![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 50 to 74 of 74. Go back in thread:
Posted by greenhornet on April 9, 2005, at 13:20:36
In reply to Re: Flip-Codeine » greenhornet, posted by Larry Hoover on April 9, 2005, at 10:31:37
> Thanks for weighing in, greenhornet.
>
> If I may be so bold, I would draw the following theme and conclusion from your post....
>
> Medication is not the only answer to depressive symptoms, if cognitive coping strategies are actually promoting depression. Therefore, changing cognitive processes can lead to remission of depression, and relieve the need for medication.
>
> I'm with you on that, but....
>
> Cognitive therapy can be reduced to a very simple concept, IMHO.....
>
> Same input, different output.
>
> What happened, happened. Life is life. What you feel about it is largely a matter of choice, habit, training, internalization, experience, attitude, belief, expectations, faith, and similar.
>
> So, there's a lot to work with in that list (and I certainly missed some). That's what cognitive therapy is for. To work with the list of interpretive cognitions we all employ.
>
> That said, it may also be an inappropriate expectation to assume that modification of cognition alone can lead to remission. Medication has a place in recovery (and maintenance) for some people. You really can't generalize about that.
>
> Lar
Larry,
Thank you for putting it so well. Relating my experience/opinion has often only caused totally negative and/or defensive reactions. I appreciate others positive input and correction.
By the way, I should have mentioned this to FST too, but I cannot tolerate many opiates at all(morphine, codine, Dilaudid, Talwin) -- I become violently ill. So in some ways I suppose I envy those of you for whom these medications work for physical pain.
GH
Posted by Larry Hoover on April 9, 2005, at 13:32:04
In reply to Re: Flip-Codeine » Larry Hoover, posted by greenhornet on April 9, 2005, at 13:20:36
> Larry,
> Thank you for putting it so well. Relating my experience/opinion has often only caused totally negative and/or defensive reactions. I appreciate others positive input and correction.You're welcome.
Also, I was not correcting you. I never had that sense.
> By the way, I should have mentioned this to FST too, but I cannot tolerate many opiates at all(morphine, codine, Dilaudid, Talwin) -- I become violently ill. So in some ways I suppose I envy those of you for whom these medications work for physical pain.
> GHThat is one reason for the fentanyl patches. That bypasses the stomach.
Just a thought, if acute or chronic pain is a significant impediment to daily living.
Lar
Posted by flipsactown on April 9, 2005, at 14:01:15
In reply to Re: Flip-Codeine » flipsactown, posted by greenhornet on April 9, 2005, at 13:08:57
GH,
No apology necessary. I totally understand and congratulate you and your husband for 38 years of marriage, which is quite an accomplishment in this day of 50% divorce rate.
FST
> FST,
> I am sorry --I do owe you an apology. You are right about chronic pain, I'm afraid that in my "passion" I overlooked your situation. Please accept my apology. I hope things continue to go well for you. You seem to have good insight into, and an understanding of your problem.
> It is also good to hear from someone else who has been married 30+ years. My husband and I will celebrate thirty eight years soon. GH
>
> GH,
> >> In my case, I was not taking Codeine to "feel better" mentally, I was taking it to feel better physically. Chronic low back pain, from 2 failed back surgeries, numerous injections to the spine, having had tried many different treatments, including acupuncture, TENS unit and biofeedback, I had no choice, but to take narcotics, mainly Codeine, to get some pain relief.
> >
> > I had tried for over a year to go without any medications or talk therapy and that nearly cost me my marriage. When I came close to being physical with my wife, I decided to seek psych therapy, which I have to say saved my marriage. My therapist of over 10 years had recommended I take Prozac. I was very hesitant at first because of all the bad press I had read about. Fortunately, I tried Prozac and in less then 3 weeks, I realized I was feeling like my normal self, a happy-go-lucky guy with a wonderful wife and three sons. I have now been married 32 years to the same woman, who put up with me when I was in constant physical and mental pain.
> >
> > Bottomeline: Chronic physical pain is very real which from my research, usually results in depression. Apparently, chronic pain uses up certain chemicals in the brain, like serotonin, which in turn causes depression. Without having had tried narcotics with regular talk therapy, I would not now be still, happily married. Again, this is my own personal experience.
> >
> > FST
> >
> > > This entire discussion makes me want to weep! Using opiates to "feel better" is not all that much different than the rest of biopsychiatry. For over twenty years of my over sixty years of life, I too was a prisoner of "psychotheraputic" treatment. At the time it seemed the right thing to do. After all, I am a nurse/therapist and my husband a physician.
> > > Slowly, over the years, through my own experience and that of those around me (clients and coworkers), it bergan to dawn on me that I was not reallly facing up to life, not taking responsiblilty for my own behaviour, and was running from reality through drugs (prescribed) and "therapy"....
> > > I have posted most of this before and it usually get lots of really angry responses from folks who are just sure that; "Well, that worked for her, but "I have" or "I am" or what ever. That's called "I Disease" people! Put the stuff down, and take charge of your own life! I finally did and what a difference! The whole world is a different/better place. Stop letting the American Psychiatric Association label you and call it "illness" and trying to fix what "ain't really broke" to begin with!!
> > > It was two decades of not feeling emotions that simply fed into my not learning how to deal with them. Every time you get off medicatioon you "relapse"?? That's what I though too, until until the whole debacle with first Effexor then Lexapro. What have people (myself included ) experienced there? Painful, often prolonged withdrawal - not relapse. So what does the physician do? Give out another drug!! But you can live through it (the withdrawal), and you can live without dumping chemicals into your body. I finally am able to live that way.
> > > A therapist from another culture once shared this with me:
> > > "Of course Americans are depressed -- you are raised to believe that you are entitled to the good things in life and that pain is to be avoided at ALL cost. Then when tough times hit, you are surprised and becoome "depressed"
> > > In some other cultures the people grow up EXPECTING pain and suffering, so when it happens there is no big shock, and the "good things" are seen as rare and not a way of life.
> > > I have been drug free for a year now and it's wonderful. Try it, you might be amazed. GH
> > > PS Coming off took me over a year -- do not rush it! By the way,in those twenty-plus years, I took something like twenty-five psychoactive substances, antidepressants, stimulants, anxiolytics, antipsychotics - the whole pharmacopea, So please, don't tell me I don't know what I am talking about..
> > >
> > >
> > >
> > > Paulbwell,
> > > > > > You take 60mgs 5x a day=300mgs?
> > > > > and find pain relief better than Oxy?
> > > >
> > > > Yes on the dosage. Initially, like the first couple of months, Oxy was superior in pain relief. After that, pain relief dropped down to the level of relief I was getting with Codeine.
> > > >
> > > > > -No Euphoria/stimulation from Oxy?
> > > >
> > > > None
> > > >
> > > > > -Apparently Oxycontin is a stimulating Opiod,
> > > > > thou I'm guessing when abused, not when used medically, as in your case.
> > > >
> > > > Exactly
> > > >
> > > > > If I may ask, what dose of Oxycontin did you use for your injuries?
> > > >
> > > > Max daily dosage my Paindoc RXed was two 20mg x 4 = 160mg/day
> > > >
> > > > > Thanks for your relpy
> > > >
> > > > Your welcome.
> > > >
> > > > FST
> > > >
> > > >
> > >
> > >
> >
> >
>
>
Posted by barbaracat on April 9, 2005, at 16:33:06
In reply to Re: Flip-Codeine, posted by greenhornet on April 9, 2005, at 8:09:05
Dear GH,
I think what you're responding to is choosing to 'get high' as a way of dealing with pain, rather than trying to 'feel better' and I definitely agree with this. But I've come to see that in my case, certain meds are necessary because 'feeling better' is necessary if I want to continue with this life. I agree with you philisophically that we shouldn't have to rely on meds and there must be another way. I've tried this in every form possible and the reality is that it hasn't worked.This has caused some struggle for me because I passionately believe in finding the root cause of a problem, doing the hard work to get to the bottom of it, learning to tolerate and grow from pain rather than make it all nice and pretty by subverting it with meds.
I also follow a Buddhist path, meditate, and appreciate the Buddha's first noble truth that 'Life is Suffering', but also the second - 'Suffering is caused by desiring', or resisting suffering and craving pleasure.
I know all this, and have tried many times over the years to slowly wean off meds believing that 'healthy living', accepting what is, being in the moment, whatever, will suffice. I've gone long times au natural. Problem is, something goes haywire with my brain after a while and I no longer have access to those noble thoughts and my life becomes a shambles. I alienate friends because I become critical and mean. My body and mind hurt from the stress of having to wade through a psychic minefield day after day. Everything is overwhelming and hard.
I'm a strong and resourceful person, have been all my life and can take alot. But that strength and resourcefulness go out the window when my brain is broken, and I feel so alone. This is no way to live. How many times must one lie in bed crying in anguish for themselves and the world, without the impulse or capacity to exeperience the joy and wonder of the world?
In my case, Lithium simply must be in my life, as must thyroxine. I will die without them, this I know. Anything else is gravy, like benzos when I need soothing and nothing else works, Ambien because I can't seem to sleep otherwise, a low dose of an AD because without it life feels too complicated. And yes, sometimes a snootful of booze and some illegal substances because heck, they feel good. As long as I know when to stop.
I guess that even with all the spiritual, psychological and just plain life experience I try to put to good use, there's something I'm missing. Everything in moderation, but if happiness lies within my reach, I'm going to reach for it. There's no nobility in senseless obsessive suffering. I think the key word is 'balance', and whatever gets you to that place has merit. Regards, Barbara
Posted by Phillipa on April 9, 2005, at 17:02:14
In reply to Meds or not » greenhornet, posted by barbaracat on April 9, 2005, at 16:33:06
Greenhornet, Good to see you bsck on the Board. It's funny, after working in the medical field, especially when I was on a surgical and medical floor, was that the nurses were always so judgemental when it came to pain. "Oh he's on the call bell again, Yep it's been exactly 4 hours, he's addicted, and he can wait l0 more minutes!" I also found myself responding like this at times. As they say "walk in the other person's shoes first". So, now when I've had some facial surgery [elective my choice], I went by my "training" refusing to take the pain meds as RX'd. I wonder if I would be having the complications I'm having as we speak if I'd listened and taken the meds. I wouldn't take percocet, but brokedown and took the tylenol #3. Now because of the complications, and a drain tube still in place I've "allowed" myself to take the meds at night only. And when I wake up I take another pill. I'm doing this because i realize how important sleep is to heal my body. I'm not going to worry about becoming an accict at the moment. So what if I'm sleeping l0 hours. Evidently my body needs it and I don't need an infection on top of this. I am on antibiotics too. The surgeon isn't sure what to do but since he's a Professor at a large teaching hospital I trust him to find out the answers if he doesn't know which he has admitted. Hasn't seen a case like this in over 20yrs. He's honest. So, now I've had to rethink my attitude on pain meds. Each day I learn a little bit more. I've always tested well and have book knowledge, but experience speaks loud and clear. Fondly, Phillipa
Posted by Larry Hoover on April 9, 2005, at 18:19:16
In reply to Re: Oxycontin for mental health....WOW!!!!!!!!! » jerrympls, posted by flipsactown on April 8, 2005, at 1:31:29
> I had been taking Tylenol-Codeine 3, 60mg x 5 times daily for years and finally decided to try the Oxycontin since I heard it was long lasting.
> I did not experience any withdrawals from my years of taking Codeine. I went for weeks or months without taking any Codeine, just to prove to myself that I was not addicted.
All I have to say is Wow!
Codeine is slowly desmethylated to morphine....at least for most people, that's what happens. It's like slow release morphine, but the rate of conversion is highly dependent on a liver enzyme that functions at different rates in different people.
Your absence of withdrawal leads me to believe that perhaps your 2D6 enzyme (the enzyme in question) doesn't work at all, and you got a pure codeine effect. If I'm not mistaken, oxycodone also is activated by that same enzyme. (Have I got that right, ed?) Total dysfunction of 2D6 might happen in 0.1 to 1% of people.
Perhaps that explains your unusual history? I'm not suggesting there's anything untrue or suchlike about what you've described....it just doesn't fit with what you'd expect.
What most amazes me, really, (I know you said nothing about this at all) is that you could take that dose of codeine and still have bowel movements. Codeine is very constipating at high doses. Maybe the worst of them all, on a mg per mg basis? If not the worst, it's near the top of that infamous list.
Total dysfunction of 2D6 might happen in 0.1 to 1% of people.
Thanks for your input. It's really important to try and understand just how variable the effects of drugs really are.
Lar
Posted by flipsactown on April 9, 2005, at 18:21:02
In reply to Just My Two Cents, posted by Phillipa on April 9, 2005, at 17:02:14
Phillipa,
"So, now I've had to rethink my attitude on pain meds. Each day I learn a little bit more. I've always tested well and have book knowledge, but experience speaks loud and clear. Fondly, Phillipa"
Been there, done that.
I had to jump through so many hoops just to increase, continue taking Codeine and get an Oxycontin RX, which my Paindoc denied and RXed MSContin instead, which promptly made me sick to my stomach, constantly vomiting and extremely constipated. Only then, did he Rxed Oxycontin and even then was not totally accommodating by not giving me a grace period in which to get a refill. He would only write a refill on the day the Rx ran out. Even some Paindocs are so afraid of abuse that they unknowingly lump all patients together. I told my Paindoc that I never abuse anything. I never smoked cigarettes or pot and didn't drink alcohol except on my wedding day, when I drank Champagne, nearly 32 years ago. Hopefully, in time, this "addiction" attitude will change. In my opinion, no one should be physically suffering, needlessly because of the "addiction" attitude, when narcotics are available, especially when it is for a chronic, lifetime physical pain such as back pain and/or arthritis.
I could have continued taking Oxycontin, but because of the withdrawal pain I experienced from not having Oxy even for just two days, and the fact that in the long run, I was only getting the same level of pain relief as Codeine, I used my common sense and voluntarily asked my Paindoc to put me back on Codeine, after very slowly tapering off Oxy to minimize withdrawals. Tapering very slowly was not totally painless, especially the last week.
FST
Posted by Larry Hoover on April 9, 2005, at 18:24:47
In reply to Re: Oxycontin for mental health....WOW!!!!!!!!!, posted by Larry Hoover on April 9, 2005, at 18:19:16
> Your absence of withdrawal leads me to believe that perhaps your 2D6 enzyme (the enzyme in question) doesn't work at all, and you got a pure codeine effect. If I'm not mistaken, oxycodone also is activated by that same enzyme. (Have I got that right, ed?) Total dysfunction of 2D6 might happen in 0.1 to 1% of people.
Oxycodone's effects are due to the parent drug, not metabolites. It only took me twenty seconds to check. (Note to self: Check references before posting.)
Lar
P.S. That leaves me more baffled than before.
Posted by Paulbwell on April 9, 2005, at 18:25:13
In reply to Just My Two Cents, posted by Phillipa on April 9, 2005, at 17:02:14
I think GH was making the point that theres too many folks taking too many pills UNNESSARILY. The APA has a duty, hell a crusade to convince folks that when thinks arn't hanky dory, as we see it, we should reach for the drugs.
We should see through their trade, and find our own resourses, with support, and heal the best we can, while taking charge of our own situation, without placing ourselves into the hands of professionals, so READILY.
Posted by flipsactown on April 9, 2005, at 18:35:48
In reply to Re: Oxycontin for mental health....WOW!!!!!!!!!, posted by Larry Hoover on April 9, 2005, at 18:19:16
Lar,
>
> Your absence of withdrawal leads me to believe that perhaps your 2D6 enzyme (the enzyme in question) doesn't work at all, and you got a pure codeine effect. If I'm not mistaken, oxycodone also is activated by that same enzyme. (Have I got that right, ed?) Total dysfunction of 2D6 might happen in 0.1 to 1% of people.
>
That sure sounds logical to me!
>
> What most amazes me, really, (I know you said nothing about this at all) is that you could take that dose of codeine and still have bowel movements. Codeine is very constipating at high doses. Maybe the worst of them all, on a mg per mg basis? If not the worst, it's near the top of that infamous list.
>
I was only slightly constipated initially. I imagine after that my system totally adjusted to it. When I tried MSContin, I was extremely constipated.
>
> Thanks for your input. It's really important to try and understand just how variable the effects of drugs really are.
>
Your welcome. That is the very reason I always include in my post that "It is my personal experience."FST
Posted by Phillipa on April 9, 2005, at 18:43:42
In reply to Re: Just My Two Cents, posted by Paulbwell on April 9, 2005, at 18:25:13
I agree with you and after reading GH posts in the past know what she's been through. I was addressing more acute conditions, not longterm. I agree excercise, diet, meditation, therapy are a lot more helpful than dumping chemicals into your body that may do you more harm than good. I believe in the lowest possible dose of a med if needed to alleviate symptoms that interfer with the functioning of your life when other measures are being used in conjunction with meds, etc, Fondly, Phillipa
Posted by ed_uk on April 9, 2005, at 19:40:08
In reply to Re: Oxycontin for mental health....WOW!!!!!!!!!, posted by Larry Hoover on April 9, 2005, at 18:19:16
Hi Lar!
>What most amazes me, really, (I know you said nothing about this at all) is that you could take that dose of codeine and still have bowel movements. Codeine is very constipating at high doses. Maybe the worst of them all, on a mg per mg basis? If not the worst, it's near the top of that infamous list.
Oxycodone is pretty constipating, possibly more so than morphine 'on average' (although apparantly not in the case of flipsactown)...........................
(It's a good thing that methylnaltrexone and alvimopan are in development for opioid bowel dysfunction!)
Controlled-release oxycodone and morphine in cancer related pain.
Controlled-release (CR) formulations of oxycodone and morphine were compared in 45 patients with chronic cancer pain. The study was started with an open-label, randomised titration phase to achieve stable pain control for at least 48 h, followed by a double-blind, randomised, crossover phase in two periods, 3-6 days each. To blind the study using available tablet strengths, the dose ratio of oxycodone to morphine was set at 2:3. A daily telephone contact was maintained between the patient and the investigator. The patients were asked to assess pain intensity four times a day and acceptability of therapy twice daily, and to record possible adverse effects. Pharmacodynamic evaluations were performed at the end of each double-blind period. The patients were allowed to use escape analgesic (respective opioid as oral solution) as needed. Twenty-seven patients were evaluable for both safety and efficacy. Pain was well-controlled during both stable phases. When the period effect was taken into account the two opioids provided comparable analgesia. If the results of the two periods were combined, the patients consumed significantly more escape doses and the mean pain intensities were significantly greater with CR oxycodone. The total opioid consumption ratio of oxycodone to morphine was 2:3 when oxycodone was administered first, and 3:4 when oxycodone was administered after morphine. The total incidence of adverse experiences reported by the patients was similar, but significantly more vomiting occurred with morphine, whereas constipation was more common with oxycodone.
Incidence of constipation associated with long-actingBACKGROUND: Opioid therapy plays a key role in the management of chronic pain. Constipation is one of the more frequently occurring adverse effects associated with opioid therapy. METHODS: A retrospective cohort design study was conducted to determine the incidence of constipation in chronic pain patients who received three different long-acting opioids (transdermal fentanyl, oxycodone HCl controlled-release [CR], or morphine CR) for malignant or nonmalignant chronic pain. The data source was claims data (January 1996 through March 2001) from a 20% random sample of the California Medicaid (Medi-Cal) database. Claims data were from adult patients with chronic pain (malignant or nonmalignant) who had no prior diagnosis of constipation and no prior usage of long-acting opioids for at least 3 months before the observation period. Patients were followed for at least 3 months after the initiation of opioid therapy. ICD-9 code for diagnosis of constipation was the main outcome variable. Crude rates of constipation, annual incidence density, relative risk, and adjusted odds ratios were compared. RESULTS: A total of 1,836 patients (601 receiving transdermal fentanyl, 721 receiving oxycodone CR, and 514 receiving morphine CR) were included in the analysis. Crude (unadjusted) rates of constipation were 3.7% for transdermal fentanyl, 6.1% for oxycodone CR, and 5.1% for morphine CR (P > 0.05). Transdermal fentanyl had a lower annual incidence density and risk of constipation than oxycodone CR and morphine CR (P > 0.05). After adjusting for confounding variables, including race and supplemental opioid use, the adjusted risk of constipation was ***78% greater in the oxycodone CR group (P = 0.0337) and 44% greater in the morphine CR group*** (P = 0.2242) than in the transdermal fentanyl group. CONCLUSION: In this population, patients receiving transdermal fentanyl had a lower risk of developing constipation compared with those receiving oxycodone CR or morphine CR.
Regards,
Ed.
Posted by greenhornet on April 9, 2005, at 20:43:45
In reply to Re: Just My Two Cents, posted by Paulbwell on April 9, 2005, at 18:25:13
> I think GH was making the point that theres too many folks taking too many pills UNNESSARILY. The APA has a duty, hell a crusade to convince folks that when thinks arn't hanky dory, as we see it, we should reach for the drugs.
>
> We should see through their trade, and find our own resourses, with support, and heal the best we can, while taking charge of our own situation, without placing ourselves into the hands of professionals, so READILY.
Paulbewell
You got it! GH
Posted by greenhornet on April 9, 2005, at 20:50:52
In reply to Re: Just My Two Cents » Paulbwell, posted by Phillipa on April 9, 2005, at 18:43:42
Phillipa is right on the acute vs. long term thing. The very biggest problem in all of this as I see it, comes when the physicians pile one drug on top of another, trying to fix symptoms that could quite likely be CAUSED by the previous chemical or withdrawal from it.
It becomes an endless, circular nightmare -- at least it did for me. GHI agree with you and after reading GH posts in the past know what she's been through. I was addressing more acute conditions, not longterm. I agree excercise, diet, meditation, therapy are a lot more helpful than dumping chemicals into your body that may do you more harm than good. I believe in the lowest possible dose of a med if needed to alleviate symptoms that interfer with the functioning of your life when other measures are being used in conjunction with meds, etc, Fondly, Phillipa
Posted by reefer on April 11, 2005, at 13:48:20
In reply to Re: Flip??? » Paulbwell, posted by flipsactown on April 8, 2005, at 22:38:00
This makes me think you have impaired enzyme function. The codeine isn't being converted to morphine in your body. Poor metabolizers with impaired enzyme function (Cytochrome P450 2D6) comprise approximately 7% of Caucasian, 2% of African American, and 1% of Asian populations.
Actually i'm a poor metabolizer of CYP2D6 myself, and codeine does have an effect on me, BUT it doesn't kill pain(doesn't work as an analgetic). So while still binding to opioid receptors, codeine might not be very addictive when not converted to morphine in the body.
Posted by ed_uk on April 11, 2005, at 13:57:25
In reply to Re: Oxycontin for mental health....WOW!!!!!!!!! » Larry Hoover, posted by flipsactown on April 9, 2005, at 18:35:48
Hi,
How well does acetaminophen work for your pain on its own? I'm just curious, I wondered whether the codeine wasn't doing much.
Regards,
Ed.
Posted by flipsactown on April 11, 2005, at 14:53:08
In reply to Re: Oxycontin for mental health....WOW!!!!!!!!! » flipsactown, posted by ed_uk on April 11, 2005, at 13:57:25
I have tried taking Tylenol Extra Strength Capsules for 3 or 4 months taking maximum dosage and felt no significate pain relief.
FST
> Hi,
>
> How well does acetaminophen work for your pain on its own? I'm just curious, I wondered whether the codeine wasn't doing much.
>
> Regards,
> Ed.
Posted by flipsactown on April 11, 2005, at 15:02:58
In reply to Re: Flip???, posted by reefer on April 11, 2005, at 13:48:20
I am Asian which really throws a curve on your stats. I urinate frequently, and I think that may have something to do with it? I don't know, but I am still getting adequate pain relief for a couple of hours. Since I take it 5 times a day, every 4 or 5 hours, I am not completely pain free, but this is better then no relief.
FST
> This makes me think you have impaired enzyme function. The codeine isn't being converted to morphine in your body. Poor metabolizers with impaired enzyme function (Cytochrome P450 2D6) comprise approximately 7% of Caucasian, 2% of African American, and 1% of Asian populations.
>
> Actually i'm a poor metabolizer of CYP2D6 myself, and codeine does have an effect on me, BUT it doesn't kill pain(doesn't work as an analgetic). So while still binding to opioid receptors, codeine might not be very addictive when not converted to morphine in the body.
Posted by ed_uk on April 11, 2005, at 15:33:31
In reply to Re: Oxycontin for mental health....WOW!!!!!!!!! » ed_uk, posted by flipsactown on April 11, 2005, at 14:53:08
Hi!
I'm not sure what country you live in........
Do you have a controlled release codeine on the market? Perhaps it would be more convenient. Then again, you'd still have to take the acetaminophen several times a day so it might not be that much help!
We have a controlled release dihydrocodeine in the UK (DHC Continus) but we don't have a controlled release codeine, apparantly it's available in some countries though.
Regards,
Ed.
Posted by Larry Hoover on April 11, 2005, at 15:49:58
In reply to Re: Flip???, posted by reefer on April 11, 2005, at 13:48:20
> This makes me think you have impaired enzyme function. The codeine isn't being converted to morphine in your body. Poor metabolizers with impaired enzyme function (Cytochrome P450 2D6) comprise approximately 7% of Caucasian, 2% of African American, and 1% of Asian populations.
>
> Actually i'm a poor metabolizer of CYP2D6 myself, and codeine does have an effect on me, BUT it doesn't kill pain(doesn't work as an analgetic). So while still binding to opioid receptors, codeine might not be very addictive when not converted to morphine in the body.I'm a poor metabolizer at 2D6, too, and it sure makes a big difference for me to know that. So many psych drugs depend on that enzyme....many of my medication failures can be traced directly to my liver.
Lar
Posted by Larry Hoover on April 11, 2005, at 15:53:27
In reply to Re: Flip??? » reefer, posted by flipsactown on April 11, 2005, at 15:02:58
> I am Asian which really throws a curve on your stats. I urinate frequently, and I think that may have something to do with it? I don't know, but I am still getting adequate pain relief for a couple of hours. Since I take it 5 times a day, every 4 or 5 hours, I am not completely pain free, but this is better then no relief.
>
> FSTActually, ed and I concluded you might be 2D6 deficient, earlier on in this discussion. Don't let race fool you. Most testing for enzyme function has been done in Causcausians. There are over 100 known genetic variants of this enzyme, and many of those are null (i.e. genetic coding for an enzyme structure that does not work).
If you are 2D6 deficient, it makes us wonder if it's not the acetominophen (paracetamol) that's giving you analgesia.
Lar
Posted by flipsactown on April 11, 2005, at 16:21:32
In reply to Re: Oxycontin for mental health....WOW!!!!!!!!! » flipsactown, posted by ed_uk on April 11, 2005, at 15:33:31
I live in the US, and I have not heard of controlled release codeine. I will have to research it.
FST
> Hi!
>
> I'm not sure what country you live in........
>
> Do you have a controlled release codeine on the market? Perhaps it would be more convenient. Then again, you'd still have to take the acetaminophen several times a day so it might not be that much help!
>
> We have a controlled release dihydrocodeine in the UK (DHC Continus) but we don't have a controlled release codeine, apparantly it's available in some countries though.
>
> Regards,
> Ed.
Posted by ed_uk on April 12, 2005, at 10:50:02
In reply to Re: Flip??? » flipsactown, posted by Larry Hoover on April 11, 2005, at 15:53:27
Hi Lar!
>If you are 2D6 deficient, it makes us wonder if it's not the acetominophen (paracetamol) that's giving you analgesia.
I asked FST whether Tylenol helped, he said he'd tried it but it didn't work.
I hope you are ok at the moment and that the side effects of gabapentin have reduced.
Regards,
Ed.
Posted by Larry Hoover on April 12, 2005, at 13:04:50
In reply to Re: Flip??? » Larry Hoover, posted by ed_uk on April 12, 2005, at 10:50:02
> Hi Lar!
>
> >If you are 2D6 deficient, it makes us wonder if it's not the acetominophen (paracetamol) that's giving you analgesia.
>
> I asked FST whether Tylenol helped, he said he'd tried it but it didn't work.
>
> I hope you are ok at the moment and that the side effects of gabapentin have reduced.
>
> Regards,
> Ed.I sure hope I get used to the cognitive effects, or that they fade. The pain was oppressive, but I actually functioned better than I am under the gabapentin.
Lar
Posted by ed_uk on April 12, 2005, at 13:43:59
In reply to Re: Gabapentin » ed_uk, posted by Larry Hoover on April 12, 2005, at 13:04:50
Hi Lar,
Could you reduce the dose?
Regards,
Ed.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.