Opiods reduce breathllessness

[skate4life]

www.empr.com/review-opioids-reduce-breathlessness-in-copd/printarticle/407263/

I take Norco/Vicodin half a tab usually mid afternoon and it such a great help. I've learned my own symptoms and when/if to take it. Article also says it does not increase exercise capacity. If I am going to exercise (sit and stand but not treadmill) I can do them after a 2-3 hr. rest. My pulmy had me try liquid morphine in the past but I did not like it. It was some Canadian docs that published reports on the morphine with good results. But I was 'healthier' at that time......I stay with the Norco for as long as possible. The most I've taken is a total of one full tab in 24 hours (+stool softener) and I have been doing that now for at least 5 months without difficulty.

[David]

Thanks for posting this. I will show it to my Doctor. He is a little confused on how pain medicine can help breathing and I don't know how to explain it.

I chose to take Tramadol for my low dose pain medication. It helps with my breathlessness and keeps me forom going into that panic mode. It's very hard for me to explain but I do hate that feeling. I have been taking Tramadol for about 10 months now and I have not had 1 panic attack. I was having one about 4 or 5 times a day. I couldn't take it anymore. I was going to go on Ativan but so far the Tramadol is working.

I take a half of a 50 MG pill every time I use the Nebulizer. That is 4 times a day. So that is 2 pills a day.

I am probably the only person on earth that does this but it sure does work for me.

It also helps me to exercise

[skate4life]

David, basically it has a central (brain) effect that allows for a longer time for a fuller exhalation.

Give this link to your doctor. There are a number of articles available. Or he could do a search on PubMed for Opioids in COPD. Most of the articles were published in 2011-2012.

www.ncbi.nlm.nih.gov/pubmed/22529167

[David]

Thanks, I will save the link. My Primary Doctor is very good to me. He believes in treating each patient as an individual. He will listen to what I say. It's very important to me to be honest with him.

My Dyspnea had gotten so bad in 2013 and the first half of 2014 that I could not take it anymore. I told him something has to be done. I was really suffering.

I asked for Ativan first so he let me try that. It worked great but I did not want to start Ativan at that time. Maybe later down the road.

I told him I know other people that take low dose of opioid. I had read that Tramadol acts like morphine so I asked him to let me try Tramadol. It worked for me. It solved the panic attack problem. It keeps me from going into the panic attack mode and does relax my breathing along with the Albuterol.

A few years back in the state of Florida we had a Pill Mill problem. They were handing out pain pills like candy. The State has cleaned up most of it. It ruined it for the people who do need pain pills. Doctors are reluctant to write a prescription for pain. We have Pain Management Clinics. I would hate to think I had to go to a Pain Management Clinic for Emphysema.

[David]

I forgot to add this to my post.

During my searches I ran across this article that was interesting to read.

Using opioids to treat dyspnea in advanced COPD

Read Article Here: www.ncbi.nlm.nih.gov/pmc/articles/PMC3395547/

I found this way down in the article.

Other participants thought they lacked the necessary knowledge to implement opioid therapy under any circumstances. The most frequently cited reason for not engaging in opioid therapy for dyspnea was lack of education and guidelines.

"I guess the thing is I don’t have enough experience in doing that yet opioid use for advanced COPD and there hasn’t been enough studies out, enough physicians that are on board with it yet."

And

It was also interesting to note that respiratory therapists with palliative care education and experience were more comfortable with use of opioids to treat dyspnea. However, they believed they lacked sufficient knowledge and education to make recommendations to physicians, and also worried that physicians would not be receptive.

"Depending on the physician, it’s easier to take the pain route if they have pain and get it addressed with the opiates than it is to try to tackle and convince a physician that opiates would be beneficial for breathlessness."

That's what I did not want to do. Tell the Doctor I was in pain in order to get pain pills to treat my breathlessness.
I am glad I was honest with him and he understood.

[jim]

Thank you Skate and John, I'll remember this, I may need it in the future. thumbsupde1

[David]

Also it says in the article...

It’s interesting and then you have to re-educate the morphine issue ’cause people do think that morphine accelerates death. I think that there’s other clinicians that don’t recognize that opioids are probably more first line for breathlessness than, say, Ativan.

[skate4life]

Thanks David - yes I am familiar with the article you linked/quoted. My pulmy first spoke with my PCP on the phone and then faxed her the articles. It was about 18 months ago. I still have the morphine liquid. Yes, it is a shame about the restrictions now on pain meds. Most all of the general articles re opioid restrictions don't mention for respiratory patients.

Hopefully, more docs will become familiar with the advantage of using opioids for COPD patients in their later stages of disease. This is not for the earlier stages or when anxiety is the only problem.

Anyway, glad to hear how your doc managed the trial and error process and you found what worked for you.

[David]

One thing on our side is the CT scan and the Pulmonary Function test don't lie. I didn't start this until my FEV1 hit 20%. Ct scan shows severe emphysema. So the Doctors can see it is bad and I am not faking it.

I will have the same test run again this year. My Pulmonary Doctor has told me he wants to see how fast the emphysema is progressing at this point. I have had emphysema for over 30 years now. They know it never improves. I have another appointment May 11.

[skate4life]

You ARE doing great!! Remember how you felt before you got into a real exercise program?
Emphysema does not necessarily progress in a linear fashion - you can have plateaus, improve, drop back, improve again.

[David]

Yes 2013 and half of 2014 was bad. I started back to exercising in May 2014. Started taking Tramadol in June 2014.
I have not had a panic attack since then. I still struggle with Dyspnea but no panic. Now I can just stop and rest without feeling like I am going to pass out.

I went to the grocery store about an hour ago. I can get in and out better than I use too. At least people are not asking me am I alright or do I need an ambulance. I have my oxygen and and I don't struggle to breath as much as I use too.

My main concern now is to feel comfortable and not suffer. To me that is a good life.

[izzie]

For the people using opioids...........does it relax muscle and/or the nervous system and is that why it works? Panic and nervousness can be a scary thing and sometimes it causes me to breath too shallow. When I notice myself breathing too shallow.......I will do some deep breathing by exhaling through my mouth as much as I can and then inhaling very deeply through my nose. After a few exhalations and inhalations, I get a sense of relaxation and wellness. I think the deep exhalations get rid of the stale gases (oxygen/carbon dioxide) trapped in my lungs.

The use of opioids is an interesting topic though and worth talking about.

[David]

I think the people who benefit from the opioid are the ones who have severe and end stage emphysema or COPD.

I know that is the way it was with me. I was ok until I hit the severe stage. That's when the Dyspnea got so bad I had to look for some kind of relief. I found it in the low dose pain pill.

It will be interesting to see how long I can go until I have to use something else other than the Tramadol.

I have gotten to where I have to use the rescue inhaler at some point during the night. I have to use the Nebulizer every 4 or 5 hours. If I don't then I can barely take a step without becoming breathless. My mornings a rough until I can get to the Nebulizer which is generally the first thing I do when I get out of bed.