True, you do want to avoid tolerance, but long-term studies show that in
individuals with real, organic pain, titration tends to slow down, even
level off, as you reach those levels where pain is attenuated to a level one
can handle.  I have been titrating slowly upward over a period of seven
years, but I still don't feel as if I've reached "setpoint".  The bitch is
that research has demonstrated the brain's capability of building new neural
networks to get around the pain-relieving effects of the opiates.

Re: the paradox effect, I can relate.  When I was using Lortab, Laura would
call it "Crabtab" because I felt anxious and grumpy.  The pain was
attenuated, but I didn't like the way the stuff made me "feel".

-Kyle

-----Original Message-----
From: Bobby G. Greer, Ph. D. [mailto:[log in to unmask]]
Sent: Monday, February 25, 2002 12:20 PM
To: [log in to unmask]
Subject: Re: My Mom, my physiatrist in Ottawa


In a message dated 2/25/02 10:11:08 AM, [log in to unmask] writes:

>Bobby!  So good to hear from you!  Whar's your perspective on the pain
>management/addiction equation with respect to narcotic analgesia?
>
>-Kyle

    While I am far from an expert of pain management, the general rule of
thumb is avoiding the phenomenon of tolerance to a pain killer. Tolerance is
the feature where it takes more and more of the drug to get the same level
of
relief. If you are steady on your level of medication and your physicians is
aware of the amount you are taking, I see no problem. The trick is that
every
individual is different and reacts to medications different, so it may be a
lengthy process to titrate the dose in order to get the maximum pain relief
with a low dosage, There is also a thing called the "paradoxical effect"
where a drug effects one individual in the manner opposite to what is
expected. For instance, opiates, instead of making one drowsy, "peps" you
up.
This is the phenomenon which gets many health professional hooked on opiate
to cope with the stress and long hours.

Bobby