I welcome any comments/advice. I'm posting in this forum because I am seeking advice of those who are knowledgable in pharmacology. I need to know my options before discussing a med change with my doctor in 2 days. I am certain that I will be seeking opiate type medication to manage my pain at this time--that is not in debate.

1) Are there any other schedule III narcotic type medications (besides tramadol) that can be used long-term that do not have tylenol/NSAID's in them? and 2) What are some of the NSAID/opiate drugs that could be used for chronic pain, & are they available in extended release form and appropriate for long-term (1-2 yrs) use? *I most likely will need to go on schedule II drug in the near future, but would like to postpone it if at all possible--most of all, I want to be able to travel internationally for more than 30 days at a time., so for that reason I would like to avoid schedule II drugs if possible FOR NOW.

*see below for quick background* Lack of $, job and insurance is a big factor in mine & my doctors decision making. For that reason I've been taking methadone for the past 3 weeks now . . . no side effects, but no pain relief either (due to extra low dose no doubt). He started me on 5 mg/24 hr, then last 10 days 5 mg/2 x day. I understand the caution and slow titration. I'm also taking voltaren 150-200mg /day, which used to help, although not sure anymore my doctor wants me to continue with it for now. I've since read up more on methadone and while I feel it may help and be an excellent choice for me long term, I don't want the ball & chain that comes with it right now (having to have hard copy script every 30 days, mostly) because I want to travel during the next few years, before my mobility becomes more of an issue. I just hope I'm not asking for terrible physical withdrawl even though its only been 3 weeks of a low dose. Does anyone know if I'd have trouble making a switch? Maybe dropping the voltaren and taking something like vicoprofen (extended release if there is one?) I'm not trying to obtain huge pain relief, only enough to be semi-productive, which is hard to do without any meds.

Quick background: chronic pain for many years (spinal injury/lots of degeneration/bone spurs/stenosis,ect... now dealing with thoracic outlet syndrome as well). Only in the last year have I decided to try managing pain with daily meds to help improve my (and in turn, my husband's) quality of life. Pain can get quite bad at times, but it's the losing battle of not being able to perform ADL's & get around that is most devestating. When I'm in a bad flare, it's a real challange to even get out of bed, much less shower and do basic chores without medication. I would also like to return to work--I'm currently trying to find something that won't cause more flares. **In reality, I've been in complete denial of my physical condition for years now and somehow thought through PT and other therapies that I may be able to reabilitate myself (even though my doc said otherwise)**For this reason, I'm only now considering daily opoids for chronic pain management.

Of course, my first choice of tx would be PT, massage & accupunture instead of drugs, but I cannot afford it, am unemployed & don't have insurance. I know accupuncture helps me because I did it while I could afford to. I used to be totally opposed to taking medication . . . Fast forward-Sept 2009-I ask my pcp about pain management. We try voltaren (which I had success with in the past) and tramadol. (I'm aware that some say tramadol is no better than aspirin, but it does work wonders for some--we are all different. It did for me, it just didn't last). After 2 weeks of taking this I was actually receiving enough pain relief to greatly improve my life (got up to 2, 50mg tabs 2x day--problem was, if I took tramadol after 3pm or so, I had trouble sleeping--like I drank too much coffee), so I was able to be more productive during the day & took it easy in the afternoon/eve. Of course, after Christmas I wasn't getting the same pain relief or maybe my pain just worsened. . . I returned to my doctor 3 weeks ago telling him I was having increasing pain. He thinks with my issues (based on my films, ect... ) that I most likely will need long-term opiod therapy. Said he'd like to try me on oxycontin, but because of the cost he wanted me to try methadone instead (I have taken opioids in the past off & on, there's really no issue of abuse or addiction concerns & they have been effective--more so, I'm concerned with side effects and pain relief). It's also a community/low-cost clinic, so there's probably more red tape/limitations on what & how he can prescribe as well.

Thanks to all for reading this.

Our health care system is in a real sad state, when people who need strong opiods are forced to go without due to abusers, while others are forced to rely on strong opiods instead of possibly taking something milder & receiving additional pain relief through natural therapies like accupunture, massage & physical therapy because of lack of insurance &/or $.

Nina

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