so eloquently mention.) I might know others, but I don’t have sufficient data to judge whether they’re lying or not. The ones I’m confident of are the ones who have had treatments to stop their pain that succeeded, and were immediately able to stop taking opiates without any further use of them. I don’t consider those patients addicted.

For the vast majority of people I talk to, though, I’m quite convinced that you’re absolutely correct: they’re lying, either to me or to themselves, and are just plain addicted.

22

[QUOTE=Qadgop the Mercotan]
I’ve known lots of addicts who managed to put the cap back on the bottle for extended periods, including myself. The hoarding, the breaking the law to obtain the drug, are far bigger red flags that there is a problem.
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Sure, but immediately upon cessation of pain, and without the desire to take up the pills again? If a person is using opiates for their psychological benefits, that’s addiction; if it’s just for pain relief, that’s not. In my terminology, anyway.

See, I think they’ve been a little shoddy with the writing. If he’s an addict, he should have still been taking the pills, or at least showing signs that he was struggling with his abstinence, during the period his leg wasn’t hurting. If he’s not, then he shouldn’t have been going to so much trouble to stockpile a huge stash of pills.

I’m afraid I’m going to need to hear some more exciting and terrifying tales of your dysfunctionality before I can decide how much weight to give this argument. :wink:

23

[QUOTE=chorpler]
But it’s not ALWAYS the case.
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You’re right. And I have a few chronic pain patients whom I have on opiates. But it’s never the first tool in my toolbox for treating chronic non-malignant pain, even in patients with zero abuse problems.

Opiates tend to work better for folks with well-defined, regionalized chronic pain problems like a radiculopathy, where a specific nerve root is damaged, and causing problems, or for the painful sequella of arachnoiditis, inflammation of the brain and spinal cord lining.

Opiates tend to not be so hot for poorly defined, generalized pain syndromes such as chronic daily headaches, musculo-skeletal back pains, fibromyalgia, and chronic fatigue.

Is the War On Addiction Becoming a War On Pain?
24

[QUOTE=Qadgop the Mercotan]
I

Otherwise, judicious use of medications like acetaminophen, or ibuprofen and related compounds along with stretching and exercise, distraction, meditation, nerve blocks, TENS units, and so forth have actually been demonstrated to give greater long-term relief of chronic pain than opiates.
But all too many chronic pain patients don’t need them, they only want them with all their heart and mind and spirit.
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Right. For me, the usual dose of Vicodin does no better to kill the pain than two extra str acetaminophen and 800mg of ibuprofen. In fact, that works better for me, except that Vicodin is nice to help me get to sleep when there’s pain involved. Thus to me, Vicodin isn’t any better than OTC drugs, except when it is bed-time. I have used Vicodin for back pain, tooth-ache/oralsurgery and after foot surgery. In all three types of pain, I found OTC better than Vicodin for the actual pain. As QtM sez “Opiates tend to not be so hot for poorly defined, generalized pain syndromes…”

Note, dudes- taking as little as 2x the recommened daily dose of acetaminophen can be hazardous to your liver. And acetaminophen(Tylenol) hides in many OTC remedies such as many cold medicines. So be careful. Liver failure is not pretty.

And yes, 800mg of ibuprofen is something you should only take after discussing it with your MD.

Aspirin is a true wonder drug, but one should ask your Doc if you plan on taking it after surgery as it can really impede blood clotting, which can be very bad.

In a lot of cases “doubling up” on OTC pain medications (by that I mean taking a higher than normal dose of two types, like ibuprofen & acetaminophen) is something your Doctor will approve of, but **DO DISCUSS IT WITH HIM FIRST. **Otherwise: follow the label carefully and never exceed what it sez.

25

[QUOTE=Kalhoun]
My SIL has been addicted to it for years, and she’s fully capable of doing her life. YOu build up a resistance to it.
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As far as I understood the subject, you build up a resistance to the analgesic properties of it (“tolerance”) but I haven’t heard of resistance to the side-effects associated with an effective dose. (Whether that is the recommended dose, or a dose upped to compensate for heightened tolerance)

Anyone care to dispell my ignorance on this?

26

[QUOTE=Gukumatz ]
As far as I understood the subject, you build up a resistance to the analgesic properties of it (“tolerance”) but I haven’t heard of resistance to the side-effects associated with an effective dose. (Whether that is the recommended dose, or a dose upped to compensate for heightened tolerance)

Anyone care to dispell my ignorance on this?
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The only thing you don’t develop tolerance to is the constipation. Pretty much everything else – pain relief, euphoria, breathing suppression, sedation, etc. – you can develop an amazing tolerance for. (And some people even develop tolerance to the constipation.) An acquaintance of mine who had his spine partially crushed in an accident was using morphine for over two years before he died, and for the last few months he was taking 1300mg every day (the usual therapeutic dose is 10mg) and maintaining consciousness just like a regular person. And I once read an article about a guy who took an astonishing sixteen GRAMS of morphine daily.