Stimulants

Started by kstarm
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kstarm

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Ran across this article while doing some research on phentermine written by Dr. Tennant from earlier this Summer. I have been having more requests for stimulants for fatigue, especially my central sensitization crowd and post-covid crowd. I haven't had requests for them for pain. Anyone else seeing an uptick?
 
Drugs this article says are great when mixed together:

Morphine
Cocaine
Alcohol
Marijuana
Amphetamine/Ritalin/Adderall
Phentermine
Clonidine
Modafinil
Diazepam/Klonopin
Soma
Gabapentin/Lyrica

Holy crap. I had to look again to see what year this article was written.
 
kstarm said:
Ran across this article while doing some research on phentermine written by Dr. Tennant from earlier this Summer. I have been having more requests for stimulants for fatigue, especially my central sensitization crowd and post-covid crowd. I haven't had requests for them for pain. Anyone else seeing an uptick?
Click to expand...
More to your point, stimulants aren't on label for fatigue. I would argue especially for those with central sensitization.
 
Forget the article. Check out the top book in the 'suggested reading' section:

The fourth in a series of paranormal crime novels by Laura Laasko, who lives with Ehlers-Danlos and Chronic Fatigue Syndrome.

There's a niche audience if I ever saw one.
 
Today I saw a 79 yo F on the following meds:

Adderall BID
Tramadol BID
Seroquel HS
Lexapro AM
Xanax 0.5 TID
Thorazine AM
Gabapentin
 
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kstarm said:
Ran across this article while doing some research on phentermine written by Dr. Tennant from earlier this Summer. I have been having more requests for stimulants for fatigue, especially my central sensitization crowd and post-covid crowd. I haven't had requests for them for pain. Anyone else seeing an uptick?
Click to expand...

There is a subgroup of addicts that tell me stimulants like cocaine or meth helps their pain.

pubmed.ncbi.nlm.nih.gov

Stimulant Use for Analgesia: A Case Series - PubMed

Stimulant Use for Analgesia: A Case Series
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov

I will use Wellbutrin or Provigil/Nuvigil for energizing effects in fibromyalgia/chronic pain but I don't normally use Adderall or Ritalin outside of cancer for side effect mgmt.

Never prescribed phentermine, but I have patients on it for weight loss
 
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Where I used to practice there was a remarkably high incidence of cocaine use, and people legitimately told me it helps with pain. It promotes dopamine release in the brain, makes people feel better, not in similar to all the people on opioids long term that rate their pain a 10/10 but somehow claim the opioid is still helping their pain. Herd the same thing from stimulants as well.

What’s next, Forrest tenant going to advocate for use of heroin, maybe methamphetamine, maybe nighttime propofol use to sleep.
 
This is sort of interesting to me. In psychiatric literature, stimulants are frequently listed as helpful augmenting agents for pain treatment. A lot of our psychopharmacology books say that adding Adderall improves the pain relief of other regimens, in addition to counteracting sedative side effects. It would be off-label, but it's something my training encouraged me to consider.

Since I don't prescribe non-buprenorphine opioids and refer to pain doctors for most pain problems, would me managing a stimulant while you guys manage the typical pain medications be something you'd be onboard with?

Would the stimulant off-label while also seeing you make you uncomfortable RE: alarm bells for problematic patients?

Would you not care at all, so long as I'm not also adding Valium and other things that increase fatal overdose risks?
 
Orin said:
There is a subgroup of addicts that tell me stimulants like cocaine or meth helps their pain.

pubmed.ncbi.nlm.nih.gov

Stimulant Use for Analgesia: A Case Series - PubMed

Stimulant Use for Analgesia: A Case Series
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov

I will use Wellbutrin or Provigil/Nuvigil for energizing effects in fibromyalgia/chronic pain but I don't normally use Adderall or Ritalin outside of cancer for side effect mgmt.

Never prescribed phentermine, but I have patients on it for weight loss
Click to expand...
Do you see much of a difference in pain , but also in wakefulness with provigil vs nuvigil?
 
bedrock said:
Do you see much of a difference in pain , but also in wakefulness with provigil vs nuvigil?
Click to expand...

The pain scores don't generally change, but they report less sleep issues, more energy during the day, and I then try to get them to use that for PT/weight loss/etc. I normally think bupropion first unless they more clearly meet criteria for modafinil with primarily fatigue more so than depression/etc.
 
ObsequiousAplomb said:
This is sort of interesting to me. In psychiatric literature, stimulants are frequently listed as helpful augmenting agents for pain treatment. A lot of our psychopharmacology books say that adding Adderall improves the pain relief of other regimens, in addition to counteracting sedative side effects. It would be off-label, but it's something my training encouraged me to consider.

Since I don't prescribe non-buprenorphine opioids and refer to pain doctors for most pain problems, would me managing a stimulant while you guys manage the typical pain medications be something you'd be onboard with?

Would the stimulant off-label while also seeing you make you uncomfortable RE: alarm bells for problematic patients?

Would you not care at all, so long as I'm not also adding Valium and other things that increase fatal overdose risks?
Click to expand...
Yeah, stimulants do seem to work to augment analgesics positively in most cases. I've done co-management in the setting of a really good working relationship with the psychiatrist, but it's asking a lot from both parties. I generally hate the push/pull/uppers/downers game though.

My preference is one person manage all of it, but that gets even hairier unless you're trained in psychiatry/pain/addiction/etc.
 
for those who dont remember, Forrest Tennant has been around a long time and is a huge fan of opioids. he would prescribe unheard of quantities because opioid hyperalgesia needed to be overcome, not treated with tapering.

he was investigated by the DEA twice, last in 2018, but "retired" before any charges were brought.

he ran methadone clinics that were fined by the DEA back in the 1970s.

he had relationships with the NFL and NASCAR that were terminated because of misdoings.

he has believed that patients with severe and intractable pain require opioid therapy.

he is a supporter of Arachnoiditis and lists epidurals as a cause of such

he has championed genetic testing, and for those who test "positive" for opioid resistance, his solution is to prescribe higher doses to overcome any genetic "resistance".



yes, he looks like your average grandfather, but he is everything that is wrong with opioid prescribing
 
I read this article, quite interesting information. But, I would like to tell you something more about alcohol and how you should consume it without harm. First of all you should not drink it every day, because it is addictive. If you want to drink no more than one or two glasses, otherwise alcohol harms brain tissue.
edited by moderator to remove marketing link
 
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James Murfy said:
I read this article, quite interesting information. But, I would like to tell you something more about alcohol and how you should consume it without harm. First of all you should not drink it every day, because it is addictive. If you want to drink no more than one or two glasses, otherwise alcohol harms brain tissue. Secondly, always buy high-quality and original alcohol. Here is an example, I recently found a company called vinid techology that produces wine with NFC identification on each bottle and therefore it cannot be forged and you can always be sure that you order the original.
Click to expand...
This almost sounds like a bot but I don't think it is.
 
lobelsteve said:
He is foreign and is just learning English.
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It's excellent English and way better than I could do in a 2nd language. Didn't mean to knock that.

Just poking a little fun at the randomness of posting how to consume vintage alcohol in a thread full of pain physicians discussing stimulants.
 
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possibly to market vinid technologies?

alcohol is alcohol. we dont buy fake alcohol in the US. if you are cheap (and stupid) enough to drink Mad Dog, sorry MD20/20, then you will get what you expect for $4 bottle of wine.

yes, the quality of the other compounds in the alcohol may affect its taste, and contribute to its after effects,

there is absolutely no reason to buy alcohol with some NFC labelling.
 
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