Opioid Warning (hydrocodone, codeine, oxycontin, etc)

[webslave]

Opioids (morphine and related drugs) are very useful for controlling pain in the short term. However, those who take them frequently or for a prolonged period may find out that they have a downside, and I'm not just talking about the well-known problem of addiction here.

This class of drugs may cause mast cell degranulation, which leads to inflammation and pain. In fact, opioids are a well known cause of itching and even anaphylactoid reactions.

Experimentally, morphine (the basis of many opioids) was shown to cause degranulation in the gut of rats (mesenteric mast cells), as well as in human skin (itching).

Anecdotal evidence on this forum, including my own experience, would indicate that these unwanted effects can occur in the prostate/bladder too.

More information on these drugs here:
http://en.wikipedia.org/wiki/Opioid

IN OTHER WORDS, OPIOIDS MAY MAKE chronic prostatitis / chronic pelvic pain syndrome SYMPTOMS WORSE, NOT BETTER.

[webslave]

I must modify the above warning to state that the synthetic opioid tramadol (Ultram) apparently does not cause mast cell degranulation and histamine release. Still, take care with it. I found that it caused insomnia and was much less effective than hydrocodone and other true opioids.

Update: BUT, like other opioids (eg hydrocodone, oxycodone, oxycontin etc), it still causes itching for me (I take it very occasionally to treat bouts of nausea that accompany gastroenteritis), which would indicate that it is in fact a mast cell degranulator. In fact, I find my food allergies and intolerances intensify for up to a week after taking it. So be warned.

Wikipedia has these warnings about Ultram:

Adverse effects

The most commonly reported adverse drug reactions are nausea, vomiting and sweating. Drowsiness is reported, although it is less of an issue compared to other opioids. Respiratory depression, a common side effect of most opioids, is not clinically significant in normal doses. By itself, it can decrease the seizure threshold. When combined with SSRIs, tricyclic antidepressants, or in patients with epilepsy, the seizure threshold is further decreased. Seizures have been reported in humans receiving excessive single oral doses (700 mg) or large intravenous doses (300 mg). Dosages of coumadin/warfarin may need to be reduced for anticoagulated patients to avoid bleeding complications.

Dependence

... it is apparent, in community practice, that dependence to this agent does occur. .... However, this dependence liability is considered relatively low by health authorities, such that tramadol is classified as a Schedule 4 Prescription Only Medicine in Australia, rather than as a Schedule 8 Controlled Drug like other opioids (Rossi, 2004). Similarly, tramadol is not currently scheduled by the U.S. DEA, unlike other opioid analgesics. Nevertheless, the Prescribing Information for Ultram warns that tramadol "may induce psychological and physical dependence of the morphine-type." In addition, there are widespread reports by consumers of extremely difficult withdrawal experiences.

All in all then, tramadol (Ultram, Ultracet etc) is possibly a better option for men with pelvic pain syndrome than other opioids.

[Rocker1984]

As a recovering heroin addict, I can attest to the fact lots of opiods over a period of time can possibly induce CPPD in some people. I was on a methadone program for four years and I never had a symptoms before going on that nasty shit....thank god I weaned myself off of it...one of the hardest things I've ever done.

[webslave]

One more note in support of Tramadol (Ultracet, Ultram, Tramol etc)

It has a 3-mode action: analgesic, antidepressant and mild anti-inflammatory.



One caution: it is possible to become addicted to this drug, despite reassurances to the contrary. If you start using many hundreds of mg a day, you could have a problem (the incidence of abuse is rather low, about one case per 100,000 patients).

[Jay]

Tramadol was actually the first medication I received for pain management. Although others have since been added to the cocktail, it remains the staple for pain alone, and I have really had few problems with it.

Dependence is possible, yes, though it seems to be a minimal factor for me personally. I'm allowed a maximum of 200mg a day, which is four pills, yet my regular (scheduled) dose is only 100mg. It used to be 150mg, but with my PM doctor's permission, I cut back by a pill simply for the sake of doing so. Had zero side effects as a result, and pain relief remains satisfactory in combination with my other pills. As much as one can expect from medication alone, anyhow.

From what I have gathered through associating personally with three pain management doctors, Tramadol seems to be among the least feared and most useful painkillers they prescribe. I'd hazard to guess that the addiction (as opposed to dependence) potential is far lower than a true opiate, which they seem far more adverse to using.

[scotsman]

Tramadol has been great for me too - no side effects and I've been on it for 5-6 years now. Used to be on as much as 250mg a day but now only take 50mg in the morning. Always tappered the dosages down slowly though (over a couple months) to avoid withdrawal issues.

[CMT23]

I can buy it over the counter here. Unfortunately, even 20mg makes me feel dizzy and then gives me a burst of mental energy before I become very tired. When it's time to sleep, it usually causes my mind to race. So I am still looking for something for pain relief that can be taken regularly. Valium helps, but hardly a drug you want to take every day.

[MW62]

I spent 18 years with chronic prostatitis / chronic pelvic pain syndrome before finally giving up and going on opioids for the pain. My quality of life was greatly improved through the use of morphine. I have had to slowly increase my dosage though. I am concerned about the "degranulating" of the mast cells that Webslave describes. What are the adverse effects here? I have some itching with the morphine but generally it's only a very minor irritation. Am I shooting myself in the foot here? Almost afraid to ask.

When I say that my quality of life was "greatly improved" it is a relative term. I went from an extremely unbearable situation to a somewhat tolerable QOL. I was able to continue to work and even be somewhat successful. For a while my personal life was greatly improved as well. Now things seem to be heading downhill again, thus I find myself back on the Internet looking for answers.

I do find that Dr. Wise's relaxation tapes are helpful as well. Biggest thing for me was when I finally realized one day almost two decades into this problem that the pain was due to muscle tension, and not some underlying disease.

Opioids are of course addictive and should only be considered as a last resort; but I can attest that they can be very helpful if used carefully.

[webslave]

You are trapped at a way-station on the road to cure. Opioids can be a useful temporary adjunct to break the pain cycle, but almost every time I've seen guys take it long-term, it's resulted in the path to cure being exited at that point. I had a moderator here called "MS" who became addicted and admitted after several years that he was making no progress and now in addition had to deal with addiction issues. It can be very difficult to wean off of these drugs once you are addicted as well.

[Rocker1984]

For better or for worse I'm back on the methadone. I haven't posted for a couple years but have since been going through a seemingly endless hell of relapse/severe opiate abuse/quitting/relapse etc. Although it's super difficult to get off, I had to admit to myself that the only significant clean time from my DOC (IV heroin) was on the methadone program, and at this point, that is a more pressing medical issue because I risk ODing at pretty much any time so I need to get that under control before I can again begin to focus back on CPPS. I've had internal massage in the past but can;t afford to go anymore. Still, some things have improved, others have gotten worse. I suffer from a swollen ballsack and hard flaccid penis a lot of the time, and erection quality varies greatly. I'm wondering what effect the methadone has if any of my chronic prostatitis / chronic pelvic pain syndrome since it supposedly affects the CNS as opposed to the muscular-skeletal system (according to my methadone clinic dr.) In the past my internal Physical Therapist has said that opiates have been a big cause/aggravator of my disease, so I'm confused at this point. Would like to hear some other opinions.

[NTD]

I've been taking Ultracet for over 4 years now, and the only side effect I've noticed is occasional drowsiness. I can go without doses and not feel any withdrawal symptoms, so that's a relief. My primary care doc doesn't seem too concerned about my continued use, and it has helped me quite a bit in dealing with CPPS.

[we.the.hulk]

Rocker
Can you explain how the methadone clinic works? Has methadone helped your chronic prostatitis / chronic pelvic pain syndrome pain?

[Mike Kavo]

Opioid drugs are a last resort. Many people who have no urological symptoms just pain may tolerate them better in a very low dose. With urological symptoms I would think opioid use would be utterly irresponsible.

A few key points:

1. Constipation - everyone gets this on opioid. Creates hard stools so you put pressure on a pain sensitive area. Then when you try to stop it diarrhoea kicks in putting pressure on a sensitive area with too many movements.
2. You are spaced out on it and cannot work effectively.
3. Depression and mood swings begin.
4. Mast cells probably do degranulate on Tram even if the studies are a little contradictory out there. So on all opioid you will get a tickle / irritation / sensitivity all over and in your pelvis (this is NOT just histamine studies have show it is neurological also so you have no meds to stop it). This appears to be able to trigger spasm in the pelvis. Spasm on spasm oh that will work.
5. You itch like a junkie (although I have found this dose and brand dependent as to levels). This is horrid; give me chronic prostatitis / chronic pelvic pain syndrome any day over this.
6. Your sleep and dreams are very disrupted (again dose dependent in me).
7. Appetite is much lower. I really shrunk on weight on a lot of opioid drugs, early days in my CPPS. I then gained weight when I came off them as my body craved carbs and sugars. Inexperience in diet and you could end up like a balloon.
8. Ejaculation is either premature and sensitive on small doses - or very much delayed on higher doses. Something docs never like to mention. This is not good for pelvic pain. You are forcing ejaculation or it is happening before the muscles have sufficiently warmed and relaxed enough. This makes pain much worse so if the source of pain is in the muscles/nerves used in ejaculation and you are messing the function up with opioid go figure how smart that is.

I hope this SCARES new guys enough to know at the point we are at now with chronic prostatitis / chronic pelvic pain syndrome a patient must be encouraged to exercise and relax in an attempt to control the pain FIRST. In my experience these drugs BLOCKS recovery. I battle an addiction on Tram. My dose is silly low but it does not matter it still is a nightmare to get off and I always rebound back. So before you try it remember you will become dependent and addicted and you will add to your woes not lesson them.

I must note Tram can snap a flare off...the problem is it is a risky game to play...unless you can take a day or two then no more you will dig one big hole trying this.

In saying all this if you are in pain that is unstoppable then pain control must not be off the table but do not do it via GP do it via a specialist in pain control ONLY. GPs should not be allowed to prescribe, only renew opioid drugs, as they do not know enough about them - especially the synthetic varieties like Tram which have some very complex chemistry.

LAST RESORT ONLY!

[webslave]

This underlines what Mike Kavo says above.

From Understanding Opioids: Part 1 (Beth D. Darnall, PhD, Michael E. Schatman, PhD, CPE, Charles E. Argoff, MD, Jane C. Ballantyne, MD) Jan 09, 2013:

Males on chronic opioid therapy certainly run their own unique risks, including erectile dysfunction, decreased libido, infertility, fatigue, decreased muscle strength, and mood disorders. (Thosani S, Jimenez C. Opioid-induced biochemical alterations of the neuroendocrine axis. Expert Rev Endocrinol Metab. 2011;6:705-713)

[MW62]

Quick update on my use of Opioids for CPPS. After using them (morphine sulphate) for over 10 years I've suddenly developed a very bad itching problem. It literally came on overnight. I thought I must be having an allergic reaction to something, but after eliminating all other possibilities it is the pain medications that are causing the almost debilitating itching. I've switched to a different opioid but the itching persists. I am now caught in a difficult situation of being dependant a medication to which I'm allergic. Even if I do manage to go off it (a difficult process to say the least), I then face the pent-up wrath of my CPPS, which was almost debilitating by the time I gave up and went on opioids 12 years ago. I'm 50 and chronic prostatitis / chronic pelvic pain syndrome has made my life hell since I was 21. What a terrible condition! The opioids did help and make life bearable for a number of years, however.