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Thread: Avoid opioids for chronic back/knee/hip pain

  1. #21
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    Quote Originally Posted by Mark Rippetoe View Post
    I keep a few hydrocodone at home for cough medication, but they have absolutely no analgesic effect on me, so I'd make a shitty addict anyway. At any rate, most physicians are lazy bastards, just trudging through the day, doing what they've been trained to do, never attempting to rethink anything, and never doing anything that could be called into question even though all of it should be called into question. You know this better than we do.
    That is interesting. You are the only other person I have come across to say something like this. It is true of me too. I can and have taken a maximum dose of both hydrocodone and Valium (at different times) to basically no effect. As you say, I would make a crappy addict. Nearly all drugs have a minimal effect on my system and when they don't I acclimate to them quickly. I recall once taking benadryl for some hornet stings. Whacked me out. The next time it happened a few weeks later, it barely touched it. Now, eh.

    That said, I've been having some semi chronic hip pain recently. It was really flaired up Wednesday, hurting every time I sat or stood up. I went and worked out, DL and Squat. By the end of the session the pain was down 80% and is fine right now. Lifting is one of my best treatments for what hurts.

  2. #22
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    Quote Originally Posted by MartinB View Post
    Rip, which analgesic is the most efficient for you?
    Acetaminophen works best on a headache, I use naproxen for musculoskeletal pain, and for an acute emergency I have some injectable ketorolac in inventory. To illustrate the ineffectiveness of opiate analgesics on me, I once had 3 dilaudid and a large iced-tea glass of delicious dry red wine -- what I am told is a fatal dose -- and not only did my destroyed knee not stop hurting even a little bit, I didn't get sleepy. Just laid there and read my book.

  3. #23
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    Quote Originally Posted by Alchemist View Post
    That is interesting. You are the only other person I have come across to say something like this.
    Dearly Beloved is in the same boat. The first time she took a Vicodin she was up all night cleaning the house.

  4. #24
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    Quote Originally Posted by thras View Post
    Hey Rip,

    Have you seen this yet? Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain: The SPACE... - PubMed - NCBI

    It's nice to see a big study backing up advice that I've seen here on the boards a few times from various SSCs/MDs: Take NSAIDs/acetaminophen for back/knee/hip pain, not opioids.

    The study's population was people with "moderate to severe" chronic pain. So not people with minor injuries. Looking at the results, opioids seem like a good way to keep your chronic pain around forever.
    Since the full text of this study is not made available, the particulars can't be read. But I call BS on the study, as it applies to control of "moderate to severe chronic pain." Acetaminophen, ibuprofen, and other NSAIDs all kill off your liver, your kidneys, or both, if you use the NSAIDS long-term at the highest permitted doses -- which you would have to do for moderate to severe chronic pain. I'm talking about pain that lasts for years. Opioids do not have those deleterious effects on the liver or kidneys -- so I think opioids appear more benign than the other choices. Moreover, opioids are just better pain relievers than NSAIDS (in most people - evidently not for Rip), which is why morphine is what you get after you have had surgery, or if you are dying of cancer, rather than being told to just pop a couple Advil. Only people who have never experienced severe chronic pain, with no end in sight, could possibly think NSAIDs are adequate. And I suspect the suicide rate will climb as the government makes people who are in pain suffer, for the benefit of protecting otherwise healthy people who would use opioids for recreation. Meanwhile, what people are dying from is heroin and fentanyl, not prescription meds being used as directed.

    Apparently, over time it has been learned that long-acting opioids repress your hormones, both hormones from your adrenal glands and your gonads. In men this may become visible (the testicles actually shrink). So from that perspective they look a bit less benign now, than they did at the beginning of this century when this country decided to have a "pain control decade" and told all the doctors they were not doing enough to control pain. Even with that side effect, I suspect that many people who are in serious pain would still choose them if they could.

  5. #25
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    Versed, Lortab, Valium are all quite ineffective with me. The dosages required to get them to have an effect give docs VERY BIG EYES.

    A big thanks to everyone who posted on this thread. This is a very interesting discussion. Yes, our medical (and legal) system needs some serious help.

    As a guy who has lived with chronic, serious pain, I can say my position on "addicts" has moderated. Pain sucks...if you haven't lived it I'm not sure how well it can be understood. I'm grateful the opioids never held any allure for me.

  6. #26
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    Does acetaminophen at recommended doses in fact "kill off your liver?"

  7. #27
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    Quote Originally Posted by Amy-in-PHX View Post
    Acetaminophen, ibuprofen, and other NSAIDs all kill off your liver, your kidneys, or both, if you use the NSAIDS long-term at the highest permitted doses -- which you would have to do for moderate to severe chronic pain. I'm talking about pain that lasts for years. Opioids do not have those deleterious effects on the liver or kidneys -- so I think opioids appear more benign than the other choices.
    There is so much wrong with this post. Ask anyone who has properly used or prescribed acetaminophen and ibuprofen in concert with one another, and they will tell you, this is an exceptionally powerful pain relieving medication combination. Now, with respect to opioids not being harmful to your liver or kidneys, please enlighten me on which COMMONLY prescribed opioids do not have acetaminophen or ibuprofen as part of the drug combination (with the exception of oxycontin).

  8. #28
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    This odd statement from Amy

    Acetaminophen, ibuprofen, and other NSAIDs all kill off your liver, your kidneys, or both, if you use the NSAIDS long-term at the highest permitted doses -- which you would have to do for moderate to severe chronic pain.
    indicates to me that she gets her information from Prevention magazine. Over the past 30 years I have consumed quite literally 10 kilos of acetaminophen, and maybe 15 kilos of ibuprofen. I assure you that my liver is just fine. Also, your statement is wrong.

  9. #29
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    Quote Originally Posted by Will Morris View Post
    There is so much wrong with this post. Ask anyone who has properly used or prescribed acetaminophen and ibuprofen in concert with one another, and they will tell you, this is an exceptionally powerful pain relieving medication combination. Now, with respect to opioids not being harmful to your liver or kidneys, please enlighten me on which COMMONLY prescribed opioids do not have acetaminophen or ibuprofen as part of the drug combination (with the exception of oxycontin).
    This is the crux of it. Every emergency physician knows how to treat acetaminophen overdose in his sleep. In 25 years of practice I never saw one single solitary case of acetaminophen toxicity resulting from appropriate long-term or acute use. Every single solitary case I ever saw was an intentional overdose OR from abuse of prescription narcotics, or both. Without exception.

  10. #30
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    Quote Originally Posted by Alchemist View Post
    By the end of the session the pain was down 80% and is fine right now. Lifting is one of my best treatments for what hurts.
    Though it has been espoused by the Starting Strength community, particularly Rip, for a long time, the Physical Therapy community is starting to come around to this very notion. As it stands right now, the leading Orthopaedic Physical Therapists in the country have stated that "regular high intensity cardiovascular and resistance training should be the final common pathway for virtually all musculoskeletal conditions". Another way of looking at that is this: treatment for orthopaedic conditions should be aimed with the end result being the patient returning to this level of exercise, for the evidence seems to demonstrate the best outcomes are associated with return to high intensity (read: at least a good way into the novice progression until the weights start to get really difficult) training.

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