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Pain management not working – Opioid resistance?

  • By Mafalda

    I’ve been going to a pain management clinic for several months and I’m really frustrated. Because my pain is constant, significant, generalized, caused by RA/RD, Fibro, Pseudo-gout and degenerated disks/vertebrae and hasn’t responded to 28 of the moderate to strong analgesics currently available, the Dr. directly prescribed opioids. After taking pills for one month without relief, I was prescribed Buprenorphine patches. Two months on the lowest dose (5 mcg/hour) didn’t produce any effects, so the dose was upped to 7.5 mcg/hour. I’m on the third weekly patch and I haven’t noticed any reduction in pain level, so I fear that the dose will be increased again, with the added risks. I haven’t had any negative effects either, not even the common bowel problems.

    I’ve reseached numerous academic papers and found out that a very small percentage of the population is opioid resistant. This resistance can be due to two facts: a mutation of a certain liver enzime or lacking enough mu opioid receptors in the brain. I believe there is a test to determine the enzime mutation.

    Is anyone here opioid resistant? I’ll be talking to my Dr. about this possibility at the next appointment, but wonder if anyone has experienced this situation and what may be next.

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  • By Lawrence 'rick' Phillips Moderator

    Mafalda –

    I am not opioid resistant but I do know of someone who was. It was a frustrating and difficult situation for them. I am sorry this has happened to you.

    Speaking to your doctor is of course the first best step to take. I did look up the issue in academic papers. I am sure I did not find all the articles, but this one might be helpful to frame the conversation with your doctor.

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5405610/

    I am hopeful that your conversation with your doctor will be productive and do let us know how things work out.

    rick – moderator

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    • By Mafalda

      Thanks, Rick. That’s precisely one of my go to articles. 🙂

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    • By Lawrence 'rick' Phillips Moderator

      Incidentally I can usually spell doctor.

      Or as my administrative assistant used stamp my work product she had to edit

      Rick Cna’t speill Fro Shiet

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    • By Mafalda

      Lol, Rick. No one should be expected to spell properly at this ungodly time of the night!

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  • By Daniel Malito Moderator

    @mafalda It took me two years of pain management treatment to find relief. That’s 24 months. Some things I tried didn’t work at all, like zero relief, and some stuff knocked me out totally. I know it seems like you’ve already done a lot, but it can take a long time to find the answer. From my own research it seems there are only a very few people who are opioid resistant, so it would be pretty rare, it seems. It might be worth thinking about keeping up treatment, I tried every opioid out there before I found relief in a combination of two. Keep on keepin’ on, DPM

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    • By Mafalda

      Thanks, Daniel.
      Yes, the level of frustration is beyond description. Although I was only diagnosed in early 2015 (was dismissed by Drs. for over 15 years), I have already spent 20 years taking strong pain medications -the type that comes with red tape and plenty of warnings- that seem to do wonders for everyone else.
      Thing is, with all that pain I couldn’t notice any improvement from the many meds I’ve tried to treat my conditions. In view of that, my Rheumatologist decided to hold any new treatment until the pain management kicked in, but it hasn’t yet.

      I’m in limbo at this time…..

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