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What are the adverse effects of hydrocodone for chronic pain?

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Posted on Tue, 1 Jul 2014
Question: I am a male 52 y/o semi-retired engineer and a 29-year chronic pain patient. My pain is mainly through my upper & lower left leg (aching) with stabbing pain in the top of my left foot, and occasionally aching/burning in my left groin. The best diagnosis I have been given is some type of injury to a nerve root or roots in my lower back. I have been through hell trying almost every conceivable treatment including back surgery, steroid injections, physical therapy, chiropractic therapy, acupuncture, dozens of different drugs & drug combinations. About 12 years ago, my doctor zeroed in on a combination of medications that have worked extremely well to manage my pain. These are: Neurontin 600x3, Prozac 20x1, hydrocodone 10-650x3 (changed recently to 10-325x3) & XXXXXXX 350x3. Although I still always have some pain, it is tolerable & I am able to get on with my life. My problem is that after 12 years, my pain specialist of 3 years abruptly quit all his patients (moved practice). With only 2 weeks before my bi-monthly appt., I find out I have a new doctor who will not continue my meds as in the past. He doesn't like prescribing XXXXXXX I asked why and he stated that it combines with hydrocodone to form a molecule that can be dangerous. I asked in what way (since I have been taking that combination for 12+ years - I was very concerned). He said it can be addictive to some people. I explained to him that during the past 12 yrs I have not had to increase my daily dose, except for occasional but rare times when I experienced flare-ups (break through pain), and wouldn't that suggest that my body is not addicted to it? He avoided the question saying only that he doesn't like prescribing it, if at all possible.

My delimma is that I lived in a small city with limited choices for pain management. I believe that the most important result from treating chronic pain is 'quality of life' first, followed by controlling the pain. My quality of life prior to this change was great, relatively speaking, for a chronic pain sufferer. Since the med change, I have been basically bed-ridden unable to do any physical work. The only way I can get any relief is to stretch out and remain as still as possible. I am at my wit's end and don't know what to do. Can you explain to me why I can't continue a medication regiment that has worked so well for 12+ years w/o any adverse effects? Sorry for the long-winded lead-up to my question.
doctor
Answered by Dr. K. V. Anand (3 hours later)
Brief Answer:
Pain management with alternative techniques

Detailed Answer:
Dear XXXXXX
Welcome to HCM
We understand your concerns

I went through your details. I can understand how pathetic your condition currently is. I really am feeling sorry.

But feeling sympathetic is not an answer here, I know. Your doctor is almost right with his point that he shall not prescribe hydrocodone. Hydrocodone is used to treat moderate to severe pain or its management. Hydrocodone is a semi-synthetic opioid derived from codeine. Hydrocodone is used orally as a narcotic analgesic, often in combination with paracetamol (acetaminophen) or ibuprofen. Hydrocodone is prescribed predominantly within the United States; elsewhere it is rare.

Common side effects of hydrocodone are nausea, vomiting, constipation, drowsiness, dizziness, lightheadedness, fuzzy thinking, anxiety, abnormally happy or sad mood, dry throat, difficulty urinating, rash, itching, and narrowing of the pupils. Serious side effects include slowed or irregular breathing and chest tightness.

Several cases of progressive bilateral hearing loss unresponsive to steroid therapy have been described as an infrequent adverse reaction to hydrocodone/paracetamol misuse. This adverse effect has been considered due to the ototoxicity of hydrocodone. Recently, researchers suggested that paracetamol is the primary agent responsible for the ototoxicity.

Keeping all these above, your new doctor is right in his judgement. Most of the doctors, now, avoid such a great risk to their patients. Therefore you should take the advice and treatment given by your new doctor.

Along with the medicines prescribed by your doctor, I suggest Pain management using psychotherapy should be useful to you. As per psychotherapy principles "The perception of pain is in your brain, so you can affect physical pain by addressing thoughts and behaviors that fuel it".

1. The worst thing about chronic pain is the sense of learned helplessness -- ‘there is nothing I can do about this pain,’. If you take action against the pain (no matter what that action is), you will feel more in control and able to impact the situation. Action means engagement. You should engage yourself in creative activities and games activities which keeps your mind engaged.

2. Self hypnosis can work wonders. The following link suggests how to perform self hypnosis. http://www.wikihow.com/Perform-Self-Hypnosis.

3. Meditation named Anuloma Viloma Pranayama or alternate nostril breathing (based on Yoga) is also immensely useful in this case. In this Breathing Technique, you inhale through one nostril, retain the breath, and exhale through the other nostril. The whole procedure is available in this link: http://www.abc-of-yoga.com/pranayama/basic/viloma.asp.

4. To have more information about Cognitive-Behavioral Therapy for Individuals With Chronic Pain. please download and read the XXXXXXX Psychologists Associations article: https://www.apa.org/pubs/journals/releases/amp-a0000.pdf.

I request not to underestimate the importance of psychotherapy and breathing exercise in the treatment of pain management. I can assure you, if you are able to do it sincerely, along with medicines, you shall get immense relief within a week's time.

Do not rush the follow up question now itself. Please read everything carefully. Practice the steps without fail every day. Come back with the follow up query after a week or so.

Hope you are satisfied with my answer.
God bless you.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. K. V. Anand (2 days later)
Dr. XXXXXXX thank you for your response. My doctor is adamant about getting me off XXXXXXX I met with him again yesterday and had a detailed consultation. I explained to him that since XXXXXXX is no longer a part of my treatment, I would like to get off the hydrocodone, as it does very little in managing my pain w/o the XXXXXXX combination. He was pleased to hear this and has switched me to a low dose of Tramadol. He also explained that as part of the change in medications, my pain will seem exaggerated but slowly get better as my body once again takes over the functions of the pain meds. He did not explain this when I first saw him. I now have a better understanding, knowing that the pain & disability I have been experiencing for the past week is temporary. That in itself is helping me cope better with it. My follow-up question is: Is Tramadol a safe alternative to hydrocodone? I hope one day not to need either but I need to start somewhere. Thank you.
doctor
Answered by Dr. K. V. Anand (10 hours later)
Brief Answer:
Mind has capacity to ignore pain

Detailed Answer:
Dear

Thank you for the follow up query. I was sure that you shall have better understanding about yourself when I answered your first query. My experience is such. Your consultation and detailed discussion with your doctor has come as an icing on the cake. I believe that the time has come to end your sufferings. That is why these things happen together. Blessed you are, for sure.......

In my opinion, tramadol is surely a safe and better option than hydrocodone. You shall discover that in a few days. Once you start tramadol, you shall also feel like you need to stop that even, that is so low a dosage. Now you should chalk out a plan to stop all these unnecessary medicines and only continue with what ever necessary.

Chronic Pain requires management. I shall give you one example: During our childhood we play some game. We are totally engaged. Suddenly we get injured. We see the wound, blood. But we are not interested. We ignore the pain, wound and blood for sometime. Playing is foremost priority then. After the game is over, we realize the pain, wound and blood. We feel the agony. We may not even able to walk for two days. See the fine line. MIND HAS THE CAPACITY TO EVEN FORGET A PAIN WHICH WAS ACTUAL....... REASON....IGNORANCE....DIVERSION TOWARDS OTHER INTERESTING ACTIVITIES. Our lesson.

Please go through all the details I gave line by line, word by word and adhere to the guide lines. I am sure that you shall manage your pain without pain killers. God bless you.

Dr. KV Anand PhD
Above answer was peer-reviewed by : Dr. Prasad
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Dr. K. V. Anand

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Practicing since :1993

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What are the adverse effects of hydrocodone for chronic pain?

Brief Answer: Pain management with alternative techniques Detailed Answer: Dear XXXXXX Welcome to HCM We understand your concerns I went through your details. I can understand how pathetic your condition currently is. I really am feeling sorry. But feeling sympathetic is not an answer here, I know. Your doctor is almost right with his point that he shall not prescribe hydrocodone. Hydrocodone is used to treat moderate to severe pain or its management. Hydrocodone is a semi-synthetic opioid derived from codeine. Hydrocodone is used orally as a narcotic analgesic, often in combination with paracetamol (acetaminophen) or ibuprofen. Hydrocodone is prescribed predominantly within the United States; elsewhere it is rare. Common side effects of hydrocodone are nausea, vomiting, constipation, drowsiness, dizziness, lightheadedness, fuzzy thinking, anxiety, abnormally happy or sad mood, dry throat, difficulty urinating, rash, itching, and narrowing of the pupils. Serious side effects include slowed or irregular breathing and chest tightness. Several cases of progressive bilateral hearing loss unresponsive to steroid therapy have been described as an infrequent adverse reaction to hydrocodone/paracetamol misuse. This adverse effect has been considered due to the ototoxicity of hydrocodone. Recently, researchers suggested that paracetamol is the primary agent responsible for the ototoxicity. Keeping all these above, your new doctor is right in his judgement. Most of the doctors, now, avoid such a great risk to their patients. Therefore you should take the advice and treatment given by your new doctor. Along with the medicines prescribed by your doctor, I suggest Pain management using psychotherapy should be useful to you. As per psychotherapy principles "The perception of pain is in your brain, so you can affect physical pain by addressing thoughts and behaviors that fuel it". 1. The worst thing about chronic pain is the sense of learned helplessness -- ‘there is nothing I can do about this pain,’. If you take action against the pain (no matter what that action is), you will feel more in control and able to impact the situation. Action means engagement. You should engage yourself in creative activities and games activities which keeps your mind engaged. 2. Self hypnosis can work wonders. The following link suggests how to perform self hypnosis. http://www.wikihow.com/Perform-Self-Hypnosis. 3. Meditation named Anuloma Viloma Pranayama or alternate nostril breathing (based on Yoga) is also immensely useful in this case. In this Breathing Technique, you inhale through one nostril, retain the breath, and exhale through the other nostril. The whole procedure is available in this link: http://www.abc-of-yoga.com/pranayama/basic/viloma.asp. 4. To have more information about Cognitive-Behavioral Therapy for Individuals With Chronic Pain. please download and read the XXXXXXX Psychologists Associations article: https://www.apa.org/pubs/journals/releases/amp-a0000.pdf. I request not to underestimate the importance of psychotherapy and breathing exercise in the treatment of pain management. I can assure you, if you are able to do it sincerely, along with medicines, you shall get immense relief within a week's time. Do not rush the follow up question now itself. Please read everything carefully. Practice the steps without fail every day. Come back with the follow up query after a week or so. Hope you are satisfied with my answer. God bless you.