The Pain Experience - Reviews of Opioids.

Ever since a nasty car/bike crash, of the "Hamburger Helper" variety, I've been suffering from unbearable, debilitating pain in my legs and back.  With a little help from my friends the opioids, I've had a bit of pain relief, and even some help upstairs, but the pain still dominates my life, day in, day out.  Finally, my doctor decided enough was enough, so she dumped me onto the pain management department of a large Jewish hospital in central Toronto.  Now, let it be known that I'm what might be called a "righteous dopefiend"---the only difference between me and John Smith from St Elsewhere's, Anyshire is that he drinks and I take pain meds.

So, because of my experience with these substances of sin, I feel very strongly about what I'm able and/or willing to take.  My doctor has been very understanding of this (my orthopaedic surgeon wasn't!), and worked with me to agree on what I'd be willing to take and what wouldn't cost her a licence.  I am filled with trepidation, because my doctor has honestly informed me that once I was under the care of an algiatrist, he or she would be my sole care provider as regards pain meds.

This is a problem, because when I was seeing the orthopaedic surgeon as my primary care provider, he believed that when it came to pain management, it would be his way or the highway, and that pain was preferable to addiction.  I was offered the choice of Tylenol (the American name for Panadol) with codeine or Tylenol with tramadol.  I am afraid that it will be the same situation with the algiatrist.

I like several opioid painkillers to the exclusion of most others, because they work with few side-effects and they make me feel good too.  I also will not take anything that contains Panadol.  So, for any pain patients that happen to read this, here's my list of what I won't take, and why you shouldn't take it either.

Hydrocodone - this is known in America as Vicodin.  It contains Tylenol---there is no Hydrocodone preparation without Tylenol or Ibuprofen in it.  Also, this is short-lasting, and you will find that you will be taking Vicodin more often than other pain pills---approximately six to eight times per day. *** / 5

Tramadol - this is available as instant-release with Tylenol, or extended release without (this means that the drug is released into the bloodstream over the course of the day and does not need to be taken more than once without).  Women: take this if you don't want to be addicted.  It works well for pain control.  Men: DON'T take this.  The most important organ in your whole body will cease to function.  If you have to take this, take Viagra too. **** / 5 for women, * / 5 for men

Fentanyl - this is available as extended release patches, or instant release lollies.  If you get the lollies and they work, consider yourself lucky, and do a little dance to the opiate gods.  If they don't, talk to your doctor.  Don't take the patches - people have died from a bad patch that leaked too much into the skin.  Fentanyl is VERY strong --- so strong that the effective dose is in MICROgrammes.  Doctors use morphine (pure heroin) as a yardstick.  This is approximately one hundred times stronger, and shorter lasting, so the lollies are used for emergency pain relief only. ** / 5 patch, **** / 5 lolly

Methadone - yes, this is used for pain relief, not just as a heroin substitute.  Fentanyl and hydrocodone are short-lasting; this is long-lasting.  However, it also takes long to act, so this must be taken every day in order to maintain a constant level of pain control.  For those of you that like the pleasant feelings associated with opioid use---also those of you that dislike them---note that Methadone does not cause pleasant feelings, but it doesn't cause drowsiness either.  Comes as a beautiful green syrup. * / 5

Pethidine - the Americans decided they wanted to be different, so they came up with the decidedly more awkward name Meperidine.  Opioids, just like alcohol and marijuana, cause side-effects visible to others and characteristic to them as a class: specifically, the pupils of the eyes narrow.  Pethidine doesn't narrow the eyes, so it is the choice of those wishing to secretly enjoy its effects in the company of doctors.  However, one note: pethidine is far weaker than morphine.  Above a specific dose, which varies between people but tends to be approximately 200 mg, it causes seizures. * / 5

Codeine - it's weak, you can't sleep despite being drowsy, and your bowels slow down to a crawl, making visits to the toilet... interesting, to say the least. ** / 5

What do I take?  Well, I'm certainly fine with good old-fashioned morphia (Avinza, Kadian, Kapanol, Roxanol), oxycodone (anyone heard of OxyContin?), and hydromorphone (Dilaudid, Hymorphan, Palladone).  Those three obey the "rule of threes": hydromorphone is three times stronger than oxycodone, which is three times stronger than morphia.  Those three score perfect fives.