[Arnold Layne]

This looks good, and I hope that folks will now be getting more useful analgesia. I have been lucky, my GP has no fears about prescribing high end Opioids, although she does check first with the Pain Management Team. But for over two decades now I've been on Opioids, and the dose is largely up to me to decide. For what its worth, I think this report is bang on the money, and is entirely Good News for those with chronic and/or acute pain symptoms.

If your GP is proving less than helpful with prescribing painkillers like Morphine or Oxycodone, it may be worth printing this off and taking it in to show them?

Personally, I think Morphine rocks as a pain control tool. Gold Standard, and as safe as houses so long as you are not silly and don't go crazy with the doses, chasing some illusory and fictitious "High". Whilst Oxycodone works bloody well, it is synthetic, and that is a minus sign in my book. At the moment Oxy is my front line attack on pain, with Morphine as back-up and support. Oxy is way less nod-inducing, almost coke like in its first effect. Makes it a more useful analgesic for daytime needs. I reserve Morphine for evening and night time if at all possible, when being knocked out is not such a bad thing 60mg of Oxycodone, with a top-up of 40mg quick release Morphine Sulphate, and a fat neat spliff of something good, is one hell of a send off, and it usually gives me a few hours half decent kip, which is nice.

I also keep a spliff in my bedside ashtray for night-time top-ups where and when required. Only thought of this a little while ago, and cannot believe I did not think of it earlier! Works wonders! Wake up with Sciatic pain chewing on your legs and feet, sit up slowly and gingerly, two puffs on the spliff, and Zzzzzzzzzz away you go back into the Morphine rich dreamscape. Its not perfect, but its the best I have and can hope for.

Anyhoo, here's the news item from the BBC news website:

Quote

Many patients with advanced cancer and other debilitating conditions are being "under-treated" for their pain, new guidance from the health watchdog says.

NICE wants doctors in England and Wales to make more use of morphine and other strong opioids - the only adequate pain relief source for many patients.

The guidelines recommend doctors discuss patients' concerns.

These may include addiction, tolerance, side-effects and fears that treatment implies the final stage of life.

The guidance deals with five opioids: morphine, diamorphine (heroin), buprenorphine, fentanyl and oxycodone. They come either from the opium poppy or are synthetically produced versions.

NICE - the National Institute for Clinical Excellence - says "misinterpretations and misunderstanding" have surrounded the use of strong opioids for decades, which has resulted in errors "causing under-dosing and avoidable pain, or overdosing and distressing adverse effects".

There is also the legacy of Dr Harold Shipman who used diamorphine to murder his victims. It has made many doctors wary of prescribing strong opioids.

NICE says the aim is to improve both pain management and patient safety.

Mike Bennett, St Gemma's professor of palliative medicine at the University of Leeds, said: "Almost half of patients with advanced cancer are under-treated for their pain, largely because clinicians are reluctant to use strong opioids."

Prof Bennett said the issue also applied to the late stages of other conditions such as heart failure and neurological disorders.

In a summary of the guidance in the British Medical Journal, he said doctors should address patients' concerns and reassure them that addiction is "very rare".

Doctors are also told to advise patients about side-effects, including constipation, which can be treated with laxatives.

Dr Damien Longson, Chair of the NICE Guideline Development Group said: "People worry they can become addicted, particularly if opioids are prescribed over an extended period of time. This guideline puts a strong emphasis on good communication between healthcare professionals and patients, which is key to ensuring any worries or uncertainties are addressed with timely and accurate information."

Dr Fiona Hicks, chairwoman of the Royal College of Physicians' recent working party on improving end-of-life care, said she welcomed the new NICE guidelines with its "emphasis on strong communication with patients, including how to help patients cope with both taking opioids and deal with the side-effects."

Sarah Wootton, chief executive of Compassion in Dying, said: "This guideline will support healthcare professionals in providing good end-of-life care across all settings, and will help to ensure that many people have what they consider to be a good death with their pain properly managed."

Source

[bhudika]

Or put in more context " we have been guarding all the opium fields in Afghanistan for some time now as a result of which production has increased by a whopping 70% , we have the supply and need to increase the demand" I know they work for you Arnie but nothing touches the acute pain I suffer , even morphine , it knocks me into a comatose state but conscious pain relief is something i have yet to achieve

[StevieRays]

Great news, it cant get much harder than it already is to get pain relief, that's for sure

[Arnold Layne]

bhudika, on 23 May 2012 - 08:27 AM, said:

Or put in more context " we have been guarding all the opium fields in Afghanistan for some time now as a result of which production has increased by a whopping 70% , we have the supply and need to increase the demand" I know they work for you Arnie but nothing touches the acute pain I suffer , even morphine , it knocks me into a comatose state but conscious pain relief is something i have yet to achieve

I hear you mate, and I know what you say is right. Yes, Morphine works for me, but not perfectly ~ nowt does. It reduces my pain levels significantly in some areas like sciatica and lower/upper back background pain. But Neuropathic pains as my feet get, nope, it doesn't seem to touch that - as you say, nowt does, really. Like weed, they all work to reduce one's perception of pain, distracting the mind, or dulling it. The tag "Painkiller" is without doubt a cruel and misleading misnomer on any drug apart from GA type drugs.

Conscious pain relief is the pot of gold at the end of a long, long rainbow I fear. The equation always seems to be, pain relief with loss of wakefulness. Although Oxy is not nearly as soporific.

Have a good'un mate, I hope you can

[Uncle Elroy]

dear Arnold i also suffer with sciatica pain in my left leg and wot feels like my left testicle and recently when driving the car my left lower back around kidney feels like someone is trying to ring it dry.ive had this since i was sixteen,lifting massive wieghts in the gym untrained and un supervized.now im thirtysix my back goes out more times per year and takes longer to recover from.at the minute my gp gives me the 30ml codiene and diclofenac (cant take tramadol).with your experiance wot painkiller would suit me best before i go waving that article at me gp

peace elroy

[Arnold Layne]

Elroy, I have no idea mate. Analgesia is such a personal thing, what works for one is not likely to work for another in the same way. See bhudika's post above My spine is a wreck, not broken or owt serious like that, but worn out, with bony growths and showing signs of being more like 90 than 60 years old. I've had two major bouts of neurosurgery, one at the cervical region (upper spine) one at the lumbar region (lower spine). Have you had your spine examined using MRI scans etc? Sciatica and other similar pains are symptomatic, rather than being diseases in their own right. So getting a handle on the main cause is important, and has implications for your analgesia regime. It may be that a decent scan like an MRI will show up precisely where you are damaged (My guess, L1-4 will be the culprit vertebrae); unsupervised weight lifting will have put huge strain on the wrong things. Especially in the Lumbar zone. So few folks, even in Gyms, lift correctly. I've seen championship level body builders lift like idiots, when I used to work out in a gym. Watched one chap inject steroids, then consume a huge dose of Codeine, just so he could go a little bit further in his training. He was also lifting badly, putting huge strain on his lumbar region. Bad, bad news!

For me, the analgesia that works best is the combo I am now on. Oxycodone and Morphine. My doses are getting higher, but then I have been using them daily for over two decades now. But that's the beauty of Morphine in particular ~ You can titrate your doses upwards as far as you care to go. So long as you Titrate for analgesia (and not for the Hit/High), there is no upper dose. Some folks consume grams per day. If I use only Morphine, I end up on around 300 -500 mg per day, quite a load. That's simply due to established tolerance. But its cool, because Morphine is benign as far as bodily organs go.

One thing I would say is that the real value of cannabis for me is not analgesia (its crap at that), but in its impact on other drugs, Morphine in particular. I don't know the science, but I do know that the two drugs seem to like each other's company hugely. Morphine on its own is a 50% pain killer (50% general pain reduction). But add a fat neatie into the equation, and the figure is nearer 90% ~ yet on its own, that fat neatie would only have a pain killing impact of around 20% max.

GW Pharma have been developing their sub~lingual spray for THC (Sativex) with Morphine in mind. I would safely bet a ton of notes on this: GW Pharma will introduce a combo sub-lingual spray containing a mixture of THC and Morphine Sulphate within the next 25 years or so. Morphine + THC is about as good a standard as they will, get IMO. My view is, however, that they need to add a good natural CNS into the equation, to counteract the soporific nature of Morphine + THC. Coca maybe? It certainly works But it is nasty stuff, so they would do better to find an alternative for long term usage. Guarana or some other plant extract would work, I'm thinking.

Hope you get some sense and pain relief from your GP. They are a mixed bag, GP's. I'm so very lucky to have what I regard as a genius as my GP, stunningly good looking as well, which helps. Although I need the man doctor for things down below. I have an appointment in an hour, as it happens. Our meetings are more discussion than one way communication. She's also willing to learn about cannabis, which is very helpful. I'm giving her GW Pharma's website address today, she asked for some info on them at our last meet. I suspect she'll also suggest upping the doses again. Hmmmm.... we'll see.

All the best with it man, I know how bloody un-clever Sciatica can be. Especially when it snatches at your nuts (mine grabs hold of the right nut sometimes - nasty). That's (for me) the second or third worst kind of back pain.

This post has been edited by Arnold Layne: 24 May 2012 - 07:35 AM

[stevebay1]

Hi ARNIE this may help you feel a little better about taking oxycodone,oxy is actually a semi synthetic derivative of the opium extract thebaine unlike the fully synthetics methadone,buprenorphine ect I am prescribed oxy for my degenerative disc disease and can concur that it does not cause the nods and is actually quite the opposite certainly at the dose I am on. I also have a wonderful GP and this helps so much as you have said.atb stevebay1

[Uncle Elroy]

Arnold, Thanks for the reply. Bit of a stupid question really asking you what painkillers i should take! Nevertheless the infomation you have given me has been very informative, You have spurred me to turn up the heat abit with my GP (something i have never done before due to the sporadic nature of my condition). As i get older it seems to be happening more often and for longer periods of time, with regards to an MRI scan i guess i am just scared. My brother had one (which he had to fight long and hard to get), it ended up in an operation for a crumbled vertebrae, and now he walks like (pardon the expression) an old dude. To be perfectly honest with you it will probably be when i can not physically take anymore pain from it that i will go and get some help. Once again thanks for the great reply.
'Nice one bruva' Elroy

[fatmax62]

heh uncle Elroy the earlier treated the better you will be! ATB F ats

[The Sinner]

The last few days iv been back on the oramorph they give me oxicontin as well like this morning had 30ml of oramorph it takes the slight edge off but doesn't kill it the oxicontin are good but stopped those as got a bit keen on it for a while. That's usualy what I do have some oramorph just before bed with 4 spliffs rolled in a ashtray in the bedside table. I had real problems getting the prescription for morphine and oxi but they don't even question it now the only problem I have with oramorph is I don't eat and can't eat if iv been on it for a while lost 3 stone the other year on it everyday it seems to work for some and not for others. They gave me some butra-trans patches recently but they don't seem to do much.


TS