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Suggest An Alternative Medication For Oxycontin

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Posted on Fri, 13 Feb 2015
Question: oxycontin is very expensive. what is a good alternative? Not morphine, I have found that I live in a fog while taking morphine
doctor
Answered by Dr. Dr. Matt Wachsman (1 hour later)
Brief Answer:
depends upon the context.

Detailed Answer:
Cannot say in your particular case, but I can quote the most recent position of the experts in the field.

"Opioids for chronic noncancer pain: a position paper of the XXXXXXX Academy of Neurology. XXXXXXX GM1; XXXXXXX Academy of Neurology.
Author information
Abstract
The Patient Safety Subcommittee requested a review of the science and policy issues regarding the rapidly emerging public health epidemic of prescription opioid-related morbidity and mortality in the United States. Over 100,000 persons have died, directly or indirectly, from prescribed opioids in the United States since policies changed in the late 1990s. In the highest-risk group (age 35-54 years), these deaths have exceeded mortality from both firearms and motor vehicle accidents. Whereas there is evidence for significant short-term pain relief, there is no substantial evidence for maintenance of pain relief or improved function over long periods of time without incurring serious risk of overdose, dependence, or addiction. The objectives of the article are to review the following: (1) the key initiating causes of the epidemic; (2) the evidence for safety and effectiveness of opioids for chronic pain; (3) federal and state policy responses; and (4) recommendations for neurologists in practice to increase use of best practices/universal precautions most likely to improve effective and safe use of opioids and to reduce the likelihood of severe adverse and overdose events.

Would mention that they did NOT do a modeling analysis of the situation and if they had they would see that nearly all the adverse outcomes are within the first year of chronic use. Signs of going off the rails are agreed and, egregious:
equating how much narcotics as "how much help" and/or "how helpful and good the care"; escalating dose; unregulated dose and going against or around what the doctor is ordering; drug seeking/fixation; anger/denial.
People going progressively onto more narcotics, having more problems in their life due to relation to pain and narcotics and becoming fixated on them, need an integrated program to not focus entirely on pain.
1) phys ther to emphasize function.
2) other modalities including psychological ones (anti-depressants, nerve dampening meds like perhaps pregabelin and counseling) and rewarding more function and less illness behavior.
3) and lastly considering narcotic management systems such as suboxone. It precludes going off the rails with taking unregulated additional narcotics (they are blocked) and provides small but significant narcotic pain relief while likely blocking some of the tolerance.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dr. Matt Wachsman (1 hour later)
My pain started in July 2008 after herniation of 3 disk. S1, L5, L3. Surgery in Sept. 2010. Surgery was not successful. In fact, the surgeon now has 19 pending mal practice claims against him. He has fled the country. I've gone through hell with this injury. I absolutely loved my profession. 25 years of being in the health care field, all of the resources, all of the hours and hours of multiple types of therapies, all of the different options and types of drugs, psychological and psychiatry counseling have been of some help. The 1 thing that troubles me the most, "if you have never been in debilitating chronic pain, how can all of the experts REALLY know what a person actually goes through each and every day". I've gone from being a well respected professional in my community, a very competitive wanna-be athlete 20 years younger than my actual age, to a 60 y/o discarded person of society who has been in a fight for my life with this fucking pain. I've spent all of our life savings, outstanding medical bills and bankruptcy trying to get some relief. I'm often asked, "are you depressed"? I think anyone who has been in my shoes, may have had some degree of depression at some point. Another question I get asked quite frequently, "have you or do you have any thoughts of suicide"? My answer, "EVERY FUCKING DAY! But I'm not going to waste your time on explaining what it's like waking up every morning and praying for the first step to the bathroom to be painless.
So, thank you for the copy and paste answer. If this site is here to actually help people with questions regarding their health, maybe you could have done a little more to understand why an educated person would be asking for help with determining which medication would be an alternative to Oxycontin. I know what the alternative is, I also know how much I hate having to live this way! The price a person pays for having to live in pain goes much further than dollars. The reality of what pain does to families who suffer from the loss of a loved one who is no longer the person who they used to know. Thanks
doctor
Answered by Dr. Dr. Matt Wachsman (8 hours later)
Brief Answer:
I think I have answered this

Detailed Answer:
as there is no new question from you, there would be a list of usual questions one would ask in the context of chronic narcotic use:
(furthermore, an examination would really be required to say anything about your particular situation. Had one person faking cancer to get narcs, had one person with a cancer pain diagnosis who died from an infection not recognized and didn't actually have either addiction OR cancer, had one person who ER diagnosed with bad chronic arthritis who actually had a very small bit of disk disease that is mostly over.. and that was just yesterday... indicating the need for direct observation to make real judgements).
Questions in general:

what can you do on narcotics that you cannot do without them?
is use of narcotics for positive life goods or avoiding negative consequences when you do not get them?
and, if it is to mostly/totally to avoid negative consequences, are there negative consequences from the narcotic use?
what are some things/activities/goals/purposes which are more important than narcotics?

Otherwise I would be saying that other pain modalities and focuses other than narcotics have much better outcomes in the medical literature (phys ther., psychological counseling, etc.) and that chronic stabilization narcotics such as suboxone or methadone are important.
Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Dr. Matt Wachsman

Addiction Medicine Specialist

Practicing since :1985

Answered : 4214 Questions

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Suggest An Alternative Medication For Oxycontin

Brief Answer: depends upon the context. Detailed Answer: Cannot say in your particular case, but I can quote the most recent position of the experts in the field. "Opioids for chronic noncancer pain: a position paper of the XXXXXXX Academy of Neurology. XXXXXXX GM1; XXXXXXX Academy of Neurology. Author information Abstract The Patient Safety Subcommittee requested a review of the science and policy issues regarding the rapidly emerging public health epidemic of prescription opioid-related morbidity and mortality in the United States. Over 100,000 persons have died, directly or indirectly, from prescribed opioids in the United States since policies changed in the late 1990s. In the highest-risk group (age 35-54 years), these deaths have exceeded mortality from both firearms and motor vehicle accidents. Whereas there is evidence for significant short-term pain relief, there is no substantial evidence for maintenance of pain relief or improved function over long periods of time without incurring serious risk of overdose, dependence, or addiction. The objectives of the article are to review the following: (1) the key initiating causes of the epidemic; (2) the evidence for safety and effectiveness of opioids for chronic pain; (3) federal and state policy responses; and (4) recommendations for neurologists in practice to increase use of best practices/universal precautions most likely to improve effective and safe use of opioids and to reduce the likelihood of severe adverse and overdose events. Would mention that they did NOT do a modeling analysis of the situation and if they had they would see that nearly all the adverse outcomes are within the first year of chronic use. Signs of going off the rails are agreed and, egregious: equating how much narcotics as "how much help" and/or "how helpful and good the care"; escalating dose; unregulated dose and going against or around what the doctor is ordering; drug seeking/fixation; anger/denial. People going progressively onto more narcotics, having more problems in their life due to relation to pain and narcotics and becoming fixated on them, need an integrated program to not focus entirely on pain. 1) phys ther to emphasize function. 2) other modalities including psychological ones (anti-depressants, nerve dampening meds like perhaps pregabelin and counseling) and rewarding more function and less illness behavior. 3) and lastly considering narcotic management systems such as suboxone. It precludes going off the rails with taking unregulated additional narcotics (they are blocked) and provides small but significant narcotic pain relief while likely blocking some of the tolerance.