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Opiates and IBS


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#1 Marc76Law

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Posted 11 January 2003 - 07:32 AM

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After 5 years of pain and not getting relief from antispasmotics, my doctor finally prescribed me percocet. I am going off of it now because I will probably have surgery and don't want to be too tolerant, but I think that every IBS sufferer should be allowed to choose the advantage of opiate therapy v addiction potential.For me, percocet stopped me from having to visit the ER, it slowed down my BMs, and when I had severe abdominal distention, it was the only thing that stopped the pain. The drawbacks for me is that I am a student and need to be able to think straight. However, during my exams I had to choose between running out of the exam room to the toilet every 20 minutes and pain distraction, or using percocet and not thinking as clearly.This is a decision a patient should be able to make and not a doctor. I am lucky that I have a compassionate MD who will prescribe percocet for me. I have been seen by GI doctors in the past who have flat out declared they will not give opiates under any circumstances to IBS sufferers. I think this is wrong and paternalistic to be refused the option of opiate therapy if it works.From all the research I've done on the internet, this is a discussion that is not going on in the medical community and its sad. I take 50 mg of elavil for pain and it doesn't do anything for me.One of the side effects of opiate therapy is constipation. It would seem that IBS-D suffers would benefit the most, while IBS-C people would have to be careful.Does anyone have strong feelings one way or the other about opiate treatment for IBS when antispasmotics and TCAs fails?


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#2 G0NE

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Posted 11 January 2003 - 02:32 PM

Marc76Law,Yea, I feel pretty strongly about it. Oxycodone (think it's in percocet) is the only thing that has made me feel 'normal' also. Just about impossible to get, I have asked. The antispasms don't work for me either, nor did the anti-depressants i've wasted time trying. And if I eat right and take fiber, I'm usually ok.. except for the anxiety of going places, and then days like today, when I wake up in such bad pain I walked hunched to the bathroom, run the bath and switch for hours between soaking in the tub and going the nasty D. I would like to try codeine phosphate, but I'm not sure how easy it will be to get. As I have been told though, doctors have a lot of legitimate reasons for not just handing out opiates. They should stick with a patient, chart their progress, make followup calls and determine their quality of life with and without opiates and see if it could help them. But you know... one and a million that a doctor would actually care enough to do that...ben

#3 LaurieJ

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Posted 13 January 2003 - 02:08 PM

I agree with what you said concerning the use of opiods for pain. However, I also understand that there is reluctance to prescribe these due to reasonable views (it may do more harm to the underlying condition than good) and for unreasonable ones ("I don't want to make my patient an addict"). It is my opinion that narcotics are being under prescribed when the patient has a legitimate need. But I don't know much about IBS so I will not say that Drs who refuse to prescribe for IBSers are wrong so I will not address your specific question about narcotics and IBS. But in my personal case, I would not be alive if I didn't have my oxycodone for the last two and a half years. I have not escalated my use, and in fact, start out with half a dose when I feel unable to cope with the pain. This usually works. I have not engaged in any drug seeking behavior other than maybe stock-piling (but this is a result of reading horror stories from people whose meds are restricted). A search of publications that I have done reassured me that if taken for legitimate reasons for pain and not to get a psych high, the incidence of drug addiction (not tolerance) is really low (something like 1-5%). So I agree with you that Drs should be more willing to work with a patient to relieve pain and not be so hesitant to prescribe narcotics...And if this means that the patient has to be monitored more closely....so what. It takes time from both the doc and the patient so if you are willing to put in your time, the doc should be willing to offer his / her oversight.I think we may be seeing a change in this soon ,though, because the accrediting agencies are really looking to see how drs and hospitals are responding to patients pain issues.

#4 G0NE

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Posted 13 January 2003 - 03:15 PM

Yea, I've had some bad experiences trying to get meds for real pain. Hopefully it will be changing...I think opiates could help IBS-D folks. My doctor told me for over a year my stomach problems were cause by a hernia that I had. When it was repaired my stomach felt normal again for about two weeks, I realized it was from taking the oxycodone, as it got worse when i stopped. Since then I've taken oxycodone about 5 more times, for different things, and every time it helps a LOT. I wonder if it helps your stomach at all? If you've been taking it for so long, I wonder if it affects your gut at all? Are you IBS-D?I plan on trying to get an rx for codeine phosphate, as I've read several stories about it really helping people. Anyway, thanks!ttyl, ben

#5 Bada Shanren

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Posted 13 January 2003 - 03:19 PM

Laurie, since you're from Milwaukee, have you called IFFGD about this?tom
I am a licensed clinical psychologist so take what I say with a grain of salt.

If there's a problem I am licensed in the State of Tennessee.

I am also a poet and I suffer from IBS so sometimes my opinions come from there.
My opinions should be seen as no more correct than any other person's opinions who has IBS, like you.

#6 LotronexLover

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Posted 13 January 2003 - 03:39 PM

I have a question...have any of you tried taking Loperamide on a regular basis? Loperamide is prescription Immodium. Immodium IS an OPIATE.Yet it is not habit forming or half as bad for you as the other drugs you have named.If you haven't tried it for D I think you really should give it a chance especially before resorting to stronger / habit forming drugs. Just a suggestion.I personally take 2 - 4 Loperamides daily.

#7 G0NE

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Posted 13 January 2003 - 04:31 PM

I have taken loperamide daily for a couple weeks. It was alright, stomach still hurt a lot, and sometimes it makes me feel sick. It's hard to explain, someone said maybe trapped gas, that's kinda what it feels like. Lomotil works better for me, but after taking it for 2 days, I feel worse than when I started. I know it's weird that those two opiates wouldn't work as say... oxycodone. I wish someone could explain it to me. =ben

#8 LaurieJ

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Posted 13 January 2003 - 04:36 PM

Ben,The reason I was prescribed oxy to begin with is for abdominal pain after having three surgeries on my "belly" (two emergency, one follow-up). I am unable to take any other pain killers because of a slight liver abnormality (no tylenol, etc)....oxy seems to be the least harmful so far. I do not think that it is affecting my gut, but I am not sure how to tell. I am not IBS - D or C, the best I can tell is that I am IBS - "S" (surgical) as I was told that I got it as a result of the surgery (woke up with it in the recovery room, and it never has gone away) over the last years I have just a lot of pain, nausea, weight loss - no other problems, nothing like the majority of people write about here.My post surgical GI consultation resulted in this advice: "learn to live with it, here are your pain killers, you're lucky to be alive". So I am living with it the best I can....with my 2.5mg oxy b.i.d!Good Luck with your quest for pain relief.... Let us know how it works out!Tom,I am not sure what the IFFGD would offer me, or I it: can you expound?????Lotronex Lover,I haven't tried immodium because I guess I haven't seen the need....it is marketed strictly as an anti-D and I haven't needed that. I would worry that I could cause a problem that I don't have.

#9 G0NE

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Posted 13 January 2003 - 04:48 PM

LotronexLover,Another few things I forgot to mention... about the dependence/habit forming... Does that really matter? You are 'dependent' on imodium.. whatever we take that makes us better we are dependent on. And from what I have seen... stepping off a pain killer isn't much worse than stepping off an anti-depressant.. some of the have nasty withdrawal, like effexor (i.e. laying in bed crying for weeks... like I saw my g/f go thru with effexor, even when she stepped down normally.) Another points is the side-effects... obviously the same things don't work for everybody.. i never felt tired or out of it while taking oxycodone. In fact I just felt normal, like I did before IBS. The only thing I don't know about, is taking it for a longer period of time, most I could ever take it for was a few weeks. Plus the tylenol in it probably was not helpful to the gut. Laurie, Yea, I still have pain from two abdominal surgeries... although it's much better now that they have removed some staples. Still, if I move the wrong way (like squatting down), it feels like it catches, and it must hit a nerve or something because it burns like stabbing fire.. if I lay down and let it calm.. it just goes to a dull ache which lasts most of that day. They gave me neurontin for it, but I have not tried it yet, as it's expensive and I've been told it's not all that pleasant.. might upset the stomach and really knock me out. I might try it though... I dunno.. I am hoping to mention this pain also... kinda kill two birds with one stone. Two kinds of pain and the D.. i go in on feb 5th. I'll let you know how it goes, but I'm really not too optimistic about it, doctors are very reluctant, like you said, to take the time to listen. I've already tried a lot of different medicines, it seems silly not to let me try the one that has helped other people, and has helped me in the past. Who knows... =] Later!ben

#10 Kathleen M.

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Posted 13 January 2003 - 06:31 PM

I think there is "dependant" and "dependant"There is a difference between something that if I stop taking it the symptoms come back (like an antihistamine, it wears off I sneeze again) and something that I have to take more and more of to get the same effect and if I stop taking it I get a whole bunch of other things going wrong that were not wrong before I started taking it and the best way to detox off of it is to be put in a drug induced coma for a week.Now you can actually turn Imodium from the former to the later, at least one opiate addict managed to do it, but it takes extreme doses of Imodium (like 160 pills or more at a time, enough to actually get enough in the Central Nervous System to have an effect) and the addict did have to be methadoned off the Imodium because he couldn't quit cold turkey without having severe withdrawl problems.Now when you are in pain the risk of addiction to opiates is lower than if you just take them recreationally. But it can be hard to know who really needs them from who does not. Some people taking them for legitimate pain reasons do get addicted. Whether that is because they are just predisposed to it, or they keep taking them after the pain is gone because they feel good...who knows. I know that for most people in severe pain opiates do not make you feel good (a friend of mine needs severe pain meds for migraines, but occasionally gets the light show without the headache and says that how much fun the meds are is vastly different in the two situations) but I think for many people it is easy to keep taking them if the pain subsides and the feeling good part starts up.Even OTC pain meds can cause "addiction" like problems for some people and some conditions. If you take any of the OTC's for headaches too regularly they cause bounceback headaches that are more severe than the headaches you originally took the meds for. This is one reason when I have a headache for weeks on end (baby version of migraines that is related to allergy problems so once they start they tend to keep going) I rarely take stuff for it because I don't want to get in the cycle of the pain meds making the headaches worse. I'll pop something when I start getting bad vision focus and need to be in the dark, otherwise I just tough it out.K.
My story of beating IBS: My Story with IBS
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#11 G0NE

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Posted 13 January 2003 - 07:00 PM

Well, everyone who takes opiates becomes dependent. Your body gets used to it, and works normally with it, but not without it. The same could be said for IBS, except that it's not the lack of it that makes the body work improperly.. just the fact that the body is broken. The cause of dependence is different, but in the end, it's really the same. Of course there is psychological addiction, which would cause you to perpetuate use, even if you weren't in need of it, like someone taking 160 imodium. That, like laurie said, happens to about 1% of people... but I don't believe it happens as much with chronic pain. Really, I just want a chance to try it, as it's the thing that's worked the best in the past... I hope I can convey this to my doctor, I'm perfectly happy to try for a month, and if it doesn't work.. not to use it. You are right, if it didn't work, it would just be an additional problem!However, if it might work, then it would probably be worth trying... that's my opinion anyway.ben

#12 LaurieJ

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Posted 13 January 2003 - 07:38 PM

Ben,I wanted to respond to a couple of things you wrote. First about the neurontin: I tried that for a few months and ended up in the ER for eye problems: couldn't see because it caused my eyes to get so dry that they became unable to tolerate any light for a few days at a time...this happened twice. And I wasn't even at therapeautic levels yet when I had to stop. They also make you groggy, many times more than narcotics. But your description of burning pain does sound neuropathic so neurontin may be worth a try - my reaction was "very unique".I also feel that if you stress that you want to partner with your doctor over your pain med use, that you agree to enter into a "contract" about use, and stress the things that you told us about being aware about the differences between tolerance and addiction you will present a good case for getting them.I am concerned (as I am sure you are too) that there is still some confusion over what is addiction and tolerance and dependence. For example: I am dependent on my glasses to hold down a job, read books, not get headaches, but I am not addicted (I do not spend 100% of my day looking for glasses, hording glasses, stealing glasses). And like with using meds, there are side effects from my specs: sore nose, ears, red marks....but the bonuses outweigh the minuses. When I need a stronger prescription to see the same, this doesn't mean that I am addicted to my lenses, it just that my medical condition has changed (as is the case if you start to use more pain killers, your pain level has probably become worse or changed in some other way). I have learned to tolerate my glasses so that they do not feel so uncomfortable on my ears and nose as they did when I first put them on (it seems like half a century ago!!!) Tolerance is expected with any new thing that you put into or on your body (think new shoes) including meds that you take, but that doesn't mean that it is bad. Tolerance is not addiction! Dependence is not addiction!!! I urge everyone who doesn't understand this (I know you do Ben) to look at pain clinic home pages and check out the medical definition of addiction as opposed to the general populations definition: it may change the way you look at things and increase your compassion for people who are only asking for someone to help them figure things out in a non-judgemental way.(sorry ben for using your post to preach - you touched a raw spot with me!)Lj

#13 eric

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Posted 14 January 2003 - 02:11 AM

Kmottus was just pointing out the bounceback headaches, which was just on tv on ABC recently where a person, and there were quite a few of them, had headaches for ten years and use over the counter meds. He went cold turkey off them and thought he was gonna die, but the headaches went away afterr he quite the OTC meds. Pain receptors in the brain become weeker and weeker in there tolerence for pain and the bowel wall is lined with the same kind of pain receptors and they too can have less and less pain tolerence, meaning a smaller amount of pain causes more pain, hence why they don't want to give people narcotics for any lenght of time, one for addiction and two because of narcotic bowel syndrome, which someone has on the bb here and is not happy camper. Since the brain is not working properly in IBS to release endorphines back to the gut there are other ways that can help deal with the problem of pain in most people.This is good to read on pain."Mind-Body-Pain Connection: How Does It Work?By Michael Henry JosephLive Event TranscriptEvent Date: 05/11/2000.Moderator: Welcome to WebMD Live's World Watch and Health News Auditorium. Today we are discussing "The Mind-Body-Pain Connection: How Does It Work?" with Brenda Bursch, Ph.D., Michael Joseph, M.D., and Lonnie Zeltzer, M.D.Brenda Bursch, Ph.D., is the Associate Director of the Pediatric Pain Program, Co-Director of Pediatric Chronic Pain Clinical Service and Assistant Clinical Professor of Psychiatry & Biobehavioral Sciences at UCLA Department of Pediatrics in the School of Medicine. She has written about asthma, developmental & behavioral pediatrics, emergency medicine, AIDS education and prevention, chronic digestive diseases and pediatric bowel disorders. She has membership in the American Pain Society, American Psychological Association, Munchausen Syndrome by Proxy Network, and the UCLA Center for the Study of Organizational and Group Dynamics.Michael Henry Joseph, MD, is an assistant professor of pediatrics and co-director of Chronic Pain Services at the University of California at Los Angeles Children's Hospital. He is a recipient of the Golden Apple Award for Excellence in Teaching.Lonnie Zeltzer, M.D., is an expert in the field of pediatric pain. She is a former president of the Society for Adolescent Medicine and member of the National Institute of Health?s Human Development Study Section. She is currently a Professor of Pediatrics and Anesthesiology at the UCLA School of Medicine. She is Director of the UCLA Pediatric Pain Program and Associate Director of the Patients & Survivors Section, Cancer Prevention and Control Research Branch of the UCLA Jonsson Comprehensive Cancer Center. She has well over one hundred scientific publications, reviews and chapters in medical journals, and has lectured internationally.Moderator: Doctors, welcome back to WebMD Live." http://my.webmd.com/content/article/1/1700_50465? This is on the science of drugs for IBS. I personally believe and I have had pain predominate IBS all my life, that narcotics are not the way to go for IBS and I am saying IBS or maybe used temporarily, but even then its a tough call. " Narcotic. Narcotic analgesic drugs are usually not prescribed for continuous treatment because of possible development of physical dependency or addiction and unwanted side effects, such as drowsiness and interference with clear thinking. Furthermore, continuous narcotic use can actually increase pain sensitivity and also alter gut motility, leading to severe constipation. This is called the �narcotic bowel syndrome� Annals of Internal Medicine, 1984;101:331�334. Keeping these cautions in mind, narcotic analgesic drugs are occasionally used to relieve intermittent attacks of more severe pain." http://www.grandtimes.com/Treatment_of_Irritable.html
I am not a doctor. All information I present is for educational purposes only and should not be subsituted for the advise of a qualified health care provider.

Please make sure you have your symptoms diagnosed by a medical practitioner or a doctor.

#14 G0NE

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Posted 14 January 2003 - 02:39 AM

How does imodium differ in it's effect on the gut? Obviously doesn't stop pain, but that is only because it does not cross the blood brain barrier correct? Or no?If it's the nerves in the gut that are over sensitive, wouldn't imodium have the same bounce back effect?Thanks!ben

#15 flux

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Posted 14 January 2003 - 03:11 AM

quote:
How does imodium differ in it's effect on the gut? Obviously doesn't stop pain, but that is only because it does not cross the blood brain barrier correct? Or no?
The effects of opiates is complicated. Different parts of the gut are affected in different ways and there are multiple effects over time. Opiates increase and decrease gut motility in sequence, but that is even simplified because the effects are different depending on whether you are talking about the small intestine or the colon. It is probably reasonable to say as general as can be that opiates decrease peristalsis but at the same time can increase tone and increase segmenting contractions. As some people might like to put it, they cause spasms.In addition, loperamide decreases secretion and enhances absorption and this is primary reason drugs like these are used to treat diarrhea.As for pain, theoretically, it should increase pain threshold (meaning to reduce pain) because that effect begins in peripherally (along gut-brain axis) and not centrally (in the brain).As a result of this a drug called trimebutine (Modulon) was developed, which was supposed to target the pain and like loperamide, it does not cross the BBB. Fedotozine just mentioned also was supposed to do this, but apparently did not work out.
quote:
If it's the nerves in the gut that are over sensitive, wouldn't imodium have the same bounce back effect?
I�m not sure it has been studied whether loperamide would have this effect and to what degree.
I am not a doctor, but utilize sources of information not readily available to the public. Some of this information may contradict what you think you know and some of it may sound harsh, but the information is what it is, and you got it here for free. I am just a messenger. Always consult a real doctor.





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