When Pain Killers Don't Cut It

Erowid user confesses to possible addiction to opioids for kidney stone pain. Commentary to follow quote.

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http://www.erowid.org/experiences/exp.php?ID=22485

I came online tonight searching for answers to my questions about the myriad of drugs I am currently taking, and thought my experience so far with these drugs could prove useful to someone in my position in the future. I have had been passing kidney stones for the past week - the most painful experience of my life - and in between my many trips to the ER, I have been given oxycodone, toradol and dilaudid to control the pain.

I am extremely afraid of developing an addiction to these drugs, as I have an 'addictive personality' and have had drug habit problems in the past. It's been a difficult situation because the onset of kidney pain sends me into such a fright that I pop the maximum amount of pills that I am supposed to take at once. I am afraid that slight pain I begin to feel will worsen until I am in the state I was in the first day I had the stones - a pain that I would not wish upon my worst enemy. The pain had me reduced to a blabbering, crying mess. When I got to the ER that day I had no control over my words and actions, and I was screaming and moaning for painkillers. When I finally got my shot of toradol and dilaudid I was in heaven...and I tried so hard to convince myself it was just from the pain relief, not from the drugs themselves.

I finally left the hospital that day and continued to have bouts of pain that would sometimes be relieved by the prescriptions, and sometimes not. By the fourth day, I noticed the meds were having no effect whatsoever. It scared me that I already was having such a tolerance to the meds, especially because of how strong I was told dilaudid was. Was it the strength of pain or my tolerance to the meds? I don't really know. I just got home from my third visit to the hospital in the past week, except I had to stay overnight with a morphine drip to control the pain. I was later switched to oral medication - oxycodone - and I was able to handle the pain that way so I got sent home with 30 more pills.

There is no real point to my story except that I question my actions...at the slightest possibility of my beginning to feel twinges of back/abdomen pain associated with kidney stones, I take the oxycodone, toradol, and/or dilaudid. I really don't know if it's more because I am afraid of having pain like I did, or because I am developing an addiction to these pain killers. I must admit that the pain killers make it so much easier to sleep, and as soon as I feel the 'coming down' effects like increased sensitivity (crying at the drop of a hat) and increased annoyedness (especially at loud noise), I feel compelled to take the drugs. At the same time, however, these drugs do not provide all bliss to me either; I experience intense itchiness, mild nausea, and an overwhelming grogginess that brings about a depressed mental state. I personally feel much better having written this, because I think I am being a lot more honest with myself, and have realized that I have caught myself giving in to an addiction...

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Commentary: Acute pain caused by kidney stones is never remedied by opioids, except when the user is asleep. Had the Emergency doctor been on the ball, had she co-prescribed hydroxyzine or suggested an OTC antihistamine such as Benedryl (diphenhydramine), Chlor-tripolon (chlorpheniramine) or even cetirizine (which has not sedative properties but being a metabolite of hydroxyzine) does moderate opioid potentition, the user would have experienced pain relief earlier once the sedation of the antihistamine kicked in. This also implies less opioids can be taken to relieve the pain.

As shown in the above case, the person reporting his experience with opioids is under great pain, and under these circumstances, tries to dull the pain. Adding an antihistamine to lessen his dose of opioids would complicate matters i.e. scheduling when to take it and how to tell the difference between an antihistamine and an opioid. So the combination would only be useful in a hospital setting where dose scheduling could be better controlled.

This is why antihistamines, especially first-generation such as Benedryl, Chlor-tripolon and hydroxyzine, are usually not given to people with their pain medication due to the risk of overdose.

This is also why tobacco products are addictive, because of the synergy between the nicotine (an acetylcholine agonist) and harmaline, a central nervous system (CNS) stimulant and a reversible inhibitor of MAO-A (RIMA), contained in cigarettes and other tobacco products.

A RIMA prevents the breakdown of neurotransmitters, especially acetylcholine, adrenalin, dopamine, GABA, noradrenalin, serotonin, and tyrosine.

As a RIMA, harmaline also prevents histamine (a monamine) from breaking down. In high doses, with susceptible people it might cause hallucinations because of this action by preventing the breakdown of endogenous dimethyltryptamine. This is not true in all cases.

Nicotine itself too is a CNS stimulant, though its metabolite cotinine is both an anti-psychotic and nootropic.

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Original post: June 10, 2010 at 7:40 PM

Flexeril and Its Antidepressant Effects due to Antihistimine Properties

Monday morning I got up early enough to visit my doctor. Due to my insomnia, I had delayed a follow-up visit to him while tapering down to one tablet of mirtazapine when needed i.e. when I need a good sleep before morning.

After 5 minutes of talking to my doctor, he recommended stretching exercises - and I countered with "I practice tai chi". So he suggested cyclobenzaprine (flexeril), a tricyclic antidepressant with strong muscle relaxant properties i.e. another antihistamine chemically different from benadryl and mirtazapine.

This drug has a slow onset of 2-6 hours but lasts for up to 20 hours.

I know because after I got home around 11 PM, it took me about 2 hours before the first effects hit me, but had taken one tablet about 8PM. By 4AM I was off to bed.

It's unknown if dissolving the tablet in my mouth leads to this delayed effect. Then most of Tuesday was spent in bed. I'd only gotten up around 5 PM.

There may be a synergy with alcohol, because I slowly sipped a Colt 45 circa 9.45 PM at a friend's place and was out of there by 10:25 PM.

However, I felt no alcohol buzz; this may have been due to smoking a couple cigarettes for most of the time at my friend's place. In fact, I believe nicotine may have been the protective factor, as it kept me alert and less likely to yield to both alcohol's and flexeril's sedative properties.

When I awoke during the time before 5 PM, I just felt the need for more sleep. This, most likely, was a "hangover" effect due to the combination of alcohol with flexeril and trace amounts of mirtazapine.

Therefore, the mixing of liberal amounts of alcohol and/or other CNS depressants with Flexeril is not recommended. This includes mirtazapine and other psychiatric medication. Also included is gabapentin and other anti-epileptic drugs.

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Updated: 20111116.1625

Flexeril is a muscle relaxant which has sedation as one of its side-effects. Currently, I use flexeril 10 mg daily.

Mirtazapine is being marketed as an antidepressant, however, it has antihistamine side effect of sedation in low doses. I used to take this medication at 2 doses of 15 mg daily. Over a year after I first wrote this article, I no longer take mirtazapine.

Gabapentin is used for nerve pain and is used mainly to control seizures in epilepsy in high doses. Currently I use it for its ability to reduce anxiety at 2 doses at 100 mg per capsule.

20121225.0841

Currently I use 10 mg of flexeril and 200 mg of gabapentin at bedtime. The gabapentin helps improve the ability to enter deep sleep and the flexeril helps me to fall to sleep.

fixing the 24-hour summer flu

benadryl 12.5 mg
gatorade ice
passionfruit drink: try TnT's market or a vietnamese grocer or convenience store.
ginger beer

the ginger beer is for the stomach
the passionfruit and benadryl is for sedation. the latter also slows down urination and tendency to vomit
the gatorade ice provides water for hydration and sugar for energy

if this does not work, the emergency umeboshi & sweet rice congee (okayu) cure consists of japanese rice cooked, one to 2 bowls depending on severity of flu with one umeboshi, once every two-three hours with chinese green tea.

you can get umeboshi at tnt's too or at the konbini on robson street.

proof that the emergency okayu exists: http://en.wikipedia.org/wiki/Rice_congee#Japanese

Paris busted Out of Prison!

I just read that Paris Hilton who went to jail 3 days ago is out.

Tomorrow at 9 am sharp, she's going before the judge to determine if she's faking her mysterious medical condition.

My guess is that Paris is suffering from stress due to anxiety about being jailed with real hardcore criminals.

Here's my solution to deal with that, rather than let her serve time at home using an electronic monitoring device:

a package of 48 tablets of Benadryl (diphenhydramine) to sedate her for 20 days.

All she needs to do is take one 25 mg pill at bedtime, and if that doesn't work up to 2 tablets.

It will clean up her stress-induced rash and help pass the time sedated.

Why I Didn't Take Meds

Regarding meds, my doc (GP) strongly objects to me being medicated with any psychotropic medications, due to the risk of addiction (from benzos), discontinuation/withdrawal syndrome (of anti-depressants) etc.

He even advised against anti-psychotics.

During my recent visit to him, he stated twice that borderline personality disorder counterindicates against medication because, from what I have discovered from my research, of being comorbid with suicide *when medicated*.

Basically, a BPD person would threaten to OD on meds because the pdoc (psychiatrist) isn't competent enough to do him any good. And proof of such incompetence is giving him drugs that could kill him in the first place!

Though, in my case, I have never had therapy by a shrink nor have I ever exhibited any of the behavior that make most shrinks "give up" on BPD people.

IMHO most of the meds just "manufacture" the illness e.g. cause side effects which may be rationalized as "symptoms of the diagnosed mental disorder" by the pdoc.

Untrue. Most behaviors are side effects of the medication in that the meds amplify what were once eccentric behaviors.

I have a friend whose medication renders him able to "talk to himself" - he can hold a lucid conversation with his invisible friend, including "channelling" his "friend and his replies- which may be a drug-induced mania or psychosis and is possibly evidence of a neuroleptic being administered at a higher dose than it ought to be.

When he is off his meds, he has difficulty communicating which sometimes leaves him so frustrated he will hit inanimate objects, be it his computer monitor or dashboard of a car. This too is effect of the meds.

Prior to the meds he was shy, socially withdrawn, yet of a high intellect. The fact that he is now able to communicate more freely shows to me that he is still intelligent. However, he requires therapy but avoids it - he even avoided meditation training while initially hospitalized.

What really works for me for therapy is sleep: benadryl 50 mg when I absolutely want sleep.

However, what really works is marijuana. 2 puffs and my sleep cycle is normalized for 48 hours. After 48 hours, the chronic insomnia is back with a vengeance. However, I do not take marijuana regularly because my roommates have noticed my sleep behavior.

The good news is, I am of the 75% of people who is not negatively affected by 9-THC i.e. no psychosis, no hallucinations, no mania.

In contrast, the first time I took two 50 mg of Gravol I had a minor "trip". So I am strict with the benadryl.

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As of December 23, 2012, I only take gabapentin and flexeril - been taking both for about a year and it is better than mirtazapine.

I only use benedryl in emergencies.

As of now I only have cetirizine for the case of flu, when every breath is filled with mucus and wheezing.

Other than that, I feel that I am less incapacitated by my curren nightly dose of 100 mg gabapentin and 10 mg of flexeril.

This reigiment follows my Less is More philosophy towards drugs of all kinds.

For I believe strongly that the more is better philoosphy is deadly.