Pain go away! (2) - «Can low-dose opiate patches also become addictive?» (2023)

Specialists in the "Pulse" chat

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Dr. Barbara Ankle
Specialist in rheumatology and general internal medicine
Head of Rheumatology
Pain Clinic Basel

Christian Cesna
Specialist in Psychiatry and Psychotherapy
Senior Physician in the Department of Psychosomatic Medicine and Psychotherapy
Clinic Barmelweid AG, Outpatient Clinic Aarau

PD dr Konrad Maurer
Specialist in anesthesiology and pharmaceutical medicine
Institute for Interventional Pain Medicine IISZ, Zurich

chat log

Dear Sir or Madam, We all know the dramatic effects of the opiate crisis in the USA in recent years - to what extent, according to your assessment, can painkillers based on cannabis (THC, CBD or mixtures of both substances) be used in the therapy of chronic pain, or an alternative to prescribing opiates?

Christian Cesna: Good evening. Unfortunately, these have little analgesic but mainly calming effect.

Hello, What do you advise against pain in the feet and legs caused by pnp (polyneuropathy). All possible causes have been investigated, but nothing concrete has been found. Thanks

Barbara Ankli: Good evening There are medications specifically designed to treat neuropathic pain, these are generally derived from epilepsy therapy, such as gabapentin or pregabalin. There are other options as well. Discuss them with your family doctor or pain specialist.

I read from a former top Swiss skier that she suffers from grade 4 gonarthrosis and that she is still able to do very extensive and intensive sporting activities without painkillers. Other people with the same diagnosis can no longer do without a joint replacement. Do you have an explanation for this? What does the former top athlete do differently so that she doesn't suffer from chronic pain? Is there still a need for research?

Barbara Ankli: Good evening. It is a mistake to believe that every osteoarthritis of the knee is painful. It is not only the X-ray findings that are important (Grade IV here probably refers to the X-ray findings). The former top athlete becomes whs. Maintain a balanced exercise regimen that includes quadriceps and other leg axis exercises. There are also structured "GLAD" training programs that will soon be offered throughout Switzerland. Furthermore, z. B. Nordic Walking is highly recommended for osteoarthritis of the knee.

For more than 20 years, a disc hernia operation. the S1 nerve is injured. Since this operation I have had severe nerve pain on my left foot and on my 2 smallest toes. In the pain clinic Prall. Nottwil 5 years ago, unfortunately, they couldn't help me. I was prescribed the drug "NEURONTIN film tablets 600 mg". Unfortunately, these pills are of no use to me. What can I do to make the pain finally go away?

Konrad Maurer: The type of pain you suffer from is often difficult to treat. At best, neuromodulatory methods should be considered, which can often alleviate back pain radiating into the legs. However, you must contact a pain management facility experienced in this therapy method. please refer:

Good evening I suffer from migraine have to take 2 times or migraine tablets I'm dependent. What's an alternative best thanks

Christian Cesna: Good evening. Discuss this with your neurologist. The usual pain medications often cause pain themselves and have to be stopped first. There are good therapy programs for that! Let us advise you.

Good evening everyone. Is it possible that poppy seeds actually have side effects in small amounts since they apparently contain morphine and codeine? The opioid is intended to provide relief from severe pain, but also to produce side effects. Poppy seeds are also used in baking. Thanks for your answer. bg

Christian Cesna: Good evening. Stiftung Warentest checks these types of poppy seed again and again. There shouldn't be much left in there...

My diagnosis is: metastatic breast cancer, metastases to the spine. I often have pain at night, so I take a Novalgin every evening. My question: is Novalgin a painkiller that should not be taken for a long time? Thank you very much for your answer.

Barbara Ankli: Good evening It is understandable that you are suffering from severe pain. With your illness it would be quite justified on stronger painkillers like z. B. to switch opioids. Novalgin only works for a few hours at a time, it would be important for you to be able to sleep through the night. There are now opioids (morphine preparations, so-called slow-release drugs) that have a longer effect. Discuss it with your family doctor or the attending gynaecologist/oncologist. Please don't hesitate to seek help. There are also radiation therapies for the bone metastases that can have a rapid effect on the pain.

I've been taking 300 mg Tramundin retard and 4 grams of paracetamol for X years because of back problems. Is this a problem?

Christian Cesna: Good evening. This is a high dose of the mild opiate and the acetaminophen. It would be important to reassess whether these drugs are really necessary. Let us advise you.

After my back surgery it turned out that I was allergic to morphine. I mentioned that during my ankle joint surgery, and then I got something with Oxi…. I didn't need it at all because the pain wasn't that bad. Was able to drop it off after a day. Why are such medications already prescribed as a precaution? Would go with less strong medis for the beginning and only if they are of no use, open up with coarser artillery. Thank you and goodbye

Christian Cesna: Good evening. Doctors often think they are doing their patients a favor.

A 72-year-old person close to me has been taking Oxicontin for 20 years because of back pain after surgery. How can I support the person to get rid of the addiction? Is there any chance of withdrawal at this age?

Christian Cesna: Good evening. At this age, opiates can also be discontinued. Suitable clinics (e.g. psychosomatic departments) can do this on an inpatient basis.

My husband had an accident four and a half weeks ago, breaking six ribs, other fractures and bruises. In the clinic he was prescribed Targin 20/10 mg every 12 hours (along with ibuprofen and paracetamol). Because he couldn't tolerate ibuprofen (gastritis despite stomach protectors). He has therefore been taking Targin for over three weeks with a five-day break. How great is the risk of physical dependence? How do you stop such a drug?

Konrad Maurer: In the case of acute pain, as is often the case after broken ribs, opioids are definitely a good option. However, this therapy must be "managed" well and the opioids slowly tapered off as soon as they are no longer necessary (maximum after 2 months). This keeps the risk of dependency low.

Are there alternative painkillers to opioids?

Barbara Ankli: Good evening, there certainly is. It depends on the cause of the pain. if e.g. B. an inflammatory pain, as in a rheumatological disease z. B. gout is present, the inflammation should be treated first. Then the anti-inflammatory drugs come into play (e.g. ibuprofen). If the kidneys or liver are attacked, or if there is an inflammation of the stomach, these anti-inflammatory drugs should not be taken. In general, it should be said that the cause of the pain should first be clarified so that the right therapy can be prescribed. Please discuss it with your family doctor.

I have had pain in my calves for a long time what can it be??

Christian Cesna: Good evening. Answering this question remotely is difficult. What does your family doctor say?

I have had chron for 15 years. SZ in the knee. I'm 21 years old and work, so I take opiates every day. So far no one has found another solution, even the 8 surgeries didn't help. Do you have another tip? Thanks.

Christian Cesna: Good evening. I recommend that you try a different approach if necessary: ​​eg pain group therapy. Especially at this age you need help on another level so that you can still lead a long and beautiful life!

I've been taking Targin 10/5 for a Sudeck for 8 years, what can I take instead, I'm in terrible pain sometimes??

Konrad Maurer: Basically, this dosage of Targin is small. After such a long time, it is questionable whether this still works at all, since there is certainly a strong physical habituation and opioids no longer produce a pain-relieving effect. It would certainly make sense to develop another strategy, the best thing to do would be to consult an appropriately trained pain specialist:

I have been treated with Targin 20/10 and other medications for back pain since 2018. So look for a psychiatrist and only get rejections because there are no free places. Who can help?

Christian Cesna: Good evening. Unfortunately, we know this problem. Too many doctors only treat the healthy and reject the sick. The health insurance companies often set the wrong incentives. Keep searching! There are, but a long wait is common.

If someone doesn't have good insurance, how do you get to such a good specialist

Konrad Maurer: Have your family doctor refer you, in the outpatient area of ​​medicine the insurance class is NOT important.

I've been taking Novalgin and Davalgan for a long time. Reason had an epididymis surgery. Do these drugs also make you dependent? Thank you very much

Christian Cesna: Good evening. This is common, sometimes not all medications can be stopped. Are you with a specialist, e.g. a urologist to help you treat this condition. Centers often have different arrows in their quiver.

I've been taking Oxynorm 5 mg 1-2x a day for about 3 weeks...after knee replacement surgery...since I don't tolerate painkillers very well, according to the doctor, that was the only option...although I told the doctor that I was addicted to lexotanil 20 years ago was… now i have concerns about re-addiction what should i do??? I have to mention that I am a chronic pain patient and also take Celebrex 200 mg and sertraline 50 mg...many thanks for your answer....

Christian Cesna: Good evening. Give the knee and the area around it some time to heal. 5mg is not much. Do not be afraid to discuss your fears with the doctor treating you.

I've been traveling around eastern Switzerland for two years (an acquaintance). Everything is diagnosed, from Morbubechters to mentally ill, also gets time and again with other painkillers, now currently iv recipients, but nobody knows what really is, who can really help?

Christian Cesna: Good evening. That sounds like a difficult story. Encourage your acquaintance to seek good help. I'm sure she's glad you're helping her. Keep it up.

+++ I've been taking Oxycontin for 20 years. On the last show, I reduced myself from 40 mg to 20 mg. The dosage was 2 x 20 mg plus 40 mg which I reduced to 20. I would also like to reduce this 20 mg on my own. Then I would be on 2 x 20 mg. I am chronically ill and in a wheelchair. By the way, starting in September, instead of hemp, I'll get injections directly into the cramped muscles. Want to try something new. You can do it yourself with the reduction of the medis. +++

I'm 25 years young. I have arthrosis in the facet joints, double scoliosis, 2x herniated discs. 2x band plastic according to OSG. Shoulder operated twice. Now with the unlaris nerve problem, nerve pain in the legs. I have been suffering from chronic pain since 2012. Multiple withdrawals from opiates. Currently opiate free, but it hurts. The doctors say only opiates help and there is no other option. I just don't want to accept this. I don't want any more opiates. alternatives?

Konrad Maurer: For certain complicated pain problems, opioids are often part of the drug therapy, but they lose their effect over the long term and all other options must be carefully evaluated, preferably at an institution specializing in chronic pain.

Good evening. For 30 years I have been suffering from chronic pain in the neck, shoulder and back area due to severe tension and migraines. With moderate painkiller consumption, weekly physiotherapy, relaxation techniques and psychotherapy, I can still work 60%. However, my quality of life is severely limited. What could help? Thank you.

Christian Cesna: Good evening. Discuss with your therapist how exactly your quality of life is negatively affected and what can be done about it. A small stone in the shoe can often make a hike difficult, and removing the stone can work wonders. Say it out loud! Ask for!

Hello, after a car accident with permanent whiplash, I take Mirtazapine Mepha 45 mg for the headache, which works very well. Is this going in the direction of opiates?

Konrad Maurer: No, mirtazapine is not an opioid.

I had shingles at the end of April 2021. This has subsided, but moderate pain has remained until now. Which painkillers are useful. I am 79 years old and diabetic. In 2019 I had pancreatic cancer. The entire pancreas was removed, as was the spleen. This only as additional information.

Christian Cesna: Good evening. You have a difficult story behind you! Be sure to talk to your family doctor!

Good evening. For almost exactly 2 years I have been suffering from severe pain as a result of post zoster neuralgia after shingles on my face. This despite the use of 3-day Fentany patch 100mg. and physically 2 pregabalin I'm in pretty bad pain all the time. Then there are the side effects of the drugs. At the moment I don't know what to do next. My quality of life and zest for life "are on the ground". What do you suggest?

Christian Cesna: Good evening. Be sure to speak to your practitioner. A depressive mood with hopelessness may also have developed. Let yourself be referred to a treatment team or even to inpatient treatment.

What about the sporadic use of opioids (Targin 5/2.5 or 10/5 & Oxynorm drops)? About 6 years ago I had an operation on my back & since then I have had episodes of severe pain again and again... I still struggle with chronic pain to this day.

Konrad Maurer: The sporadic use of opioids, especially "fast-acting" opioids such as Oxynorm drops, is strongly discouraged for chronic pain. If opioids have to be used, then only under the dosage prescribed by the doctor and under control of the therapy effect. If this is not done, there is a not inconsiderable risk of opioid dependence.

I take carbamazepine for epilepsy. In addition, I have an endplate impression fracture LWK 1 – 4 and two disc hernias LWK ¾ and 4/5, as well as C2/3 and C3/4. Now tramal and fentanyl (because of the CYP3A4 phenomenon??) no longer work, there is an antidote (inhibitor ) So that these painkillers work again, antirheumatic drugs are not intended for life either

Barbara Ankli: Good evening When taking carbamazepine, there are many interactions with other medications, e.g. B. Ibuprofen, this changes the level of carbamazepine, in turn, carbamazepine affects painkillers such as fentanyl and tramadol. Please discuss the case in detail with your general practitioner or pain specialist. You would have to get another morphine preparation.

Do the painkillers Novalgin and Zaldiar belong to this group

Konrad Maurer: No Novalgin, Zaldiar yes. Zaldiar is classified as a "weak" opioid because it is less potent. However, there is also a risk of dependency here.

Good evening everyone, I have had severe arthrosis in both feet for years and have been taking Arthrotec 75 mg once a day for about 3 years. My question is that I am 57 years old and will have to take painkillers (without surgery) my whole life. How dangerous is it becoming addicted as I will likely need to increase the dose at some point as the pain continues to increase. Thank you for your reply.

Christian Cesna: Good evening. Arthrotec does not contain any opiate. But I would discuss the fear of the future with your family doctor. He may be able to reassure you by offering further help for you in the future. The psyche can also need balm from time to time.

My father has trigeminal pain and takes Palladon retard 4mg morning and evening. Is this a useful therapy?

Barbara Ankli: Good evening. This can be a sensible therapy for this often excruciating pain. There are also other medications, so-called antiepileptics such as carbamazepine. However, this can lead to interactions with other medications. Discuss this with your father's family doctor, she knows all the prescribed medications.

I have had very severe nerve pain (occipitalis) right for several years. and take Zaldiar 1 tablet in the morning and 1 in the evening.

Christian Cesna: Good evening. This sounds like a long tale of woe. Who will help you?

I am 85 years old and have a stenosis in 3 places. Now I've started taking Tramal Paracetamol 37.5 mg/325mg, up to 3x 1-2 tablets, I'm becoming dependent on it, I've only just started taking this drug,

Christian Cesna: Good evening. Combination preparations often have the problem that they are taken together and, with the increase in dose, both enter the body in higher doses. It is also unclear whether both are really needed. What else could help? Ask your doctor!

I've had pain in my left shoulder, specifically in the joint, for about a year. The family doctor thinks it could be the joint capsule. What can you do, he wanted to give an injection, but I'm still unsure. What is the chance of treating this with pain ointments etc.?

Barbara Ankli: Good evening. Good physical therapy is very important. The shoulder joint does not have a proper glenoid like e.g. B. the hip joint, it is held in place by ligaments, tendons and muscles. If it is not moved enough because of pain, the capsule can shrink. Have yourself referred to a rheumatologist, an ultrasound should be carried out, then an infiltration (injection) can be carried out if necessary. The most important thing is to maintain mobility.

Age 74 male Pain area: Restlesslex, back pain in the loin area, about 1 x per week whole body pain like a rheumatic attack Duration 2 - 3 hours Medication Sifrol, Ecofenac Duration of the pain several years. is this chronic pain? thank you for your answer

Konrad Maurer: In principle, all pain that lasts longer than 2-3 months is referred to as "chronic". Much more important for establishing a meaningful therapy is the clarification of the causes of the pain.

Good evening, I am 86 years old and have had severe back pain since I was 30. X-rays, MRI and many physiotherapy, examinations etc. etc. All kinds of painkillers were prescribed again and again with very little effect. I have been prescribed oxynorm and targin for about five years. The only method that took the pain away from me. Now I sometimes take 5 drops of oxynorm when I have acute pain and Targin only when the pain is persistent.

Christian Cesna: Good evening. They have a very long history behind them! If this helps, why would you want to change anything?

Good evening, I am 41 years old, since my accident in 2000 I have had severe to unbearable back pain every day. Various electrical stimulators, morphine pain pumps, X opiate tablets and others, local puncturing etc. never helped. After the last unsuccessful attempt by Temgesic, I am currently taking Apydan extent 300mg for testing. Why can nobody help me until now???

Barbara Ankli: Good evening, you suffer from a chronic pain disorder. Many individual measures have been implemented. I would recommend an inpatient stay in a pain clinic. There you will receive a multimodal therapy program involving many specialists who will look at your case. Have your family doctor refer you.

I have chronic pain and have been taking MST Continus for many years. According to the doctor, the pain is psychosomatic and chronic, and inpatient treatment in a pain clinic is being considered. My question: Which clinics in Switzerland, possibly in the Zurich region, specialize in such treatment?

Christian Cesna: Good evening. There are a number of clinics for this. Of course, the Barmelweid above Aarau would be an option... talk to us, there are many clinics that do an excellent job.

Good evening My father suffers from severe neuropathic pain and has been taking targin etc for many years. Last week he received dronabinol on application. Now he takes both because dronabinol doesn't work. Is it dangerous?

Konrad Maurer: Both are drugs that act on the central nervous system and can have dangerous side effects. It is important that such therapy is well and regularly monitored and that patients adhere to the prescribed dosages.

I have shingles since April 6th with great pain with several painkillers Tramadol, ecofenac and Pregabaline 75, Novalgin. Would you advise me to go to the infectiologist?

Christian Cesna: Good evening. Shingles is caused by a pathogen that is already in the nerves and sometimes causes symptoms to return. You can no longer get the pathogens out of it either. However, you can talk to your doctor to see if there are other things that can help relieve your suffering.

Good evening, How can I solve my itching problem on the right shoulder blade, my family doctor wants to prescribe me medication for epilepsy. The two spots are brownish. Do you have any advice for me? The dermatologist can't help me either, he thinks the itching has something to do with the nerves. Thank you very much

Barbara Ankli: Good evening whs. if it is not dangerous, it is called notalgia paresthetica, a common problem. Unfortunately very painful, pepper patches may help (capsaicin). If the family doctor does not know what to do, have it sent to a pain specialist.

6 weeks ago I had an operation in the University Hospital Basel. Spinal fusion L4/5. Then Targin 5 mg 10 days. Then received Targin 20 mg in rehabilitation in Rheinfelden without information/consultation. After 14 days (gut feeling) "googled" read about addiction. addressed to doctors. Then (after 2 1/2 weeks) reduction to 10 mg and since today reduced to 5 mg. In a self-experiment (1x omitted) after 6 hours already withdrawal symptoms (breaks out in a sweat/trembling/aggressiveness. When can I stop?

Christian Cesna: Good evening. I would discuss this with your trusted doctor. Sometimes you can also omit the medication in the second step when the acute pain is over. Other things often help too. Let us advise you.

Are hemp drops also addictive?

Konrad Maurer: If the drops contain the psychoactive THC, they can primarily cause psychological dependence and should therefore only be taken under expert and regular supervision.

I have on 1.6. 2020 injured muscles, tendons, connective tissue in the buttocks while jumping on a trampoline, left and right. I'm 61 years old, sporty, swimming, cycling, yoga, as a teenager I set a Swiss record in hurdle sprints, probably also wear and tear. I've been in physiotherapy for 1 year, family doctor, now sports doctor. made me Slight arthrosis in hips. Pain is better but still there. What else can I do? - In addition, joint pain, conjunctivitis in the shoulders??

Barbara Ankli: Good evening Possibly. Are tendons torn? An MRI can provide information here, if conservative therapies fail, the orthopedist should be consulted. What type of joint pain is present? If night pain, swelling, morning stiffness are present, the rheumatologist should be consulted. Possibly. are the tendon attachments of the buttocks also inflamed? This would also be seen in the MRI of the pelvis.

I have been prescribed Sevre-long 60 mg and gabapetin since December 2014 due to Sudeck's disease, intervertebral disc pain and neuropathic pain throughout the body. Is there an alternative? I've been suffering from chronic pain for longer than 2014 though...

Christian Cesna: Good evening. Pain is often the result of various factors. See if anything else could help.

Since 2016, the first back operation (falling down the stairs), I have been given Oxinorm and later Targin up to 20 mg and others. In rehab I was asked if she really wanted to kill me because the doses were so high. In any case, it doesn't help. Just stuns you. Just won't take any more of it now. Don't know what to do with the pain. Where and with what can I get help?

Christian Cesna: Good evening. That's a terrible story you've experienced! Sometimes a center using different tools helps to improve the quality of life. Take advantage of this help. You deserve it.

Good evening. Is there a risk of dependency and addiction with (low-dose) opiate patches? If so, how long can you use them without getting addicted? Thank you!

Konrad Maurer: Yes, this danger also exists with low-dose opioids. Basically, opioids should only be used for a short time because they lose their effect with long-term use and the risk of dependence increases.

I have arthritis in both thumbs and soft tissue rheumatism. The left thumb was treated 3x with cortisone injection. The third injection didn't help anymore. The soft tissue rheumatism partially goes away with a lot of exercise. I have bad pain in the morning. My doctor prescribed me Ecofenac CR 150 mg, which helps, but I don't tolerate the product well. What do you recommend to relieve the pain?

Barbara Ankli: Good evening Here a diagnosis would have to be carried out with X-rays, ultrasound, blood tests (increased inflammation values ​​in the blood?), the question is whether a rheumatological disease is present here. If necessary, the general practitioner can register them with a rheumatologist. In the meantime, instead of Ecofenac z. B. Etoricoxib 30-60 mg/day can be used, for rhizarthrosis I would recommend splints.

Hello Mr. Cesna, thank you very much for your answer! what do you mean by giving the knee time that I can continue taking Oxynorm 1-2 times a day until the knee pain is gone??? Thank you very much for your answer!!!!

Christian Cesna: Good evening. Yes, sometimes healing takes time.

Are opiates dangerous?

Barbara Ankli: Good evening. They are very effective painkillers. However, they are only used if other medications do not work or are not tolerated. If absolutely necessary, e.g. For example, there are safe preparations for cancer patients today, but the doctor often has to check the patient, especially at the beginning, because everyone reacts differently to medication. At the beginning you can B. also not driving a car.

I've suffered from Fybromialgia for years and have had Restless Leegs my entire life. I've been taking Tramadol against Restless and Zaldiar against Fybro for about 20 years. I have tried various other medications but none were without side effects and helpful like this one. But I couldn't put it down anymore. You can't go a day without it. What do you recommend. ? How should I proceed ?

Christian Cesna: Good evening. So you've been on these drugs for a very long time? Do you even know if it still helps or if there are better medications? Let us advise you. Group psychotherapy often helps, where you can meet others with the same story and exchange ideas. Inpatient treatment would be a place to try things and leave others out. Let yourself be competently advised! You deserve it.

I am 58 years old. I have had a Medtronic intraspinal pain reliever pump since 2007. I get morfin, carbosestin and clonidia. Since the 2 operations on the lumbar vertebrae didn't work out. 5 weeks ago, my anesthesiologist and pain doctor slowed down the flow rate after filling up. Since then I've had a weird head and a bit of balance disorders has to do with slowing down the flow rate? Didn't have this simpthome before. Thanks for an answer

Konrad Maurer: The symptoms you describe are not very specific. You should contact the doctor responsible for the dosage and flow rate so that he can check this therapy and the function of the pump and adjust it if necessary.

I was prescribed Zaldiar medication for back and hip pain. It works very well. I take one pill in the morning and one in the evening. How long can I take this drug without becoming addicted?

Barbara Ankli: Good evening, unfortunately I don't know your age. Zaldiar is a weak morphine preparation combined with paracetamol. It can be taken for a long time. However, one should also clarify the cause of the back and hip pain and treat it specifically. Certainly physiotherapy always makes sense at the beginning or as a refresher.

What would the alternative medication be? The hand is partly discolored blue and very sensitive to touch because of the Sudeck.

Konrad Maurer: There is a whole range of medications that can be used for M. Sudeck. The best thing to do is to contact an institution that specializes in chronic pain:

I (42) have had migraines for about 10 years and currently only take ibuprofen medication…. Does it make sense to see a pain therapist, since my family doctor only said that when I retire I won't have migraines anymore... what else would be recommended?

Christian Cesna: Good evening. Unfortunately, certain painkillers like Ibu.. also cause headaches. Then you can try to remove them. Especially good neurologists have excellent programs! If the work caused you the stress, one could try to improve something there. People have often been brought up to be very performance-oriented and can learn to reduce this pressure to perform. Your doctor will certainly have good addresses for this.

+++ Thank you very much! And have a nice evening! +++

Good evening, I am writing for my mother (85). She suffers from oral dyscesenia. During the years of treatment, she was given various painkillers. The side effects were always greater than the effect against the pain. Botox was also injected several times. With moderate success. Now we wonder if opioids or hemp would be a possibility. Or is there another pain therapy for them? Kind regards CW

Barbara Ankli: Good evening The diagnostics and therapy belong in the hands of a neurologist, who should be consulted if necessary, all the best.

Good evening. My family doctor has been prescribing me oxycodone-naloxone-mepha for 4 years for chronic pain in the pelvic area. Last year I reduced the dose myself from 10/5mg to 5/2.5mg. Unfortunately, I now have to take an additional 5mg of Oxynorm for the flare-ups. My question to you: will it be difficult to stop taking oxycodone yourself after such a long time? Can I do this alone? Unfortunately, I don't have that much support from my family doctor and I can't switch to the family doctor model.

Christian Cesna: Good evening. This is a difficult story! And yet you have taken the first reduction step. What an achievement! He may refer you to an appropriate practitioner who will support you in your incredible performance?

Where can I turn to regarding my daily facial pain, so far no one has been able to help me, I've had it for 9 years

Konrad Maurer:

+++ For me it is inexplicable that opiates are prescribed for non-specific back pain. Personally, I had gone through a 10 year odyssey with lower back pain and never took any painkillers. Physiotherapy and giro practitioners always brought about an improvement for about 2 days, but were not the solution. Only thanks to Liebscher+Bracht exercises, which relieve the tension in my back, do I now have an instrument to get the pain under control myself. +++

Good evening Mr. Maurer, I have had facial pain for 9 years and have already had x treatments, including in the pain clinic in Zofingen, currently again in the university clinic pain clinic and nothing helps

Barbara Ankli: Good evening, I would complete the treatment at the university clinic, there are many specialists involved, a so-called "multimodal therapy concept" is important, talk to your doctor about it.

Good evening, after 3 herniated discs on the same disc, 2 vertebrae were stiffened, but the radiance has remained, more or less depending on the work. I get stomach problems from Ibuprofen and Irfen. Tramadol has little effect, but Saridon without a prescription shows an effect, as can be that be? Thank you very much.

Christian Cesna: Good evening. The original substance and newer modifications often differ, as in your case with the Ibu... and a faster-dissolving form may be able to cope with the pain better?

Good evening. I have been taking Co Dafalgan regularly for about 20 years. I am in poor health and have migraines. I am aware of the danger of Co Dafalgan or codeine. That's why I'm taking it at a low dose i.e. 16 pills in a month (and am in the process of reducing the dose and even get to 2 months with the same dose). But I also try to reduce my pain with herbal remedies etc. I see the doctor regularly. Can I keep going like this? Thank you very much

Konrad Maurer: The way you describe the situation, Monika, you are doing it exactly right. Keep your doctor informed of your reduction so they can continue to support you with alternatives to co-dafalgan.

I have had chronic pain for years, due to lipoedema grade II, whiplash and an accident with multiple fractures of the humeral head. What can I do about this chronic pain?

Christian Cesna: Good evening. Haiaiai. But you have a combination of diseases. Appropriate lymphatic drainage or even specialized liposuction of the diseased fatty tissue helps against lipoedema, which unfortunately does not yet have a decent status here in Switzerland. How long ago were the accidents? Were you given appropriate psychological support? Group therapy often helps by meeting other people who are in pain and no longer feeling so alone.

+++ Not a question, but a statement: I have ADHD and have been taking methylphenidate for years. If I want to get my new prescription even a day early, the psychiatrist tells me to come back tomorrow. I find it absolutely ok per se, although methylphenidate is not physically addictive. But in the context of the practice of prescribing opioids mentioned in the program (de facto no control) I find it almost ridiculous..! +++

I was diagnosed with rheumatism and since then I have had an Actemra injection once a week, 5 mg cortisone in the morning and Lodotra 5 mg at 10 p.m. For a week now I've had severe pain in my right hand again, i.e. the feeling as if the fingers were dying. I cannot understand that I am still suffering despite all these medications. Is it possibly a misdiagnosis? How should I behave at the doctor's?

Barbara Ankli: Good evening You should clarify before the weekend the feeling that your fingers are dying, is there a circulatory disorder? If the hand is cold and purple then it would be an emergency, then seek medical attention immediately. Actually with Actemra you shouldn't need cortisone anymore, it's also unusual that they get cortisone twice a day. But I don't know your case, why don't you discuss it with your rheumatologist and ask about the exact diagnosis of rheumatoid arthritis? If Actemra does not work and the inflammation persists (monitored by ultrasound), I would discuss changing the syringe with the rheumatologist.

Hello, I have pain in my shoulders and back. the doctor prescribed me mydocalm. because i have concerns about dependency, i didn't take the drug. does one become dependent or how long can you take it and does it help?

Christian Cesna: Good evening. Mydocalm is primarily a muscle relaxant and not an opiate. It can achieve good results. Talk to your doctor and check the effect together regularly. Sometimes other things can also help to relieve the load on the shoulder...

The olfen 25mg gets on my gut. I have irritable bowel what would be a better alternative?

Barbara Ankli: Good evening Olfen is a so-called non-steroidal anti-inflammatory drug (NSAID). The best tolerated for the intestine from the same group is acemetacin. Otherwise, there are other pain relievers from other classes like paracetamol that shouldn't cause any intestinal discomfort.

Why not talk about the fact that long-term use of opiates can cause pain?

Christian Cesna: Good evening. This is a good point.

Good evening. How do I understand that when a well-known pain specialist says in Pulse Talk that painkillers cause pain? Painkillers are taken to relieve the pain that this pain causes is beyond me. Can you explain that to me briefly? Thank you very much.

Konrad Maurer: It is actually the case that taking painkillers regularly can, paradoxically, lead to pain. For example, there is the so-called medication overuse headache, which occurs as soon as the effect of the pill wears off. However, the regular intake of opioids also leads to an increased sensation of pain as soon as the effect of the pill wears off.

Rheumatism patient SL I can use the opioid Palexia retard 75mg for a longer period of time.

Christian Cesna: Good evening. does it help? You probably do a lot of other things to make your life easier, right? Otherwise, discuss it with your rheumatologist.

After a partial knee prosthesis operation (09/15/2020) I take a Voltaren 75 retard every other day, before that Omezol Mepha gastric protection, because I still have pain. I'm 76 years old, relatively fit and like to do moderate sports (swimming, hiking, skiing, etc.). I take the Voltaren so I can stay active. What side effects should I expect, or is that OK? Someone told me it can promote osteoporosis...(I don't currently have osteoporosis)

Christian Cesna: Good evening. Osteoporosis is primarily associated with the use of various stomach protection drugs. But often it is a multifactorial genesis.

Do opioids cause pain after years of use?

Konrad Maurer: Basically, the long-term use of opioids can cause a change in the perception of pain, i.e. the opioids can - but do not have to - lead to an increase in the symptoms.

Hello, I have suffered from migraines since I was 25 years old. Today I am 52 years. I used to have migraines about twice a month. Almost every day now. I'm not sure I'm on a drug cycle that I can't break and how harmful Eletriptan 40mg is to the liver. Another question: Is stress a cause of migraines or is it more hormonal or is it a genetic predisposition? Thank you for your reply.

Christian Cesna: Good evening. Lots of interesting questions. I recommend you discuss this with your neurologist.

After a back attack, myélopathie ischémique in 2011, my vascular muscles never recovered. My walking is getting worse and worse, I have severe pain every day and, in addition to the Irfen 150 mg and the obligatory Médics, I take DAFALGAN and IRFEN 400 several times a day. I'm 73, was always very sporty and do physio daily, swim weekly and run a lot, preferably with walking sticks. What do you advise me to have less pain?

Barbara Ankli: Good evening Was the cause sought? There would have to be a lesion of an artery, it can also be caused outside of the spinal canal. Has an MRI been done? The angiologist (vascular specialist) should also be involved. You write 150 mg ibuprofen, do you mean diclofenac here, this should then not be combined with the Irfen 400. I would first clarify the cause, if there is no treatment option, small doses of opioids may help, physiotherapy and a training program make sense.

Good evening, I was prescribed tramadol retard about 15 years ago because of back pain. Even though I've been pain free for years, I still get a prescription for 100 mg/day to this day. Now my family doctor no longer wants to issue the prescription from September. I've been addicted for a long time. What is your advice on how best to stop taking the drug? Thank you for your reply.

Christian Cesna: Good evening. This is a long story. I advise you to discuss this with your GP. Many psychosomatic clinics now offer to make tramal withdrawal inpatient.

I operated on the cervical and lumbar spine and both are deepened. Since 2012 I have had Fentanil patches first and since 2016 I have switched to 500 Palexia per day. Years long plus still reserve Palexia 50 . I did withdrawal in Langenthal SRO Psychiatry a month ago and I would like to thank you very much. My question is: what should I take for pain now, but I NEVER want to take opiates again. That should be forbidden! It's a crime to give someone opiates for years. Thanks

Barbara Ankli: Good evening For many patients there are unfortunately few alternatives to opioids, e.g. B. Cancer patients. Luckily this is not the case in your case. In reserve, you could use paracetamol or NSAIDs (anti-inflammatories), e.g. B. try ibuprofen, you should ask your family doctor, he knows your other illnesses and medication. It would be very important to carry out a training program 3 times a week, this was certainly conveyed to you in Langenthal.

Good evening, my wife (73) has arthrosis in the cervical spine, caused by her father hitting her head with his fists for years. Some of the vertebrae are broken. Intervertebral disc replacement, pain clinic, neurostimulator, physiotherapy, psychotherapy, all with little success. At the moment life is bearable thanks to MST Continus 10mg, supplemented with drops 10mg (max. 20/24h). How do you imagine getting off these opiates when there is a clearly defined trigger for the pain?

Christian Cesna: Good evening. With your wife with these miserable starting conditions, a tolerable life is already a huge success! Congratulations! Keep helping your wife to be on the sunny side of life (and forget that for the time being with further downsizing, there are worse things ;-) )

Good evening everyone, I am 60+ and have had a stabbing pain in the left groin and also in the back when I sit for several years (quite a lot because of office work). The pain spreads more and more often to the knee and the whole leg. The pressure on the sit bones (I think) makes it even lying in bed. Otherwise I am very active and healthy. The pain disappears when cycling or hiking as long as the ground is soft. What kind of doctor should I contact? Thank you!!

Barbara Ankli: Good evening, your sacroiliac joint may be affected, a manual doctor or pain doctor or rheumatologist can examine you thoroughly and possibly carry out imaging, the therapy can then be determined. No diagnosis possible without clinical examination.

Good evening, I am 57 and have suffered from hypersensitivity in my testicles since I was a child. In the last two years, the pain has increased quite a bit. Up until then, the pain had noticeably decreased after a few days and only came back after about a month. Now they are there about an hour and a half to two hours after getting up and all day long. Infusions, injections, psychotropic drugs did not bring. This condition makes me very tired! I'm very tense!

Christian Cesna: Good evening. You have a long history of suffering! Who will help you? Are you in a good center? Does your urologist work with other specialists?

I know that Palexia (oral solution) has started batch recall, how often does it still happen for prescription in Switzerland?

Barbara Ankli: Good evening. Personally, I don't prescribe the drops at all because I believe there is a high potential for dependency. It might be useful for cancer patients. I recommend sustained release preparations (delayed release mechanism).

Thank you for your reply Mr. Cesna, I would like to ask again what alternatives there might be. Everything was clarified for me, countless therapies, I have rehab behind me. I'm with a competent specialist, but what else can relieve severe Sudeck's disease and neuropathic pain other than opiates? (The pain in the Sudeck has been since the beginning of 2007). Thanks for your answer

Christian Cesna: Good evening. If the opiates now at least give you a tolerable life, I would not want to shake that at the moment and respectfully lift my hat that you have achieved this! Unfortunately I don't have any more.

Cryo treatments, i.e. cold (e.g. approx. 3-4 minutes in -110 degrees) should help against pain and at least greatly reduce drug treatments. What do the doctors think of this? Experiences? Recommendations??

Barbara Ankli: Good evening Yes, cryotherapy is also used in sports medicine. I personally have no experience here. Contact a sports doctor or ask your family doctor who offers these therapies.

I am currently taking because of pain in my feet. Tramal almost daily in the evening (50mg). this for 6 months. Got down from 2x 50mg to 1x 50. Have nerve damage in toes (worsening for 18 months) and right heel spur for 6 months. Is my addiction already developed?

Christian Cesna: Good evening. That's a big step! I wouldn't worry too much about the dependency.

Good evening, I have had a constant burning pain from my left hip over my thigh down to my knee for 2 weeks, a slight numb feeling on the inside of my thigh. The pain never goes away, but I can walk without problems, no loss of strength. I can not sleep. My doctor didn't have time. the emergency practice in the hospital first prescribed me 3 Irfen600t, 4 Dalfalgan, 1g, 6 Novalgin 500, without success, now I take 2 Tramal100 and 4x20Tr.

Konrad Maurer: There may be a herniated disc. If these symptoms do not improve within the next few days, you should contact your HA again so that he can discuss further measures with you. If you feel paralyzed or become incontinent (uncontrolled loss of urine or stool), you must present yourself to a hospital emergency department.

Good evening. In my case, knee pain occurs alternately in the kneecap area, then on the inside and then on the outside again. Can knee pain migrate? (There is a tear in the inner meniscus, which doctors determine is common at the age of 60). Thank you

Barbara Ankli: Good evening. Perhaps the knee is also swollen and is there increased effusion? As you noted, these meniscus tears are often incidental findings. Maybe gonarthrosis? X-rays should always be taken while standing. You are welcome to have your family doctor refer you to a rheumatologist with ultrasound.

Good evening Mr. Cesna, thank you very much for your answer. What do you mean by "center"? Since then, my left leg has also had sensory disturbances and has to walk on the walker. If you knew the whole story, your hair would stand on end. Also got a life-threatening virus in the hospital or 1st rehab. 2x sharply scraped on death. I'm 77. My will to live is slowly dying because I'm not getting any help.

Christian Cesna: Good evening. wow! What a fighter! Be sure to discuss this fainting with your family doctor. Maybe he can help you! General practitioners are often well networked and can make referrals to special centers.

Good evening, which therapy can help with chronic back pain - in the cross? Many tests have been carried out without success. The left side of the body has been tingling for over a year. Increased back pain at night, spread through the lower abdomen to the legs, movements are very difficult. My body then feels stiff. Painful, cold legs from knee to toe. Despite 3 weeks of intensive treatment in the rehabilitation clinic, the pain is the same as before. Thank you very much

Barbara Ankli: Good evening Nocturnal pain is always a warning signal and needs to be clarified. Unfortunately I don't know your age. If this has not yet been carried out, larger investigations would certainly have to be carried out here. You can also have your family doctor refer you to a rheumatologist.

I've had severe back pain for 6 weeks with a torn disc. Take 4x1g novalgin, 3x1g paracetamol, 2-3× 20 drops tramadol. Can this be addicting. Infiltration is planned for this week, hope this helps.

Christian Cesna: Good evening. The development of addiction is always related to the duration of use, so in your case I wouldn't worry too much. Good luck.

I have been suffering from chronic pain (whiplash) for over 10 years. I am regularly in therapeutic treatment & take celecoxib daily so that my everyday life is possible. I'm still young+haven't seen a pain specialist until now. Could such a clinic or a pain clinic be right for me? To become pain/medication free in the long term. Or am I being brushed off here as a whiplash patient? Are there free initial consultations or is a referral necessary? Thanks

Konrad Maurer: It certainly makes sense for you to have a location assessment carried out at an institution that specializes in chronic pain. The initial consultations are covered by the health insurance company. It is best to have your family doctor refer you to such a clinic.

My wife has been taking the following painkillers for years: Lodine 300 mg (1 per day) and Pregabalin-Mepha 75 mm (1 in the morning and 2 in the evening). The family doctor has now also prescribed her the stronger painkiller oxycodone-naloxone-mepha (1 per day). Is the latter painkiller at best questionable? To date, she has not developed a feeling of dependency. Thank you for your opinion.

Christian Cesna: Good evening. does it help? I'm sure she does a lot of other things to improve her quality of life...

Can medication overuse headaches also occur with the migraine pain reliever eletriptan?

Konrad Maurer: Yes, it can.

+++ If opiates are so addictive, why are they prescribed after every operation and why are patients so generously supplied with them? And the WHO rules are not observed on hospital wards? You give BTM first and if it doesn't help level 1 or 2? +++

Thank you Mrs. Ankli. i am 39 years old An MRI will be done tomorrow.

Barbara Ankli: Ok, very good At your age you should certainly not take Zaldiar for a long time, it is good for bridging, but be careful, do not drive 12 hours after taking it, unless you take the drug in a stable dose over several weeks. But it can always lead to traffic problems.

Good evening, I am writing for my partner (Italian), 86 years old, she has been using the opiate "Durogesic 12 + 25 patch" for about 20 months because she had hit her head in a fall and had bruises on her right leg caused constant headaches, among other things, and the family doctor finally prescribed her the Durogesic, first only the 25, which didn't help enough, and then he also prescribed the 12. Can she continue to take the drug without hesitation??

Christian Cesna: Good evening. Does it help at the moment? Unfortunately, the dose of the opiate often increases. If it helps and doesn't cause too serious side effects, it can be passed on to her. If necessary, discuss your concerns with your GP. There may be other reasons why the pain is so severe.

Knee problems: I have pain in my right knee when running, the faster the stronger, but no pain when cycling, no pain when climbing stairs, not when swimming, no pain during the night. Later in the evening it is most swollen all around, but not painful. What can you do about it?

Konrad Maurer: The most sensible thing is to clarify the cause of the swelling and the pain. This is the only way to plan a suitable and sensible therapy. It is best to contact your family doctor.

My 29 year old daughter has had an unbearable headache for 6 years. She has already had an operation to expose nerve cords at the back of her head and has tried every alternative medicine available over the last few years. The family doctor has prescribed Tramal for her. Last year she lost 18kg within 4 months because she had to vomit several times a day. Tomorrow she has an appointment with the neurologist at the CHUV, she has decided to go into withdrawal. It's her last hope

Barbara Ankli: Good evening. It certainly makes sense to consult a competent neurologist. If no organic cause of the symptoms is found, multimodal pain complex therapy over several weeks in a specialized clinic is indicated.

Hello, I am 69 years old. I've had wandering pains all over my body for about 20 years. At first it was mainly muscle and joint pain. The rheumatologist suspected fibromyalgia (without depression). At the moment arthrosis and muscle and body aches all over the body. Suspected psoriatic arthritis. I don't want to take immunosuppressants. The pain is increased at rest. div. Painkillers, which I received from my family doctor, are of no use. Thank you

Christian Cesna: Good evening. Unfortunately, especially with psoriatic arthritis, such wandering pains are common because different joints are affected. Have you talked to him about the good treatment options? Sometimes short, high doses of cortisone can reduce severe inflammation and pain. Infiltrations can also help. Talk to him.

Good evening, I have been suffering from headaches (forehead) with ringing in my ears for about 5 years. I regularly take Algifor against this. Is there a local office for this? Except for the family doctor, because he doesn't know what to do next. Thank you.

Konrad Maurer: The best thing to do is to contact a neurologist (neurologist) or have your family doctor refer you to one.

Follow-up question: Can pain that occurs repeatedly elsewhere on the knee be due to one and the same cause? (The MRI shows a tear on the inner meniscus, but is there a connection between the findings and the symptoms?) Or is an unspecific overload more likely? (so that the all-clear could be given sooner). Thank you

Barbara Ankli: Yes, but you would also have to examine the knee clinically, if nothing dangerous was found in the MRI, that's a good thing. However, I have experienced that knee joint effusions can cause pain in various places on the knee. Inflammation of the tendon attachments should also be addressed here. If the MRI doesn't show anything bad, an attempt with diclofenac ointment for 10 days is certainly advisable.

I also have back surgery behind me, 6-fold discus hernia L5 - L3 stiffened. I also got opiates, but it wasn't a problem for me to stop taking them again, even after taking them for a long time. A friend of mine had an operation this week, the screws were broken and had to be replaced. Now after the surgery he's on opiates to relieve the pain. The doctor prescribed a spa stay to discontinue therapy and painkillers. The only problem is that the health insurance company does not answer to cover the stay at the spa.

Christian Cesna: Good evening. The health insurance companies usually justify why they do not want to pay for something. The doctors can then respond and write a reconsideration of the reimbursement. It often helps to include the psychological and social aspects as well.

Hello, I have had severe pain in the area of ​​my hips, coccyx, lower back for almost 6 years and it pulls the whole back up and down, muscles very tense. I also got palexia for about 6 months and then suddenly not anymore. The doctor put me as a pill addict, because I asked for a new prescription.. and you said first that it was Morbus Bechterew. and because the inflammation was gone over time, another doctor said it wasn't morbus...what should I do???they don't clarify.

Barbara Ankli: Do you have night pains and morning stiffness and are you under 45 years old? Then the back pain would have to be clarified again by a rheumatologist. Please go back to your family doctor to discuss this.

Chat admin: The expert chat is over - thanks for the interesting questions! You can find more information on the subject in the broadcast below.

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Pain go away! (2) - «Can low-dose opiate patches also become addictive?» (1)

21.06.2021 |Tricky opiates: from pain to addiction


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