Chronic pain patients: how do your manage breakthrough pain?

[ChippyMalone]

I use various combos of high CBD and THC flowers for neurological pain after spinal fusion surgery. My mmj use allows me to stay with lower level prescription pain medications and avoid going too far with the opiates arms race.

I'm now 10 months after surgery and more surgery is in the future. Until then, and I'm trying to hold off as long as I can, I'm really struggling with breakthrough pain, particularly after sitting for extended periods of time, especially in the evenings. My sleep is being affected now,

How do you use cannabis to manage pain while managing to stay active, positive? Right now, I'm just getting really discouraged.

 

[killick]

Hi Chippy.

I don't have specific experience with your issues, but I've been fighting with some chronic injuries for many years. Both knees were injured by slipping on a steel deck on a ship - we needed scissors to cut off trousers as both kneecaps looked like there were soccer balls inserted underneath.

That, combined with another sailing injury that had my shoulders pulled apart until a rotator cuff was torn. Now that has become osteoarthritis in knees, hips, shoulders and neck. When it got to it's worst a few years ago I couldn't concentrate or focus on the combinations of medications I was 'testing' (they changed so much and so fast I can't call it anything else). I went through a 6 month period where I couldn't turn my neck enough to shoulder-check while driving, which really sucked.

I was on 3 different arthritis meds and a huge selection of narcs. I wound up in hospital for 6 weeks (3 weeks in urgent care, 10 days in Emergency) and they couldn't really find the cause, and blamed it on a suspect allergic reaction to narcs and arthritis meds.

My doc suggested trying MM as an option. My wife wasn't a fan - her only experience was in high school, and it was always the 'weird kids' who did this stuff. I was one of the weird kids, but stopped when I joined the Navy in the early 80s, so my experience with MM is all gained over the past 18 months or so. My initial goal was to at least cut back on the narcs and arthritis meds. Last summer Vets Affairs sent me to a Pain Mgmt clinic. It was kinda fluffy, but did help with some exercises and strategies on how to manage flareups, and also activity pacing.

So for the past 7 months I've pretty much stopped taking prescription painkillers. It was a gradual tapering, then only taking the morning dose, and then to only taking narcs for breakthrough pain. Now the only pills I take are Nabilone, and thats only when needed. I still have a whack of painkillers, but now they are in the closet, stuffed into an A&W Rootbeer lunchbox. I lived with them for so long I'm scared to get rid of them...

Morning - take a nabilone or two if required.
Breakfast smoothie - add a spoon or 2 of ABV to it
If I'm working I use Nabilone or Sativex for discretion. I've been on disability for the past year so discretion isn't as big a deal as it was.
Like you I have a variety of strains in the cupboard -
24% THC Indica really helps me sleep
14% THC Sativa through the day
22% THC Sativa for rougher days
8% CBD Sativa for anti-inflam
Occasionally mix up some frankenstrains to see how they turn out. Last night was a scoop of 24% Indica with 4 scoops of 8% CBD.

I usually don't start using a vaporizer until afternooons, but that also depends on the day. I've been using a Vapir NO2 for portability around the house, but got a desktop unit, Arizer Extreme Q, for more meds. I also bake - I make butter and use that to make cookies, and munch them as required as well. My last batch of sugar-free peanut butter ones work well, but edibles also take a bit of practice. I also have a new stealthy vape, Inhalater INH05, that always accompanies me now. It's a pen, holds enough for a nice walk with the dog, and no one knows, or cares, what it is that I'm puffing on. If I'm in a lot of pain before a walk I'll take a nabilone or two, load up the vape, and walk slowly until it starts to subside.

How much are you using per day? I'm assuming you are vaping? Are you using any other methods for controlling pain?

 

[rhystess]

I use various combos of high CBD and THC flowers for neurological pain after spinal fusion surgery. My mmj use allows me to stay with lower level prescription pain medications and avoid going too far with the opiates arms race.

I'm now 10 months after surgery and more surgery is in the future. Until then, and I'm trying to hold off as long as I can, I'm really struggling with breakthrough pain, particularly after sitting for extended periods of time, especially in the evenings. My sleep is being affected now,

How do you use cannabis to manage pain while managing to stay active, positive? Right now, I'm just getting really discouraged.

Hi @ChippyMalone
Good post I'm in a similar situation, had 2 fusions about 2 year ago now,, my pain is most prob worse than ever,, I get morphine tabs, patches& liquid,& if in honest I don't find the morphine helps much anymore. I suffer a lot of pain from time I wake till I sleep,,without the herb I don't know how I would cope,, I vape maybe 6-10 times a day,, recently I've tried medibles out of the abv& that has helped,, I find a nice indica to be best help out of the types,, but as for breakthrough pain it is soooo hard to get a grip of,,I tend to put some heat:cold on the area & have a vape, it does help me, I also recently made some bubble hash& the extra bit of strength makes a big diff to pain relief. I wish I was living in the USA where I could manage pain with a few diff remedies,,sadly I'm uk based & everything I do needs to be behind closed doors,, which is sad that people in huge amounts of pain have to hide the things that make a diff to
Our life's. We are the ones that are going through this , I could go on for ages on that subject .

 

[ChippyMalone]

@rhystess have any of the high CBD strains from the west coast and Colorado made it over the pond yet? They are really make a huge difference to me.

I know how frustrating it can be as a patient working to take care of yourself in secret because I had to move 2500 miles from Alabama (where the cannabis situation might be worse than UK) to Washington state.

I'm having a pretty rough night. One of those where it hurts so much I have to sneak out of bed so that I can go vape without waking my wife. And not because I'm medicating secretly (she is completely supportive), but because I don't want her to have to know how much I am suffering tonight. She deserves to sleep Sunday morning because she takes such good care of me and needs her weekend.

I have a real difficult time with narcotics, as I cannot tolerate the psychological side effects well because I'm bipolar. They would give me stronger opiates, but if I take more than a daily extended release tramadol and one or two of the lower dosage hydrocodone for breakthrough, I switch from slightly manic and amusingly eclectic to unbearably depressed. It is kind of funny when my wife catches me in pain, feeling depressed, and obviously time to vape a, little. "Go smoke some pot!" she says.

And even here in Washington state, it is still not a magical Wonderland for patients . My doctor could take away opiates because her license to prescribe medication is under federal jurisdiction and she cannot risk her job if she knows I use legal medical marijuana. I think we have a "don't ask don't tell" policy, but I'm not 100% positive of that and it is always in the back of my mind that I could be refused medicine the next time I see my doctor. I peed in a cup the first time I went and signed the pain contact that said I would not use "illegal drugs" and could be terminated as a patient for it. She did inform me of my positive THC test and the implications of a future positive test. But I've never been tested since.

 

[rhystess]

Hi @ChippyMalone
Good post I'm in a similar situation, had 2 fusions about 2 year ago now,, my pain is most prob worse than ever,, I get morphine tabs, patches& liquid,& if in honest I don't find the morphine helps much anymore. I suffer a lot of pain from time I wake till I sleep,,without the herb I don't know how I would cope,, I vape maybe 6-10 times a day,, recently I've tried medibles out of the abv& that has helped,, I find a nice indica to be best help out of the types,, but as for breakthrough pain it is soooo hard to get a grip of,,I tend to put some heat:cold on the area & have a vape, it does help me, I also recently made some bubble hash& the extra bit of strength makes a big diff to pain relief. I wish I was living in the USA where I could manage pain with a few diff remedies,,sadly I'm uk based & everything I do needs to be behind closed doors,, which is sad that people in huge amounts of pain have to hide the things that make a diff to
Our life's. We are the ones that are going through this , I could go on for ages on that subject .

@rhystess have any of the high CBD strains from the west coast and Colorado made it over the pond yet? They are really make a huge difference to me.

I know how frustrating it can be as a patient working to take care of yourself in secret because I had to move 2500 miles from Alabama (where the cannabis situation might be worse than UK) to Washington state.

I'm having a pretty rough night. One of those where it hurts so much I have to sneak out of bed so that I can go vape without waking my wife. And not because I'm medicating secretly (she is completely supportive), but because I don't want her to have to know how much I am suffering tonight. She deserves to sleep Sunday morning because she takes such good care of me and needs her weekend.

I have a real difficult time with narcotics, as I cannot tolerate the psychological side effects well because I'm bipolar. They would give me stronger opiates, but if I take more than a daily extended release tramadol and one or two of the lower dosage hydrocodone for breakthrough, I switch from slightly manic and amusingly eclectic to unbearably depressed. It is kind of funny when my wife catches me in pain, feeling depressed, and obviously time to vape a, little. "Go smoke some pot!" she says.

And even here in Washington state, it is still not a magical Wonderland for patients . My doctor could take away opiates because her license to prescribe medication is under federal jurisdiction and she cannot risk her job if she knows I use legal medical marijuana. I think we have a "don't ask don't tell" policy, but I'm not 100% positive of that and it is always in the back of my mind that I could be refused medicine the next time I see my doctor. I peed in a cup the first time I went and signed the pain contact that said I would not use "illegal drugs" and could be terminated as a patient for it. She did inform me of my positive THC test and the implications of a future positive test. But I've never been tested since.

hi @ChippyMalone I'm sorry to hear bout ur rough night,, it's a horrible to thing to have to go thru, specially on ur own ,, & I totally get why you don't want to wake ur wife,, it's good to have someone with u in those tough times, but u also feel guilty for keeping them awake,, when they don't get much rest as it is,, I think my wife has now somehow programmed herself into waking everytime I turn/wake or get up,I'm always met with sleepy eyes & "can I help" ,, I feel guilty as she's up early with my daughter everyday,, whereas it'll take me a good hour to get up in the morning at least , after the norm routine of morphine & vape,, if I'm being honest I doubt I'd bother getting out of bed if my wife& daughter wasn't around,,waking up in sooo much pain everyday just gets you down.
Na I've not had the joy of the higher cbd strains yet. I'm a farmer of mainly indica's , but I am looking for some new seeds& I've seen a cbd high seed company on the net,, is there any that you've tried or heard of that might be worth me trying to get hold of?
I bet the different state views on the herb drives you mad,, some states seems to go all in& others want to go in the opposite direction! Over here I thought we was to follow but it now looks like we'l be going backwards.. once again
I've recently got into bubblehash & I find that to be hitting the spot ,just I don't have enough to last for as long as I'd like.
Do you have access to anything like oral morph, or strong painkillers you can turn to in the hard times? I've found lidocaine patches to help at those times,, it's more licensed for brain surgery but some doctors will advise trying them ,sadly we've got nothing to loose by trying all the diff meds,, just to me at the mo the herb seems to help more than the meds...

 

[ChippyMalone]

@rhystess I know what you mean by having your family as your reason to get moving in the morning. I wake up with my wife and lay out her clothes, make her breakfast, and get her lunch ready, and care for the dogs and cats while she showers. Then I drive her to work. The truth is that it really hurts to be driving that soon in the morning before any medication oral or inhaled, but this morning ritual guarantees that I feel useful and don't stay in bed.

Thanks for reminding me of the lidoderm patches. I actually have a stack of them my mother gave me that she didn't use. Even with good insurance, they were stil
Too expensive to buy the last time I had a prescription. I hear that there is a generic now.

I actually see me pain doctor tomorrow for the first time in a couple months, so I guess this is as good a time as any to be having increased pain. I seem to have a good relationship with this doctor, and she knows how hard I try to keep my opiate tolerance as low as possible, so I'm sure that I can always move up the opiate ladder if I must. I am all out of CBD (ran out 2 days ago) and that may be a contributing factor to my increased pain. Of course, I still cannot safely talk about mmj with the pill pusher side of the medical industry.

But while the pharmacy is filling my prescriptions, I'll be down at the dispensary smelling jars of green Goodness.

 

[ChippyMalone]

Well, the new MRI results today show exactly what I knew and feared: my last lowest disc in my spine has now fallen apart. No real way out of additional surgery,just a matter of when to schedule it so we can arrange for help in the home afterwards. It's really not the holiday miracle we were hoping for.

On the bright side, my nurse practitioner who is a zillion times nicer than the doctor was very helpful and supportive. Trying a steroid pack for the short term, and tomorrow I have to go shopping for high CBD if I'm able to drive.

 

[grokit]

It's always good to have a bright side, best of luck to you @ChippyMalone

 

[CarolKing]

I have arthritis in my hands, feet and low back effecting the L4 and L5 disc. I do go in for a Spinal Epidural every so often. It's been a 1 1/2 since the last one. I have a spinal stenosis too. The doc has talked about a fusion but I'm doing better now.

I took anti inflammatories for years because that's what they tell you to take. I have damage to my kidneys from the years of pharmaceuticals. They were willing to give me Percocet but not willing to give me a MMJ Cert. I said no to the pain killers! They didn't help anyway. I was worried that I would become addicted. The HMO Group Health Cooperative of WA doesn't give out certifications for med MJ. I went to a Naturopath that I didn't even know and in 20 min I had a med cert for cannabis, that was last May.

I am going to MMJ dispensaries to find the medication that I need. It helps with the pain but doesn't take it away. I use acupuncture too and supplementing with a chiropractor. I use heat, cold and acupressure using a ball. I use cannabis creams too. It's been an education trying to figure out what works best. I'm still making my way through. Some days are better than others. I continue to work part time. When I get home and relax my feet have a tendency to stiffen up and hurt. I use cannabis to help relax the muscles and I use heat and the cannabis cream too.

Sometimes it gets hard to sleep at night. I use wax along with the cannabis in the evenings before bed. I use the higher temps with my bubbler.

For me I need to keep active. I try to walk and ride my bicycle for exercise and some days it's hard to stay motivated. I have a lot in my life right now that causing a lot of stress and anxiety. Things I have no control over and it's frustrating for me. Cannabis is helping me with the anxiety too.

I am thankful that I found this community. It's been so helpful for me to read other experiences and what works for them. Questions and answers that you cannot find anywhere else. Friends helping friends.

Remember to Fuckcombustion!!

 

[rhystess]

Well, the new MRI results today show exactly what I knew and feared: my last lowest disc in my spine has now fallen apart. No real way out of additional surgery,just a matter of when to schedule it so we can arrange for help in the home afterwards. It's really not the holiday miracle we were hoping for.

On the bright side, my nurse practitioner who is a zillion times nicer than the doctor was very helpful and supportive. Trying a steroid pack for the short term, and tomorrow I have to go shopping for high CBD if I'm able to drive.

@ChippyMalone
Shit that's not what you wanna hear anytime of the year, do you have a long wait for surgery? Feck you don't get much luck recently
Will you have an option of a gel disk as a replacement or are you looking at another fusion? Whichever it be you could do without it,,
@CarolKing dosnt sound like your luck is much better,, do you get much pain relief off the epidural? I've tried 2 in the past with no joy but I've been offered another recently and still not sure to try again.
Chronic pain changes everything we have to deal with in everyday life,it sucks beyond belief!

 

[ChippyMalone]

@rhystess I'm not a candidate for any of the up and coming procedures. I'm going to have to just live with more titanium parts and dead people's bones from the Dr. Frankenstein play set.

Well, I have had one really incredible week. The most pain I've experienced since my surgery last January. However, I have been able to get my hands on a gram of supercritical CO2 extracted oil that has 53% THC, 9% CBD, and 2% CBG. Label says it is 35% activated cannabinoids, but I don't know if that is 35% of the actual cannabinoids themselves or 35% of the oil.

I'm puttiing a rice sized grain onto some cotton and vaping in the E-Nano.

Additionally, I was given a 0.3 gram sample of a high CBD RSO oil for sublingual use at bed time. I used it the last two nights and slept better than I have in a couple months. Last night, I actually slept a full 8 hours. No waking up crying at 3am.

My biggest problem right now is that i am only comfortable in 2 positions: kneeling and standing. Makes laying down to sleep a bit rough because I know it is going to be sharply painful for 15 minutes until my spine stretches out a bit.

Anyway, I've got a mouthful of RSO and it is probably time for bed. With any luck, I won't be posting here again in 4 hours. . . . .

 

[t-dub]

Sleep is the worst for me. My wife says she can hear me whimpering in my sleep. Right now an invisible being is driving a good sized invisible nail through my right ankle. I hate chronic pain. If I get 4 hours of sleep in one shot that is a victory for me. The only thing that is worse than dealing with chronic pain is dealing with insurance and drug companies while dealing with chronic pain. No opiates for me, did the morphine thing for almost 5 years so I'm done there, but the meds to alter my immune system are necessary and expensive. Right now Celgene gives me my Otezla for free since the rat bastards at Providence STILL won't pay for it . . .

 

[ChippyMalone]

@t-dub Sorry you have sleep problems too and I know how much it really stinks to have to fight the insurance companies. I'm really lucky that my wife's job gives us good insurance because my last non-profit employer did the best they could but it was a miserable plan. I've got collections agents hounding me because the flexible spendiing account people can't properly pay their bills! And I'm not paying them twice!

I'm also doing my very best to stay on the lowest rungs of the opiate ladder. Right now, the most important thing for me to is get up and get my body moving when I am in pain. 5 minutes of walking or doing light household chores can make a huge difference.

One thing I've found that has been a little bit helpful for me is to find several very tiny home repair tasks and then go to the hardware store and get the little bits and pieces to do them. When I'm awake at 3am, having something useful to do like fixing wobbly door knobs or replacing the dishwasher's rubber seal to try to get one more year out of the old girl. I'm going to have to find someone to come and clean out the gutters and reconnect a couple ones that have broken loose. One of the most frustrating things is to have to rely on others to do the really basic stuff I always took for granted. Last thing in the world I want to spend $100 or more on is having soggy pine needles moved from my gutters to the ground. Just kills me to pay for such service.

 

[elvenflow]

Using oral preparations on a regular basis (hash infused coconut oil, RSO) for sustained anti-inflammatory effect and then concentrates for breakthrough works for me.

 

[Enchantre]

Last night, there wasn't anything that was "working" for my pain. With the asthma attack, I had to be really skimpy with the vapor. Capsules weren't even showing up on radar.

Coupled with all that, I have chronic constipation, due to nerve spasms from my damaged hip.

I had to send hubby for a Fleet this morning. Sigh.

 

[ChippyMalone]

@Enchantre Sorry to hear about your crummy night. I'm getting ready to make some of your massage oil recipe, although I am going to use it in capsules as well.

 

[grokit]

@Enchantre, have you ever looked into a product called natural calm?

 

[CarolKing]

Ive had several steroid epidurals. I had success with them. Now my low back is doing better. I still have days where I'm in pain. It seems like more in the winter. I'm getting a lot of pain in my feet so I'm getting steroid shots every so often for them too. Probably helps 60% of the time in the feet. I'm getting shots to the right foot here recently. I have some nerve damage too. At night seems to be the worst.

I had some plant material with coconut oil, leftover from the Magical Butter Maker, for a while I kept it. I used it on my feet and I think that helped the best of any creams that I have bought. I warmed it in the microwave and smothered it on my feet. I left it on for 15 or so.

 

[howie105]

I use various combos of high CBD and THC flowers for neurological pain after spinal fusion surgery. My mmj use allows me to stay with lower level prescription pain medications and avoid going too far with the opiates arms race.

I'm now 10 months after surgery and more surgery is in the future. Until then, and I'm trying to hold off as long as I can, I'm really struggling with breakthrough pain, particularly after sitting for extended periods of time, especially in the evenings. My sleep is being affected now,

How do you use cannabis to manage pain while managing to stay active, positive? Right now, I'm just getting really discouraged.

Getting discouraged may very well be a separate treatment issue from the pain. Talk to your physician about that first then address you herbal meds in light of their input.

 

[Enchantre]

@Enchantre, have you ever looked into a product called natural calm?

Yes. I have four containers of it now. .
You would be amazed how little it works for me.
But thanks. Usually it isn't that bad, and if I'm very careful with diet it works fine.
I think being sick just made it worse.

 

[MinnBobber]

I have arthritis in my hands, feet and low back effecting the L4 and L5 disc. I do go in for a Spinal Epidural every so often. It's been a 1 1/2 since the last one. I have a spinal stenosis too. The doc has talked about a fusion but I'm doing better now.
...

I am going to MMJ dispensaries to find the medication that I need. It helps with the pain but doesn't take it away. I use acupuncture too and supplementing with a chiropractor. I use heat, cold and acupressure using a ball. I use cannabis creams too. ... When I get home and relax my feet have a tendency to stiffen up and hurt. I use cannabis to help relax the muscles and I use heat and the cannabis cream too.

Remember to Fuckcombustion!!

.........................................................................................................
Hi,
I have a L4-5 protruding disk that sometimes flares up and incapacitates me.
Hope to be visiting CO in a month for some unofficial MMJ.
I see my favorite shop carries a "canna cream" which interests me a lot.

Does that do anything for lower back pain, in your experience?
How about for over-exertion muscle pain? I'm guessing it would help more for that???

Thanks

 

[Enchantre]

@MinnBobber my hubby blew that same disk a few years ago, and he finds real relief using my cannaoil. Purchased topicals have also worked very well.
i hope you find a good one.

 

[elvenflow]

I had to send hubby for a Fleet this morning. Sigh.

Have you tried Co2 Oil in suppositories yet? I've had very good results, in food grade cocoa butter. Co2 (as long as you get one without additives) is not as irritating to the rectal membrane as RSO, in my limited experience and works quickly for both back pain and, later, constipation. You can make them using a suppository mold but I just roll the mix into the correct shape in my palms.

I haven't been able to defecate without stimulation in years due to the neuropathy, so this method of medicating is really useful. Start very very very small on the added cannabinoids.

 

[elvenflow]

"Insert" pun about "butt easy to make" here:

http://pharmlabs.unc.edu/labs/suppository/prep.htm

Hand Rolling is the oldest and simplest method of suppository preparation and may be used when only a few suppositories are to be prepared in a cocoa butter base. It has the advantage of avoiding the necessity of heating the cocoa butter. A plastic-like mass is prepared by triturating grated cocoa butter and active ingredients in a mortar. The mass is formed into a ball in the palm of the hands, then rolled into a uniform cylinder with a large spatula or small flat board on a pill tile. The cylinder is then cut into the appropriate number of pieces which are rolled on one end to produce a conical shape.

 

[ataxian]

@MinnBobber my hubby blew that same disk a few years ago, and he finds real relief using my cannaoil. Purchased topicals have also worked very well.
i hope you find a good one.

@Enchantre I have been going through a lot.
During the day GSC!
Night PARIS OG or MARS OG.