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InvisibleHeisencybin
Heisencybin
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Chronic pain medication advice?
    #23453943 - 07/18/16 07:00 PM (7 years, 6 months ago)

I have chronic pain in my low low back near L5 and sacrum. It is neurogenic related pain and was also fucking up my pudenal nerve, but that is taken care of by IBS medication. Unfortunately I still have the pain, although not nearly as uncomfortable as before. I took kratom daily for almost 1.5 years before trying the ibs medication Elavil. I quit kratom cold turkey and switched to ibuprofen ay least until I see my pain specialist again here soon. So I have been taking 1200-1400mg ibuprofen daily split up with meals for almost 3 months and it's been a complete relief of pain/discomfort alongside the elavil.

Anyways, I realized I was having some liver soreness and got blood work done and sure enough, my liver enzyme ALT is high. The acceptable range is 0-40. I was 16 in February 2015, 16 again February 2016, 40 in June after taking ibuprofen for 2 months, and just now 82 at 3 month mark. So I doubled in just the past month and double the acceptable range.

I got more blood work today after abstaining from ibuprofen all weekend to confirm and see if it lowered at all. I'm kind of in a tough spot. I can take kratom when I don't use ibuprofen but I refuse to get hooked on that again, yet I don't want to fuck up my liver anymore. I'm seeing my pain specialist soon and hopefully I can get a cortisone shot or something, but if not, what should I do? Are there any medications that are non addictive AND won't fuck up my organs? Or should I develop some sort rotation between kratom and ibuprofen. I took kratom today hence the long ramble, but if I'm stuck with this pain, do you guys have any advice medication-wise?


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OfflineExceed19_2000
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Re: Chronic pain medication advice? [Re: Heisencybin]
    #23454636 - 07/18/16 11:12 PM (7 years, 6 months ago)

I've got harrington rods fused to my spine, maybe 11 inches of rods? And I was on oxy15mg for 14 years. Finally gave it up about 8 months ago, and Kratom has been my crutch. It's dirt cheap, it works, but its not really "portable" like a small 15 was.

Is medical/rec available where you live? I'd start with that and see if it works. The concentrates are really, really nice. Joe Rogan was talking about this mouth spray that hits like a tank.

If you've ever taken pain pills for a few months or more, the kratom addiction is NOTHING. If thats what you end up getting hooked on, it's not really that bad. It's cheap, it works, and isn't illegal.


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InvisibleMoonshoe
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Re: Chronic pain medication advice? [Re: Heisencybin] * 1
    #23454916 - 07/19/16 03:12 AM (7 years, 6 months ago)

Look into taking milk thistle and S adenosyl Methionine as both will help heal, protect and repair your liver.

For your pain, you might consider alternating kratom and pregabalin , both of which would likely help to some extent, as well as edible cannabis.


--------------------


Everything I post is fiction.


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InvisibleMoonshoe
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Re: Chronic pain medication advice? [Re: Heisencybin]
    #23454917 - 07/19/16 03:13 AM (7 years, 6 months ago)

Also I concur that if kratom allows you to manage your pain and avoid the harder pain meds, its likely a good choice. But alternating pregabalin and kratom on alternate days will allow you to avoid becoming physically dependent on either.


--------------------


Everything I post is fiction.


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InvisibleGlameow
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Re: Chronic pain medication advice? [Re: Moonshoe]
    #23455165 - 07/19/16 07:03 AM (7 years, 6 months ago)

Kratom is hardly the worst addiction,  if it helps for pain. 

Ibuprofen is pretty rough. My doctor prescribed a slow release brufen 1600mg ... friggen killed my stomach.  I'd rather be in pain.

Turmeric is pretty helpful though.  About a tablespoon a day, in capsules.

There are alternative pain management.  Some electrical pulse thing that stops the nerves communicating.  It's very affective.

Acupuncture and massage has also been very good for people with chronic pain.  Maybe worth a shot.

Yoga is amazing!!!! seriously give that a go for a few weeks.


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InvisibleMoonshoe
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Re: Chronic pain medication advice? [Re: Glameow]
    #23455237 - 07/19/16 07:43 AM (7 years, 6 months ago)

Yoga and Turmeric absolutely! :thumbup:

Turmeric extract (curcumin) is even better


--------------------


Everything I post is fiction.


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Invisiblechicksgrowtoo
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Re: Chronic pain medication advice? [Re: Moonshoe]
    #23455414 - 07/19/16 09:04 AM (7 years, 6 months ago)

Yes yoga! I've gotten up at 5am to do yoga for the last 7 months. After I had my epidural I had really bad muscle pain as well as nerve pain, it felt like someone was holding a hot quarter to my back constantly that only got worse with movement. Through all of the medications and herbs the yoga was what helped the most. I know my situation isn't as serious but I can vouch for yoga.


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Offlineflickedbic
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Re: Chronic pain medication advice? [Re: Moonshoe]
    #23455576 - 07/19/16 09:56 AM (7 years, 6 months ago)

Black pepper to greatly enhance turmeric absorption. Black pepper is likewise great for Kratom.  I'm usually feeling some OK effects from  a couple tsp of black pepper alone before I even down any kratom but that's nearly besides the point. 

Some milk thistle is a great idea for liver repair and one of the greatest multifunctional admixtures to be taken with, or 20 minutes after, kratom.



agmatine 30 minutes before might also be handy to potentiate kratom and reduce tolerance.

"We conclude that agmatine reduces the development of dependence to morphine"
https://m.reddit.com/r/kratom/comments/2ybe0w/agmatine_kratom_and_a_decline_of_tolerance/

Treating Neuropathy
Quote:

 
Take one B-100 B-complex vitamin daily. The B vitamins are necessary for normal nerve function, and supplementing is a good preventive measure. Do not take more than 200 mg of B-6, as higher daily doses can actually cause symptoms of neuropathy.

Take 100 mg of alpha-lipoic acid daily. This antioxidant protects microcirculation to the nerves. You can gradually increase the dose to 300 mg twice a day over the next month.


http://www.drweil.com/drw/u/ART02717/Neuropathy.html


Quote:

The American Pain Foundation also lists these herbs for pain management:

Ginseng for fibromyalgia
Kava Kava for tension headaches and neuropathic pain
St. John’s Wort for sciatica, arthritis, and neuropathic pain
Valerian root for spasms and muscle cramps 



Kava is a great multifunctional kratom admixture also...


Capsaicin patches are also getting good reviews for treating neuropathic pain.


Also, from my thread on kratom tolerance reduction while avoiding addiction, increased pain sensitivity (Many of the herbs have fair effect in and of themselves ie: kava, skullcap,  ginseng, Angelina dahurica, honokiol, myrrh, Dan shen, L-theanine,):


Start slowly incorporating herbs into your kratom routine, carefully noting changes in effect.

We'll first start to hamper the tolerance, neural apoptosis(brain cell death) and hyperalgesia (increasing pain/sensitivity) associated with opioids before getting into the potentiators.  The tolerance info applies to all opioids.

At the far bottom is a list of useful multi-functional potentiators.


The harmful effects of tolerance and hyperalgesia
(increased pain sensitivity) from opioid use hinges on several linked factors; AKA targets for inhibition: 

(1)Ceramide is induced by (2)Nitric oxide, which (along with neural apoptosis - cell death) has also been linked to (3)glial cell activation and (4)inflammatory cytokine production during opioid use. 

The Microglial anti-opioid mechanism is (5)BDNF release (responsible for hyperalgesia- increasing pain responce) and (6)NMDA expression/upregulation (that causes cell death/apoptosis).

These factors can be inhibited or antagtonized to stop/reverse tolerance, apoptosis and hyperalgesia.


Striking at the Root:
Pl3k/Akt
is the pathway leading from mu opioid to microglial activation.

Potential Pl3k inhibitors include:

Thymoquinone
Wogonin - Skullcap, Scutellaria lateriflora
Fentretinide
Isoliquiritigenin
Ascofuranone
Quercetin - capers, onion, apple skin, bee pollen,
Apigenin - Bacopa monnieri, Chamomile, Dandelion root, Damiana
Honokiol - magnolia bark, enhances GABA
Naringenin - rosemary, grapefruit concentrate
Berberine - Barberry, Goldenseal, Phellodendron amurense, Huang bo (anti-anxiety painiller), Corydalis (strong painkiller) also has "berberine type alkaloids".


Limiting N.O. production:
"One method of limiting NO production is to coadminister an opioid with an NMDA receptor antagonist or a NOS inhibitor".


Quercetin inhibits Nitrous oxide; as do melatonin and Nigella sativa and it's oil, thus reversing dependence and preventing Ceramide induction (avoid the NO precursor L-Arginine before dosing).
Combining with NMDA antagonists and NO synthase inhibitors improves effects.

"The inhibitory effect of the (Nigella sativa) oil on morphine-induced tolerance and dependence and on naloxone-induced biochemical alterations in morphine-dependent mice was enhanced by concurrent i.p. administration of the NMDA receptor antagonist(...) Similarly, concurrent i.p. administration of the NO synthase inhibitors; L-N (G)-nitroarginine methyl ester (10 mg/kg), aminoguanidine (20 mg/kg) and 7-nitroindazole (25 mg/kg) or the antioxidant, N-acetylcysteine (50 mg/kg) enhanced this inhibitory effect of the oil. On the other hand, this effect was antagonized by concurrent i.p. administration of the nitric oxide precursor, L-arginine (300 mg/kg). These results provide evidence that Nigella sativa oil, through inhibition of morphine-induced NO overproduction and oxidative stress, appears to have a therapeutic potential in opioid tolerance and dependence."
(Emphasis added)



To follow up, assuming some microglial activation is still occurring, BDNF (brain cell death) could be stopped by curcumin(w/ black pepper) and NMDA antagonists such as a therapeutic dose of DXM/O (Delsym) or memantine can be utilized. 

NMDA antagonists include:

Chelated Magnesium glycinate/taurate/citrate
L-Theanine (B6 boosts absorption)
Agmantine
Magnolia (Honokiol)
Cat's Claw
Delsym
Memantine


CCK blockers such as Proglumide, Gotu kola, or possibly Neem (Cyp3A4 inhibitor synergist) can reverse tolerance and enhance analgesia and prevent cytokine inflammation.

Kappa opioids down-regulate inflammatory cytokine expression
(Salvia divinorum, Menthol, Ketamine, DXM, Matrine of Sophora flavescens) - and also reset the opioid system. 

Fun Fact: Kappa agonists also potentiate dopamine response when taken an hour before many drugs.


Ceramide is reduced by:

Myriocin(from Cordyceps)
L-Carnitine/ALCAR(the latter may enhance absorbtion)
Lysine
Silymarin
Resveratrol

So these are great supplements especially after heavy use.


Additional Notes:



Turmeric/Curcumin w/ black pepper to enable absorbtion may remove some of the rewarding effect but:

"(...)a
health food product, curcumin, might reduce morphine analgesic tolerance(...)


Salvia divinorum
on days off to reset opioid system by kappa agonism, like Iboga.




==========================================================================================================




3 PATHWAYS OF POTENTIATION:


Kratom is metabolized by 3 pathways; CYP enzymes, P-glycoprotein (P-gp), and Glucuronidation.  These pathways can be inhibited to potentiate/extend effect.




CYP enzymes that metabolize kratom are (in order of power): CYP2D6*, CYP2C9, CYP1A2, CYP3A4 and CYP2C19.

*Some sources say 2D6 should be induced or left alone because it is beneficial; I wait 20-30 minutes after dosing.


CYP3A4 inhibitors:
Cimetidine
Quinine
Turmeric+Black pepper(Note: turmeric blocks BDNF/tolerance but also some of the rewarding effect- reversible by co-administration of 5-HT1A antagonists?)
Ginkgo biloba(1A2),
Goldenseal
White grapefruit juice from concentrate 2 cups
Cat's Claw
Schizandra
Cinnamon
Angelica dahurica aka "Korean Angelica" (has "dicursinol" opioid)
Nigella sativa
Grape seed
Echinacea purpurea
Milk thistle

Allium sativum
Ammi visnaga
Azadirachta indica
Cimicifuga racemosa
Harpagphytum
  procumbens
Hydrastis canadensis
Naringenin compounds
Panax ginseng
Panax quinquefolius
Strychnos ligustrina
Uncaria tomentosa
----------------------

CYP2D6 inhibitors:
Cimetidine (modest)
Diphenhydramine
Moclobemide
Ranitidine(UGT)

Alpinia glanga
Alstonia scholaris
Andrographis
  paniculata (UGT)
Catharanthus roseus
Cimicifuga racemosa
Cinnamomum
  burmannii
Eleutherococcus
  senticoccus
Gycyrrhiza glabra
Hydrastis canadensis
Melaleuca
  leucadendron
Panax ginseng
Panax
  quinquefolius
Piper nigrum
Punica granatum
Rheum palmatum
Santalum album
Strychnos ligustrina
Syzygium aromaticum
Tinospora crispa
Zingiber aromaticum
---------------------

CYP1A2 inhibitors:
Cimetidine
Echinacea (3A4)
Ginkgo biloba (3A4)
Kava (3A4, 2D6, P-gp)
Aleve (substrate)
--------------------

CYP2C19 inhibitors:
Fluconazole, Fluvoxamine both strong.
Moclebemide, Omeprazole(3A4,1A2?) Both moderate.
Cimetidine, ketoconazole, and Allicin all weak.

Allium sativum
Harpagophytum procumbens
--------------------------------------------



Glucuronidation's first pass is generally done by UGT1A4, UGT1A6, and UGT1A9. 
UGT1A6 is specifically named in kratom metabolism. 

Aleve(Naproxen) is a substrate for UGT1A6.

Black pepper/Piperine (works in the small intestines).

Ranitidine (zantac) @ 300mg inhibits hepatic glucuronidation.

Valerian, Saw Palmetto and Milk thistle all inhibit 1A6, Milk thistle also 1A9.

Andrographis paniculata inhibits a wide array of UGT.
Borneol, Eugenol, Vanillin interesting competiative UGT substrates.

Inducers (to avoid beforehand):
Fish oil, cigarettes.





P-glycoprotein (P-gp) is inhibited by:
Black Pepper at 1TBS (Piperine)
Quinidine
Garlic
Prilosec
Green Tea (EGCG)
Milk thistle (also CYP2D6)
Turmeric
Rosemary
Naringenin
Rhodiola rose a (also CYP3A4)
Quercetin, kaempferol & isohamnetin all in Ginko biloba





Multifunctional Kratom Potentiators:

Quercetin (Ginkgo biloba) inhibits Pl3k, Nitric oxide (N.O.), CYP3A4 & 1A2, and P-gp.  Take with black pepper for absorption 2 hours beforehand.

Aleve - inhibits CYP1A2, UGT1A6.

Devil's Claw inhibits CYP3A4 & 2C19; antiinflammatory.

Turmeric (or curcumin) with black pepper to boost absorption inhibits CYP3A4, P-gp, BDNF (hyperalgesia/increasing pain) as well as analgesic tolerance.

Naringenin (Rosemary, White Grapefruit concentrate - not water soluble) inhibits Pl3k, N.O., CYP3A4, and P-gp while inducing GABA and is itself possibly an opioid analgesic.

Black pepper inhibits P-gp well, and is necessary to absorb other herbs properly.  It may hold analgesic effect by itself.
"Beta-caryophyllene is a cannabinoid present in virtually all plants and activates the CB2 receptor, notably it occurs in high amounts in cloves and black pepper."
CB2 agonists are antihyperalgesic.



Clove has been said to induce CYP2D6 and is a substrate of UGT (via eugenol).

The following inhibit CYP2D6 (which supposedly created a more potent metabolite), so I'll only use these once effects become present or about 20 minutes in.

Cimetidine: inhibits all CYP.

Milk thistle (silymarin): also inhibits P-gp, Ugt 1A6 & 1A9, CYP3A4 & 2D6, Ceramide and N.O.

Nigella Sativa: also inhibits N.O. and inhibits CYP's 2D6 and 3A4 in vivo.

Kava kava: also inhibits 3A4, 2D6, P-gp)





https://www.shroomery.org/forums/showflat.php/Number/22167740

Corydalis as above mentioned is a strong opioid but not for those with liver problems.


--------------------
Favorite entheogen experiences in descending order:
1)Combo of oral DMT + smoked Bufotenine
2)Amanita (urine drank twice)
3)Mushrooms > Achuma 16"+cid(still need higher dose Achuma)> Cid (still need high dose)
4)Morning Glory-HBWR (+cumin, cinnamon aldehyde adducts) > Methyl chavicol (need more activators)
5)Salvia (need to try quid)


All readable matter in the above post is ficticious... any similarities to real life are purely coincidental.

Blessing.


Edited by flickedbic (07/19/16 10:27 AM)


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InvisibleHeisencybin
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Re: Chronic pain medication advice? [Re: flickedbic]
    #23456170 - 07/19/16 01:00 PM (7 years, 6 months ago)

Oh damn, thanks guys. I want to avoid kratom altogether to be honest. So I'll try the other mentioned herbs. Im really curious in using milk thistle and NAC to protect my liver while still using ibuprofen. Hasn't effected my kidneys or stomach yet. I drink a ton of water always take it with food and or milk. I was drinking reishi everyday, but didn't seem to help keep liver enzymes low. Hopefully my pain specialist can just give me a shot or something for now. If not, I'll be doing research on these anti-inflammatory herbs and liver protectants. Thanks!


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InvisibleOhMrJohnson
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Re: Chronic pain medication advice? [Re: Heisencybin]
    #23456198 - 07/19/16 01:08 PM (7 years, 6 months ago)

Cannabis and its many cannabinoid constituents are well-known to have powerful antiinflammatory properties and they're particularly effective for nerve pain, I'd recommend making/acquiring some sort of cannabis topical and applying it directly on the skin wherever the pain is felt

Capsaicin is also apparently very effective for nerve pain and you can get that in topical form as well

http://articles.mercola.com/sites/articles/archive/2014/07/14/chili-peppers-pain-relief.aspx

http://www.m.webmd.com/pain-management/tc/capsaicin-topic-overview


--------------------

Diminish the sub-principle and leave its toxic trace..
Once and for all!


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InvisibleShroomismM
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Re: Chronic pain medication advice? [Re: Heisencybin]
    #23456209 - 07/19/16 01:11 PM (7 years, 6 months ago)

Quote:

Heisencybin said:
I have chronic pain in my low low back near L5 and sacrum. It is neurogenic related pain and was also fucking up my pudenal nerve, but that is taken care of by IBS medication. Unfortunately I still have the pain, although not nearly as uncomfortable as before. I took kratom daily for almost 1.5 years before trying the ibs medication Elavil. I quit kratom cold turkey and switched to ibuprofen ay least until I see my pain specialist again here soon. So I have been taking 1200-1400mg ibuprofen daily split up with meals for almost 3 months and it's been a complete relief of pain/discomfort alongside the elavil.

Anyways, I realized I was having some liver soreness and got blood work done and sure enough, my liver enzyme ALT is high. The acceptable range is 0-40. I was 16 in February 2015, 16 again February 2016, 40 in June after taking ibuprofen for 2 months, and just now 82 at 3 month mark. So I doubled in just the past month and double the acceptable range.

I got more blood work today after abstaining from ibuprofen all weekend to confirm and see if it lowered at all. I'm kind of in a tough spot. I can take kratom when I don't use ibuprofen but I refuse to get hooked on that again, yet I don't want to fuck up my liver anymore. I'm seeing my pain specialist soon and hopefully I can get a cortisone shot or something, but if not, what should I do? Are there any medications that are non addictive AND won't fuck up my organs? Or should I develop some sort rotation between kratom and ibuprofen. I took kratom today hence the long ramble, but if I'm stuck with this pain, do you guys have any advice medication-wise?




Cannabis should help and meets those criteria.

I injured my lumbar recently (compression fractures on L2 L3 and L4) and cannabis was better and more consistent pain relief than the opiates they gave me.
And it certainly wont kill your liver.

Should also mention you can use it long term for chronic relief..
Been toking daily for 20+ years, in absolutely great health still.
Try shooting heroin or doing oxy every day for 20 years.. see where that gets you..


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InvisibleOhMrJohnson
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Re: Chronic pain medication advice? [Re: Shroomism]
    #23456223 - 07/19/16 01:15 PM (7 years, 6 months ago)

I burnt the fuck out of my fingertip on a hot dab nail one time at a festival and it hurt really really bad, well there happened to be a CBD lotion stand nearby with free sample jars so I put some of that stuff on the burn and within 10 minutes the pain had gone down almost entirely

I was in disbelief, it was like witch magic


--------------------

Diminish the sub-principle and leave its toxic trace..
Once and for all!


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InvisibleShroomismM
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Re: Chronic pain medication advice? [Re: OhMrJohnson]
    #23456228 - 07/19/16 01:17 PM (7 years, 6 months ago)

dem cannabinoids don't mess around.


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InvisibleOhMrJohnson
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Re: Chronic pain medication advice? [Re: Shroomism]
    #23456251 - 07/19/16 01:23 PM (7 years, 6 months ago)

That's why the federal government wants it to stay illegal

Free medication for the people equals less money for the fat cat bureaucracy


--------------------

Diminish the sub-principle and leave its toxic trace..
Once and for all!


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Re: Chronic pain medication advice? [Re: OhMrJohnson]
    #23456267 - 07/19/16 01:28 PM (7 years, 6 months ago)



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InvisibleOhMrJohnson
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Re: Chronic pain medication advice? [Re: Shroomism]
    #23456290 - 07/19/16 01:38 PM (7 years, 6 months ago)

I'd be willing to bet your doctor doesn't want you to find out about this stuff OP

https://www.leafly.com/news/cannabis-101/what-are-cannabis-topicals


--------------------

Diminish the sub-principle and leave its toxic trace..
Once and for all!


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Re: Chronic pain medication advice? [Re: OhMrJohnson]
    #23456313 - 07/19/16 01:46 PM (7 years, 6 months ago)

After my accident I told the neurologist that toking was better and more qualify of life pain relief than the opiates and he was like.. well keep doing it then.
Sure thing doc... no chance of stopping anyway :lol:

CBD cream is pretty fucken legit too.


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InvisibleOhMrJohnson
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Re: Chronic pain medication advice? [Re: Shroomism]
    #23456336 - 07/19/16 01:54 PM (7 years, 6 months ago)

The mind-boggling thing about it is that there's over 60 unique cannabinoids present in the plant and we actually know very little about most of them.. The plant also contains tons of terpenes and aromatic chemicals, all in varying ratios depending on the strain and phenotype.. The truth is mankind understands very little about the cannabis plant but I think it's the Holy Grail of modern medicine but the medical community refuses to accept that which is fucked up


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Diminish the sub-principle and leave its toxic trace..
Once and for all!


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Re: Chronic pain medication advice? [Re: OhMrJohnson]
    #23456359 - 07/19/16 02:02 PM (7 years, 6 months ago)

I agree wholeheartedly. Cannabis is overall the best medicine I have ever found for treating my own issues.

Also they have tried "extracting" or synthesizing the THC or CBDs to try and patent it and make a "medicine"
But the science clearly shows - the medicinal benefits of cannabis are at their absolute peak when the whole plant is used with all the 60+ cannabinoids in different ratios.. of which we know very very little about.

This is one of those cases where the sum is greater than its parts. The cannabinoids act in synergy with each other to have an even greater effect than when alone. THC all by itself can exacerbate or trigger anxiety attacks because of its highly psychoactive nature. It needs CBDs to calm it down and ground it. And assuredly the other cannabinoids come into play as well.

The medical benefits of CBDs are quite well known, but if looking for a CBD cream I would try and find one that has all the cannabinoids in it, just from a high CBD strain, if possible.

http://www.cnn.com/2014/03/11/health/gupta-marijuana-entourage/


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InvisibleOhMrJohnson
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Re: Chronic pain medication advice? [Re: Shroomism]
    #23456375 - 07/19/16 02:06 PM (7 years, 6 months ago)

I do know that different cannabis products have different effects based on the ratios of cannabinoids, my tincture is a full-spectrum flower extract in vegetable glycerin and it's fucking amazing

I kinda wanna try dropping it into my eyeballs but I'm not sure if the VG would be able to soak in properly being that it's so viscous

Do you know if cannabinoids are soluble in PG?


--------------------

Diminish the sub-principle and leave its toxic trace..
Once and for all!


Edited by OhMrJohnson (07/19/16 02:14 PM)


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