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why do pain meds have little effect on me?


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I am frustrated that I can't find painkillers that DO anything much for me. Now, this is on a minor scale compared to what many of you experience I am sure, but keep in mind that I don't really have any major issues with chronic pain and so... I shouldnt really have built up a resistance to them.

I have issues with migraines, which was controlled by a fairly high dose of propranolol, but i stopped that earlier this year. I am not getting migraines exactly.. just headaches and back pain, which is not helped by anything i've taken so far.

I've tried panadol (acetaminophen), aspirin, nurofen (ibuprofen), aleve (naproxen), panadol + codeine in varying doses. Usually the only thing that works is 60mg codeine + 1000mg of panadol. but... its not doing anything anymore. I dont take it very often. Perhpas once a month? At one stage i had some oxycodone, but thats fairly strong especially when i'm driving/at work/studying. It works but tends to make me a bit sleepy too.

Does anyone have any thoughts on why this happens? I rarely took pain killers as a kid, and even when i had more serious migraines, i usually suffer in silence rather than take the painkillers (mainly because they havent helped in the past).

Also, in the past when i had fillings in my teeth, it took up to 4 times the regular dose of anaesthetic before i was even slightly numb, and even then i felt the whole thing. The dentist was quite surprised.

So, I'm aware that my situation isnt really that bad, and im sorry if this offends anyone who is in more pain than I am. I just don't know how to deal with it. It seems to really get in the way of life.

berry.

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I know some people (for example those with ehlers danlos) are resistant to local anaesthetic. Nobody really knows why.

Also, some people don't seem to have effective opiate receptiors (for codeine, morphine).

But why nothing works, I have no idea. Maybe the pain is worse than you think? Or you need drugs for neuropathic pain, like gabapentin. What do your doctors say about it?

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Welcome to the club! I also have a high tolerance for pain medications. When I go to a doctor, I won't even take a script for them because they don't work. Opiates don't even touch the pain, and I don't even get the "high" effects from them. Acetaminophen and Ibuprofen hardly ever take the edge off of anything. Muscle relaxers don't work either.

I did get *some* relief from a prescription NSAID, but I had a strange reaction to it and couldn't take it anymore.

I have no idea why. I assume it's just because I'm wired differently.

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I've tried panadol (acetaminophen), aspirin, nurofen (ibuprofen), aleve (naproxen), panadol + codeine in varying doses. Usually the only thing that works is 60mg codeine + 1000mg of panadol. but... its not doing anything anymore.

One thing to remember about NSAIDs is that the acronym ONLY means that the meds are not steroids and they are anti-inflammatory meds. As a general group, they're not going to do much of anything for pain that isn't a direct result of fever or inflammation. Acetaminophen is an odd member of the class in that not all researchers agree how the hell it works, just that it does (It's the only one that safely works for me)

I really think you'd be better off researching other classes of medications targeted to migraines.

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I have pain I take pretty heavy narcotics for. However, even heavy narcs don't touch my headaches. Oddly, what works for my headaches and this may sound weird is a combo of 800 mg ibuprofen and 2 tylenols. I'm pretty much the exception to every rule but just something to think about. Another thing that has really reduced the number of migraines I get is Topamax. It's a good preventative and can also work as an MS.

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I'm curious (and this may be too personal to reveal), but are you a redhead? I have a high tolerance for pain meds as well, and I read at one point that studies have shown that redheads have a higher tolerance. Google it and you get a lot of info, but here's one link [link=http://www.newscientist.com/article/dn2923-red-heads-suffer-more-pain.html" target="_blank]newscientist.com[/link]. It's interesting. Like you, I've required more numbing agents, and the drs think I'm crazy. Maybe I need to carry a host of articles in my wallet.

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I have two possible reasons. Both may offend you, so please realize I'm not trying to be rude. I just wonder if they may be the issue:

Do you have any history of abuse of any opiates? I am assuming not, but this could keep your tolerance up for a long time.

Also I wonder if the pain you are experiencing is somatization. In case you don't know what I mean, somatization is when our feelings are expressed in physical symptoms such as headaches and back pain. In this case, pain killers don't help because it isn't a real medical problem. It is the way our brain is processing the extreme emotion we are feeling. You would experience the pain just the same as if it were a real medical problem. This isn't that uncommon.

Just some ideas.

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Berry,

If you are having straight up migraine pain, have you tried triptans? For example, Imitrex, Maxalt, Amerge, etc.? They are abortive medications specifically for migraine. Treximet is the newest, latest and greatest migraine medication and it blends sumatriptan (Imitrex) with Naproxen (Aleve). It's HELLA expensive, like all the triptans, so generic Imitrex (which is also still really pricey) and generic Aleve would do the same thing.

A neuro a long time ago told me that if triptans don't relieve your headache, then chances are good it's NOT a migraine. Not that he was using drugs to dx the condition, it was just an observation. It is not uncommon to have neck and head muscle involvement with migraine. Even upper back (with me) because everything is so tense from trying to deal with the pain.

Have you seen a neurologist?

Opiates do nothing for migraine pain. Not for me and not for a lot of people who get migraines. Most people who report opiates to work say that how they work is they allow them to sleep and sometimes the sleeping alone knocks out the headache. So, if opiates are little or non-sedating for you, you're screwed there. And Oxy's are just bad on so many levels. You don't even want to go down that road, trust me.

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bluelikejazz :

Maybe the pain is worse than you think? Or you need drugs for neuropathic pain, like gabapentin. What do your doctors say about it?

well, its possible that the pain is worse than i think. i seem to have a high pain tolerance in the first place, maybe its related? My docs dont seem to be really that concerned, probably because pdoc is only concerned about head stuff, and i havent seen GP much lately. he did give me 'stronger' naproxen but... it wasnt that much stronger and didnt do anything.

Have you tried massage?

yes, have tried massage, both with a swedish massage therapist, with a physio. I have had physio for my back and neck. I've done pilates, I've seen a chiropractor and a kinesiologist. Some werent *specifically* for migraines, but... it hasn't helped in any way even if they identified i had neck issues.

patheral:

I assume it's just because I'm wired differently.

yeah i figured it must be like that because i really dont see what made me like this, it wasnt overuse!

null:

I really think you'd be better off researching other classes of medications targeted to migraines.

i was interested in topamax but my doc seemed to think it wasnt worth it. im not sure why. I saw a neurologist who thought my migraines were kind of ... weird, as in, they were sort of a mix between migraines and cluster headaches, i guess i just either explained them badly or .. i dont know.

sdjeff:

Oddly, what works for my headaches and this may sound weird is a combo of 800 mg ibuprofen and 2 tylenols. I'm pretty much the exception to every rule but just something to think about. Another thing that has really reduced the number of migraines I get is Topamax. It's a good preventative and can also work as an MS.

I have tried combining, in fact more recently i tried codeine+panadol + naproxen and... even that didnt really do too much.

rabbit:

I'm curious (and this may be too personal to reveal), but are you a redhead?

no, sorry. I have brown hair, and blue eyes ;)

I've a pretty bad ache in my head for a few days now, and this could be related to an increase in tegretol but... unsure. I am not too concerned about these headaches because i have had a CT scan before and it came up clear. so no brain tumours (unless it grew recently).

When i have a serious headache and i take something with codeine, like, stronger than what you can buy over the counter, and it doesnt even help... not even a tiny bit, i wonder what it will take. I don't want to overdo it, but at the same time... theres no point taking something if it does nothing.

I am wondering what is 'serious' enough to consider alternative meds that are everyday, not prn. Such as topamax or neurontin. So, I have migraines but they come and go. I mean I'll go through a few months of having a headache nearly every day, and then I'll have a few months of being fine. I have a pain in my lower back that will stay every day all day for a few weeks, then disappear, then reappear. strange... but yeh.

but, since i posted the first post, my head hurts more. Its quite awful really. I've tried all the other things - fresh air, water, food, sleep, dark place (which does help a bit). I know feeling sick (like now) is usually an indicator that the pain is worse. I'm not really sure what to do next, or how to approach it with my doc. Since i dont see my GP often anymore i havent regularly complained about this?

hmmm. thanks for all your replies, i appreciate it :)

berry.

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ok, during my post two other people posted so:

crazybeautifullauren - no i haven't abused opiates ever. I'm only 18 so, fairly short lifespan and yeah, can remember everything i've ever taken pretty much. my parents didnt give me many drugs when i was a kid, so, unlikely i wouldnt remember stuff. never had any operations so, no anaesthetics or painkillers afterwards.

I have thought about it being psychosomatic. When i was young sometimes i'd feel sick and i think that was a childish way of experiencing depressed. But, i guess it could be stress. At the moment i have a difficult family/friend situation (interesting friend staying with me) but, i'm not at uni and thats probably a bigger stress. so... i'm unsure. Its possible, and im willing to consider it. I still dont know what to do about it though. And if thats the case... then ALL incidences of pain in my life (except say, a few) would have also been psychosomatic and thats the reason i didnt respond to the drugs? I dont know about the anaesthetic at the denists though .

S9: well, i have seen a neuro, at the time i was on propranolol and she upped that. i think those other drugs were ideas but i dont think i've ever tried them. i might ask doc about them ;) thanks for telling me about that.

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I wanted to address this because I'm a little older than Berry and have had this line of questioning before. ;) No offense taken and please don't be offended by my answers.

Do you have any history of abuse of any opiates? I am assuming not, but this could keep your tolerance up for a long time.

I've never taken any drugs outside of prescription drugs, and I've never abused opiates because they've never worked. :) The *only* time opiates work is through an IV and then they only work briefly - hardly touching the pain and then they wear off too quickly for me to even bother with them. If I remember correctly the only "pain killer" that worked in a hospital setting was the Demoral (sp?) that they gave me when I was in labor with my first kid and they gave me high doses of it and only during the last half hour of labor... I've been given morphine after surgery but they usually take the IV away after a few hours because I tell them it's not working.

Also I wonder if the pain you are experiencing is somatization. In case you don't know what I mean, somatization is when our feelings are expressed in physical symptoms such as headaches and back pain. In this case, pain killers don't help because it isn't a real medical problem. It is the way our brain is processing the extreme emotion we are feeling. You would experience the pain just the same as if it were a real medical problem. This isn't that uncommon.

This has been brought up before as well, but my degenerative disc disease and arthritis have been confirmed on X-ray, the NSAID worked on my back but not my knees. Hardly anything works on my migraines. I've had migraines since I was 13 and I'll be the first to admit that stress is a major factor.

I am only pointing out that sometimes there are underlying "real medical problems" and there are people who cannot take pain medications because, well, they just don't work. The arthritis in my knees and hands is real enough, but I can't take anything for it. The DDD in my back is real enough but I can't take anything for it. The migraines, well they're real too. I just can't take anything for the pain. Some of us are just unlucky enough too be wired wrong...

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From my Fibromyalgia research, I have come across theories that look at why opiates are ineffective against some types of pain.

I'll try to connect the dots in my explanation of some of the research I've read:

Many forms of pain( eg...Migraine and Fibro) originate and are processed within the brain itself and share similar characteristics and overlap. The errant brain signals cause the body to react (vessels to constrict in migraines and the release of cytokines in Fibro pain). Many seizure, pain and migraine disorders are result of neurotransmitter imbalance and have seizure-like thresholds and for that reason, Neuroleptics are often effective against seizures, migraines and Fibromyalgia. Opiates (Vicodin, Percocet etc) are often ineffective against migraines and Fibro pain. Opiates are processed in a specific portion of the brain that is found to be underactive in Fibro patients. I'd venture to guess the same may apply to a number of migraine sufferers, too.

Here's an article about opiates and some forms of pain-

http://www.sciencedaily.com/releases/2007/...70927131357.htm

Most mood/thought disorders are the result of a neurotransmitter imbalance as well so I'm not surprised that those who suffer from pain disorders also suffer from pych disorders.

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Most mood/thought disorders are the result of a neurotransmitter imbalance as well so I'm not surprised that those who suffer from pain disorders also suffer from pych disorders.
Well, I'm here to tell you, if you weren't crazy before chronic pain, you damn sure end up there after a few years of no relief. ;)
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I saw my pdoc yesterday, and he thought my now 5-day headache was a result of stress. Well, ok, sure i'm stressed but, that doesnt really explain the rest of it. So we may have stress as a trigger, but that didnt answer my question about what to DO about it!!

thats interesting nurse&patient, thanks ;)

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Most mood/thought disorders are the result of a neurotransmitter imbalance as well so I'm not surprised that those who suffer from pain disorders also suffer from psych disorders.
Well, I'm here to tell you, if you weren't crazy before chronic pain, you damn sure end up there after a few years of no relief. ;)

Don't I know it!!

Rheumy-"Many fibro sufferers are depressed."

Me-"No shit! Its depressing to be in constant pain and having to deal with a-holes like you!"

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Some people w/cluster headaches have received relief from oxygen. Right now nighty meds are hitting hard so I can't find cites. Sorry. But I do know this from anecdotal accounts. Very close accounts. Those canisters are fucking expensive.

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I saw my pdoc yesterday, and he thought my now 5-day headache was a result of stress. Well, ok, sure i'm stressed but, that doesnt really explain the rest of it. So we may have stress as a trigger, but that didnt answer my question about what to DO about it!!

thats interesting nurse&patient, thanks ;)

Have you tried a course of steroids?

They sometimes help me break a cycle but you have to be careful to monitor yourself for psych disturbances while on them and alert your doc ASAP.

Also, have you looked into TGN (trigeminal neuralgia)?

http://www.mayoclinic.com/health/trigemina...uralgia/DS00446

Maddy-My headache specialist is a fan of 100% oxygen in conjunction with occipital nerve blocks and meds during headache emergencies. I think it helps me.

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