April 30, 2008 - 8:34pm
I have a bit of a dilemma. I am suffering from a relatively nasty level of pain in my neck and back. The neck pain is a result of cervical facet dysfunction from an older injury resulting in chronic pain. This is documented from physicians throughout my medical record history as well. However, I am also on medication for ADD which is a stimulant medication and is a highly controlled drug. Now through my research I have found that there is no direct contraindication between the two medications, however would a physician find this unethical to treat both conditions with medications that seemingly oppose one another. Now, I am not opposed to using medications that are non narcotic, I just want something that works. Ideally I would like to have a medication that I can take that will control the pain on a constant level, as well as possibly having a low dose of narcotic like hydrocodone to take when the pain becomes extreme. Does anyone have any thoughts on this? I would especially love to hear Dr. Lois' thoughts on this as she is a physician herself. I am scared to mention the pain to my doctor as I dont want him to think I am drug-seeking. I have put off the pain for too long and it is beginning to affect my ability to work at an effective level and thus causing difficulty in my life. Please help with any advice at all. Thanks!
April 30, 2008 - 10:44pm
#2
Actually, Ritalin
Actually, Ritalin (methylphenidate) is not an amphetamine. It is closely related, and both are under the umbrella of the same parent; phenethylamine. I think the distinction lies in amphetamine and it's derivatives functional CH3 (methyl) group, an R-group that methylphenidate does not have.
May 1, 2008 - 12:16am
#3
Definition of Addiction
Actually, I am not "addicted" to amphetamines. The definition of addiction is the compulsive use of a substance despite its causing negative consequences in your life. My life has improved since beginning therapy with this medication so I would not consider that an addiction. However, I may become dependent upon this medication. There is a difference in the two terms. You are referring to "pseudoaddiction"
I respect your belief that ADD can be treated with other methods than pharmaceutical therapy and that is part of the treatment also, the medication is only a tool to help, cognitive intervention and counseling are also an imperative part of the treatment phase. I was not asking for someones thoughts on using Adderall for ADD, I was asking the ethical use of pain medication for pain due to previous injury with referral pain from facet joint dysfunction and cervical radiculopathy. Thanks for the input anyways.
May 1, 2008 - 1:20am
#4
People seem to have very
People seem to have very strong beliefs about AD(H)D. Those who believe psychostimulant use is very beneficial, and those who would rather see them eradicated as a therapy.
I do agree that ALOT of the alleged cases of AD(H)D could be remedied without pharmacotherapy. There are alot of kids who receive psychostimulant treatment, and alot of times, they are just being KIDS. It is crazy that some parents/doctors are so quick to turn to stimulants, when the child's "syndrome" could be remedied by exercise and diet change. But, thats what happens when you have lazy parents and malleable doctors who can't turn down the perks offered up by drug-reps.
However, I dont think that all cases of ADHD can be treated with healthy diet, therapy, and exercise. Especially in the adult population.
I think the approach in diagnosing the disorder is becoming more selective and structured, and it also appears that alternative treatments are becoming more common, but stimulants are definitely important for those who need them.
I wouldnt say you are addicted to them, or even displaying behaviors indicative of pseudoaddiction either. If you benefit from the therapy, then it is no different than taking a multivitamin for optimum health, regardless of the fact they are scheduled.
As far as getting a doctor to rx stims and narcotics, I would be cautious. It is not unheard of, I have seen quite a few patients filling prescriptions for ADHD meds and narcotics quite often. In fact, I was offered methylphenidate or amphetamine to offset morphine-induced drowsiness while I was taking Kadian. It was offered to me, but I declined, as I don't like stimulants. Not all doctors would go for it though.
Have you tried Strattera yet? I have heard mixed reviews, so I dont know how effective it really is, but everyone responds differently. There used to be a drug called pemoline that was pretty effective, and I dont think it was scheduled (not sure though), but I dont know if it is still available (I think there were some instances of hepatoxicity).
Good luck, hopefully you will be able to get the help you need.
May 1, 2008 - 1:51pm
#5
i can't speak on the
i can't speak on the combination prescriptions of these types of meds, but i thought i would let you know of other alternatives you may or may not have encountered.
cervical facet injections have been proven successful in people with your type of pain. this, in combination with a TENS unit, can greatly decrease your type of pain without any kind of medication therapy.
there are also other alternatives, such as neuropathic pain treatment (lyrica, neurontin, etc.)
the best thing you can do is talk to your doc or get into a pain management clinic. they see your type of situation all the time, and can not only prescribe narcotics more freely, but can also do the procedures and alternative therapies i have described, plus much more. it's well worth looking into if your pain is true and disruptive to your life.
good luck and let us know what happens!
May 1, 2008 - 3:46pm
#6
If a person acts high all the time its prob because
If a person acts high all the time considering they are taking pain medications, its more likely they should stop. At that point, the risks are outweighing the benefits. On the other hand, lethargic movement and drowsiness are common side effects for Oxycontin so I don't know.
I despise the press calling medications that truly help people in pain an epidemic. These medicines and active ingredients have been more beneficial than harmful for those who take them responsibly for their condition for more than 400 years which is much longer than this sudden bewildering conquest against Opiates.
May 1, 2008 - 3:54pm
#7
But sometimes Alternative therapies fail and waste money..
A lot of times, when alternative therapies are employed, it leaves the patient in pain a lot longer than a concise medication regiment. More likely, the physician who employs these, even though they are knowledgeable about the benefits of medication, are more concerned with addiction potential rather than truly helping pain. So at that point, the doctor is doing more harm than good. Other therapies might help, but when it comes down to it, NOTHING is quicker than medicine. This will strike a chord with Dr. Lois. Watch!
May 1, 2008 - 6:57pm
#8
I have to disagree that if
I have to disagree that if people are getting high taking a prescription from a doctor that they should stop. I think they should talk to their doctor and decrease the amount of narcotics because obviously they are being over medicated. I have yet to get any eurphoric feelings but I think it is because I was being undermedicated and finally came up with an amount that worked and kept me alert although there will always be pain but an amount that I can deal with. There are many times in the month that I have an extra amount of b/t med's
May 7, 2008 - 1:42pm
#9
The documentation supporting
The documentation supporting the use of stimulants for treatment of ADD, ADHD, depression, and weight loss is excellent. They are also used to offset the sleepiness caused by narcotics! It is well documented that giving stimulants to "normal" people lets them preform better on standardize tests, and improves eye hand coordination! They do have some addictive potential and like ALL drugs should be used with care and the risks of use weighed against the potential benefits.
If you have a painful condition and you have tried the usual home remedies without improvement: NSAIDs (motrin or naprosyn), Acetaminophen (Tylenol), heat, topical rubs (capscaisin, icy-hot, etc.), massage, etc, it is reasonable to tell your doctor that you are having neck pain. Your doctor is likely to recommend some sort of diagnostic testing, recommend PT, maybe a TENS unit, longer trial of NSAID, maybe a short course of short acting narcotics, or refer you for interventional pain management (especially for facet joint syndrome. While narcotics and stimulants can be used simultaneously, narcotics are not always the best answer for painful conditions.
May 7, 2008 - 1:54pm
#10
For acute, severe pain,
For acute, severe pain, narcotics are often the first choice. In conditons where a diagnosis is not yet established, such as a person with abdominal pain in the ER, narcotics are usually not used until a diagnosis is established because narcotics may mask the progress of symptoms, and make diagnosis difficult. Some people with severe pain respond equally well or better to NSAIDs! For migraine pain, migraine specific medication is almost always faster and more effective than narcotics.
I almost always advocate a trial of all appropriate non-narcotic therapies because the nature of chronic pain and narcotic use is that of tolerance and dose escalation.
There is not a lot of "harm" done by witholding narcotic treatment for a few days or a few weeks. People get upset about missing work, or not being able to go waterskiing, but, that cannot be the primary medical consideration.
May 9, 2008 - 9:34pm
#11
Thank You
Thank you for your thoughts. My physician laughed when I told him I was scared to mention the issue coming back up with my CFJ syndrome because I was afraid he would label me a "drug-seeker" He told me that he appreciated that I cared enough about my health to even worry about such a thing, and that he has some patients that will ask straight up for anything, even such controlled drugs as Fentanyl. He sent me for a series of X ray just to see if anything had changed, and is currently awaiting some of my other radiology reports just to confirm the Dx. In the meantime, he placed me on a short acting narcotic at a low dosage to be used as needed for pain, as well as Methocarbomol, and Meloxicam. I find the Robaxin helps more than the Mobic, but obviously the hydrocodone is more effective as it is a semi-synthetic opiate drug. I have been on long acting pain medications before and would rather find something that has less side effects but will still cut the pain. Opioids and Opiates would be the perfect medications if tolerance was never an issue, unfortunately it does result in escalation of titrating doses and stronger meds...Its an ugly cycle that I would rather avoid, but I will let the physician weigh the benefits versus potential side effects and make a judgment that way.
May 12, 2008 - 10:53pm
#12
Good for U!!
I guess I got to your topic too late, but I did just want to say that I have been in treatment for ADD for 12 years and I currently am perscribed adderall XR. Also I have been with my pain mgmt. doctor for 6 years and I am perscribed methadone and percocet(for breakthrough). Obviously I haven't had any trouble with my doctors perscribing both types of medication. The only thing I do want to warn you about is that the combo of a stimulant and a narcotic can create moments of mania (such as a bi-polar individual would experience) a feeling of being meglio-human (feeling that nothing can hurt you). You just have to be really careful to not take more of either drug then you are perscribed to take. I made the mistake of taking 1/2 more of my percocet one day to fight off a bad headache, and I felt like I could "rule the world" for about 30 mins. Good luck to you! :)
May 13, 2008 - 1:37am
#13
Never Too Late
Yeah, I understand what you are saying. When I initially fractured my neck they put me on Oxycodone for the pain, and at that time I was on Concerta™ for my ADD. The combination of the two induced an uncomfortable feeling to where I discontinued the stimulant when I needed the analgesic medication. My PCP is going to refer me to an anesthesiologist for pain treatment, and he suggested that Methadone in a low dosage would help with the pain while not causing too much interference with the Adderall®. He also said that Nalbuphine injections would also help with the facet dysfunction, but at this point all he could really do was refill my pain medication. He did so, and put me on Norco™ 10/325 at 2t PO Q6H PRN for Pain. This is until I can get in with the anesthesiologist.
May 28, 2008 - 8:15am
#14
"High as a Kite"
1st--Want to be ABSOLUTELY CLEAR this is NOT directed at/to the original post but, instead, to reinforce PharmHand's comment/s abt his friend spending most of his time "high as a kite." Before I DO, however...
As a former nurse and a present "Healer" (having decided Western Med System too "screwed-up" to continue practic'g. Apologies to Dr. Lois & all the other equally compassionate docs out there), I would FIRST like to point out something all NURSES (but, unfortunately, few doctors) know.
Pain Meds, when Rxd for legitimate need, will NOT make you "high"--IF you're "chemically dependant." If you ARE in pain, take meds you are regularly prescribed and DO get "high"--you're taking too much! (And that leads to increased tolerance, decreased effectiveness... and so, the cycle Chronic Pain patients are intimately acquainted with, begins... (NOTE: This does NOT apply to someone who, for example, breaks a bone, is given pain meds s/he is not used to taking REGULARLY. THOSE are the "lucky" folks who "fly" w/o a plane. <smile>)
Now--on to PharmHand's friend...
I have a friend who had a coke problem. She was caught, sentenced to time in a fed'l prison as WELL as rehab, had BOTH of her kids taken away by the State & subsequently spent time in a psych hospital.
Upon her release, she went to a doctor, told him her ENTIRE med history (including her prior abuse of cocaine) and the doctor gave her a test for ADHD symptoms AND the ANSWERS needed for an ADHD diagnosis, then Rx'd her a scrip for Adderall (2/day). >>"This way, you won't need buy your drugs off the streets...," his "justification." <!!!> (As I understand it, ADHD is one of the EZiest "afflictions" to fake. Meds Rx'd for it are, essentially, "legal speed.")
She fills her Rx for the month (60 pills) & proceeds to stay up, 4-5 days, "buzzing" about the house. By Day 2, she reaches a stage I've come to call "Adderall Psychosis," bbecause of her (by any definition, crazy behavior).
Unless her husband forgets to hide HIS Adderall (120/mo, but he really DOES have ADHD & ONLY takes 'em as Rx'd) meds gone, she becomes TOTALLY paranoid, the 'b-word' and "CRASHES" for the next 7-10 days. (Yes, 60 pills in 4, 5 days.) But that's not the WORST of it!
The two of them are now SWITCHING scrips. SHE takes the 120 & HE gets by on her Rx of 60. One would think she'd NEVER be w/o, right? WRONG! I've seen her go thru (as God is my witness!) all 120 pills in LESS than a week!
In those instances, when she's gone thru all 120 of 'em, she'll then STEAL *his* (her husband's) meds, blame someone else for "stealing them" and use them, as well.
Of course, he's well aware of what's going on--the reason he puts up w/ it? Too long to go into here. But what IS important, and I really hope I've gotten across, is ADHD drugs, when taken for legitimate need DOES help the patient focus and does NOT affect him/her like the "speed" that it is. (In the same way an ADHD patient finds coffee "calming.")
So if someone you know SAYS they have ADHD but are USING it like a "speed freak" does, they've a VERY, SERIOUS problem. They're like a 33 rpm record album playing at 78 rpm -- but, unlike a record, will "burn out" their bodies YEARS before their time. (Their hearts may even, literally, EXPLODE!)
So RIGHT ON, PharmHand! Keep up the good work! You ARE appreciated!
May good HEALTH accompany your Wisdom,
SilverHealer
July 10, 2008 - 7:26pm
#15
yep i take em
yea ive been perscribed adderal xr for like four years now and i love it it hleps me focus on what im doing amazingly and every now and then i get frustrated and i guess bug out but i guess its a side effect and i also got this new perscription called vyvance 50mg but hose dont work as good anyone ever heard of the new pills i belive they just came out recently
July 17, 2008 - 7:29pm
#16
vyvance
my dr put me on this drug and it really to work for me.it has a low potential for abuse because it has to have stomache fluids to work. it really calmes me down. i also take lortab for chronic pain. it does seem to bother me
(edited)
October 17, 2008 - 2:13am
#17
another side effect from
another side effect from mixing opiates/opioids with adderrall/dexidrine is that the amphetamines seem to make you more tolerant to the opiates. as i said in my earlier post, my friend takes adderall for ADHD and he also takes 80mg OC's for pain from a bad car wreck. He tells me that normally one 80mg OC would make him drowsy,and slightly nautious, but when he takes his adderall, he can easily take two or three 80mg Oc's at a time without feeling drowsy, but doing this puts him in a state of extreme uphoria and makes him act pretty crazy. Adderall/amphetamines can greatly increase your tolerance to opiates. So just remember, if your doing this, listen to your doctor, and do not take more of your meds than you are supposed to. use moderation
October 17, 2008 - 2:22am
#18
"pseudoaddiction"
dear brainiacthemaniac...I respect the fact that many people benefit from pain meds, and ADHD meds. But whether you take them legitimetly for pain/ADHD from a doctor, or you buy them off the streets to get high, and whether you are addicted or in your case "psuedoaddicted" the dependency and the withdrawls when you stop are excatly the same. So if you ever lose your script when traveling or decide to quit, have fun with your "pseudo-withdrawls"
October 17, 2008 - 11:24am
#19
i have adult adhd and am
i have adult adhd and am prescribed adderal 10mg 4x/day. also, i am prescribed 240, 10/325 percocet and 30, 120mg avinza (timed release morphine) a month. so in otherwords, i am being given pain meds and stimulant med for years now with no problems.
July 19, 2009 - 5:29pm
#20
Can someone help me with Vyvance?
The doctor placed my 8 yr. old grandson on this new medicine. I'm woorried because what they had him on before didn't work. He has ADD comperhesion problems in other words he's slower than normal kids thinking and moving. The side affects is what I need to know I've checked a few places on line and all it says is new drug. The last medicine he was on intensifty sound and he complained with headaches so the doctor wants to try this I just want whats best for him Help please I need to know something Thanks
July 19, 2009 - 5:44pm
#21
nofun
You should talk to your pharmacist.
July 19, 2009 - 5:56pm
#22
Amphetamines
are usually prescribed with narcotics to combat the sedative effects of them....I've seen many people that are on high does of opiates for cancer pain, and the amphetamines help them not be so sleepy all the times....It's common practice in pallative care.
Ray
July 21, 2009 - 2:18pm
#23
Comment for Nofun
I was diagnosed with ADHD 8-9 years ago and have been Rxed almost all of the usual stimulants involved with this disorder, including Vyvance. I have always returned to my original Rx of AdderrallXR 20 mg 1 p/d, though I did give each med a 2-3 month try. I was diagnosed at the age of 46 or so, I am now 54 and suffering from cancer. The reason for this intro is to help you understand my point of view.
I am completely 100% against prescribing stimulants to children, juveniles, and adolescents for ADD or ADHD . . . especially to chidren as young as your grandson. The side effects in young children are so numerous and varied that I am not capable of listing them. Please prevail upon the parents to seek another method of treatment, anything would be better than using such a powerful stimulant on such a young child. During the 3 month trial of Vyvance, which was overseen by my Psychiatrist/Psychopharmacologist, I felt at times uncomfortably overstimulated. Nothing dangerous mind you, it was similar to a caffeine jag. Now, you have to ask yourself, "Would I give an 8 year old child two quad shots of espresso to calm him down?" I realize that I am oversimplifying the situation, but there it is.
I'm sorry that I am unable to suggest any alternatives, the subject is out of my limited range. Perhaps another poster can help, PLEASE! good luck . . . Q
PS: I agree with you Ray, the Adderall is extremely helpful to me in countering my high dosages of both Fentanyl and OxycodoneIR. I would recommend that CPs under high Opioid analgesic treatment talk to their Drs. about it's possibilities . . . Q
i dont agree w/ treating ADD w/ adderall, dexedrine, or ritalin. these are all powerful amphetamines and are highly addictive. i have a friend that is prescribed adderall for ADD, and O.C. 80mg's for pain. he is always high as a kite and out of it. there are other ways to treat ADD besides these powerful amphetamines. and for some people (not all) what's worse: having a mild case of ADD or being addicted to amphetamines?