Fast Metabolism? (the metabolism of opiates in pain patients)

[Katie]

Justin, I think it is wonderful that you have such an interest in this. I just clicked on this thread and haven't opened your paper yet, so please excuse the possible repetitive questions/observations. I promise to get to it very soon!

A good friend is a veterinarian and comes from British stock. She has observed a strong correlation between many of those descended from European bloodlines, especially from Scottish descent, and especially those with the gene for red hair. This includes different breeds of animals.

You and I have had several conversations about my problems with medications, and similar situations like KBear. When I had my discogram, the doctors gave me a strong cocktail of drugs, knowing that I was resistant to the effects of many. It didn't touch me, at all.

The problem I hear about is when the doctors are then afraid to give enough medication to keep our pain under control after what they perceive to be a sufficient quantity. Their fear of suppressing our breathing is most likely real, but the day of the discogram, I would have gladly chosen that option

I've spoken with many doctors about this. They always answer "just increase the dose."

If only that was the case The only drug that works for me as you know, is morphine, but it goes through my system so fast. The long term ones that should last throughout the day are done in just over four hours. The short term ones....just over an hour. It makes it difficult 'breaking in' pain management doctors.

Thanks for doing the research on this. We who quite legitimately need these pain medications have a very difficult time getting relief because of what you are publishing. Thanks again for bringing it to the forefront.

[KBear]

You and I have had several conversations about my problems with medications, and similar situations like KBear. When I had my discogram, the doctors gave me a strong cocktail of drugs, knowing that I was resistant to the effects of many. It didn't touch me, at all.

My biggest fear of surgery is that they wouldn't sedate me enough and I'd be one of those people that 'wakes up' during surgery, yet can't move or talk to say they are feeling it. I have huge anxiety anytime I need anesthesia. With the c-section, the anesthesiologist listened and gave me plenty of meds. She also said because of my height (5'10"), I needed more than most women, for the spinal to be effective. I'm also heavier than a lot of women, my normal healthy weight is 145-150, otherwise I look anorexic. I think a lot of times they don't factor that in either, then top it off with just being resistant to it working.

[Katie]

Yes, that's another reason I was pretty persistent about asking for an epidural during my spine surgery. There was no problem...they were happy to oblige.

When I was in labour with my first daughter, about twenty hours in, they gave me an epidural then too. Unfortunately it didn't work well, as it only affected the right side of my body...the left was left in agony. Not sure if it was doctor error or just my weird body!

[Catherine]

Hi Kathy and Katie,

I don't think I have the non-response to pain meds, but I do have a terrible fear of the "becoming aware" problem during surgery!! My sister sent me an email about the red hair gene problem and I definitely have the European ancestry, and all that has done is scare the heck out of me! I've had many surgeries and haven't had any problems, but I wonder if after being on pain meds for over three years this could change? Of course, I haven't been on anything like you guys were. I am one of those people that has to have several injections at the dentist to make me numb for procedures, I'm assuming that's the red hair problem. I don't know that I'm actually asking a question here, just voicing my fears.

Catherine

[KBear]

Hi Kathy and Katie,

I don't think I have the non-response to pain meds, but I do have a terrible fear of the "becoming aware" problem during surgery!! My sister sent me an email about the red hair gene problem and I definitely have the European ancestry, and all that has done is scare the heck out of me! I've had many surgeries and haven't had any problems, but I wonder if after being on pain meds for over three years this could change? Of course, I haven't been on anything like you guys were. I am one of those people that has to have several injections at the dentist to make me numb for procedures, I'm assuming that's the red hair problem. I don't know that I'm actually asking a question here, just voicing my fears.

Catherine

I'm not even a red head and have the issues. Just curious, how have you responded to sedation and such with other medical procedures? I was remembering play by play things that happened during procedures (not surgery) and would be screaming in pain because the medication hadn't worked for me like a 'normal' person. I now stress to the anesthesiologist every problem I have had, including failed epidurals, not sedating, dentistry and so on. Most will give me plenty of medicine to compensate. I would definitely address it, especially if you are worried about it and don't let them brush you off.

Complete side note I'm not sure if I should brag about or be concerned: I spelled anesthesiologist for the first time without misspelling it and having to Google the correct spelling!

[Catherine]

Well hey, at least our medical vocabularies are improving, right? LOL I don't think I have ever had a problem with anesthesia other than extreme nausea, but when I had the epidural injections in May the Dr had to give me an extra one of Fentanyl because the first did nothing. I looked back over the procecure notes and she gave me a total of 25 mcg, which in reading Kimberly's posts, I think that is what her patch delivered per hr. And she gave me 4 mg of Versed. I don't know if those are normal dosages or if it means I have a high tolerance. I can't imagine being nauseous and throwing up if my stomach has been sliced open

Catherine

[Tammy H]

Wow, this is a great thread, and it's probably applicable to more people than currently believed. As a research scientist at the University of Colorado, I have also seen lectures on the tremendous variability in metabolism of pain-killers (or any molecule, really). Perhaps if we don't use the Cyp 2D6 enzyme, other enzymes turn the drug into something else in attempt to clear it. Sometimes we are what we eat...but other times we are what we make!

Personally, I seem to have the opposite problem as discussed in this thread...I am a hyper-responder to many meds. On the plus side, it is very easy to dull my pain. On the down side, I can get strongly sedated with a fraction of the dose of most drugs, and and I tend to feel the possible side effects as much as the intended effects! So, with upcoming spine surgery in my future forecast, I am very concerned about anesthesia and subsequent pain meds.

Any ideas? A few people have mentioned "twilight" method of sedation for surgery. I'd love more info, if anyone knows about it.

Thank you all!
Tammy H

[Kimberly]

Hi Tammy,

I'm right there with ya! I would also seem to have the opposite problem.

I agree that while it is very nice to have decent pain control, it kinda stinks when your side effects get turned up to 11 (although I suppose I'd rather have my problem, than not having reliable pain control.) I get verrry sedated and suffer from extreme nausea and vomiting issues (which, I must say, is quite tricky with a new abdominal incision.) I had a "mini-team" of Drs consulting with each other 3-4 times a day just to try and address the side effects so that I would be able to go home (added a couple days to my hospital stay.) We ran through a slew of different oral pain med options and anti-nausea meds before we settled on a fentanyl transdermal patch (bypassing the unreliable stomach alltogether) as well as a scopolamine transdermal patch for nausea. I also had two oral anti-nausea meds to take home with me. STILL.....I lost close to 30 pounds in those first couple months as I couldn't eat much of anything Blecht! (don't worry....I've managed to put it all back on rather nicely.) I would recommend having a good heart-to-heart chat with surgeon prior to your surgery so that they know of your issues and can be aware BEFORE you have surgery. Hopefully being proactive might give you an advantage if you do move forward with surgery.

Kimberly

[trkdoc714]

Tammy,

I had twilight sedation at Stenum for the lumbar ADR surgery. I don't know if anyone would offer that to a cervical patient. Based on my limited knowledge, the sedation might affect the nerves to your vital organs (or innards as they referred to in GA).

For my experience, I would rather have twilight sedation than being put out. They had trouble getting my BP back up after the last laminectomy/ discectomy.

I'm sure one of the more learned members can shed more light on your question.

Bob

[Tammy H]

Thank you Bob and Kimberly for the great info. I will definitely talk to the surgeon ahead of time about my sensitivity. I just hope I end up with a surgeon who has experience with this.

Kimberly, you went through quite a trauma! Your experience sounds like a prolonged version of when I had my wisdom teeth taken out. I was only given a half dose of anesthesia, but I had trouble coming out of it, and then vomited for 24 hours straight, ripping out my stitches and giving me an infection! Worse yet, I couldn't take any of the oral pain killers they gave me . I am telling the universe right now that I will NOT repeat that scenario! There must be a better way forward Do you know if there is a patch available for oxycodone? I am OK with small doses of that.

Bob, how does the twilight method work? Do they give you an epidural or just use different meds? If it involves an epidural, I agree that cervical ADR doesn't seem compatible.

I look forward to any additional comments--you are all angels-in-disguise!

Tammy