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tors that opiates bind to in the brain. I’ve seen
people get on exceedingly high doses of strong
opiates without receiving adequate pain relief.
Unfortunately, side effects of high-dose opiates
can include severe constipation, to which the
colon doesn’t become accustomed to.
While I don’t know the details of the trau-
mas that led to your chronic pain, a pain med-
icine specialist will usually use a combination
of different medications to help. This might in-
clude injections; low-dose or microdose opiates;
antidepressant medicines that help with chronic
pain, such as duloxetine or amitriptyline; anti-
seizure medicines that help with pain, such as
gabapentin; and physical therapy.
Anti-inflammatory drugs like ibuprofen
1. Which racetrack, site of the 1959 Formula 1 OPIATE PRESCRIPTIONS FOR PAIN sometimes provide significant pain relief when
German Grand Prix, had a 43-degree banked DON’T PROVIDE RELIEF TO PATIENT used in combination with other medicines.
turn known as the “Wall of Death”? However, very high doses (you are on the high-
2. What large-scale video display, produced by DEAR DR. ROACH: I have horrible neck, est recommended dose) can cause toxicities.
Mitsubishi Electric, was first installed at Dodg- shoulder, back and hip pain, which are all from I do want to make it clear that tachyphylaxis
er Stadium in Los Angeles for the 1980 MLB different traumas. I’ve been seeing a pain doctor is the usual response to opiates, especially at a
All-Star Game? for the past 14 years. I started out by taking 5 high dose, but it isn’t universal. I have patients
3. In April 2001, 43 people were killed in an mg of Vicodin and 4 mg of trazodone. Over the who do very well with moderate amounts of opi-
over-capacity crowd surge during a soccer years, my prescriptions have been raised to 7.5 ates and remain on a stable dose with adequate
match at Ellis Park Stadium, located in which mg of oxycodone four times a day and 800 mg control of their pain. Physicians should always
country? of ibuprofen three times a day. I see my doctor
4. Who knocked out “Oklahoma Giant” Carl every two weeks, and during these visits, I nor- consider the risks of opiates before prescribing
Morris 14 seconds into the first round of a mally get shots (different ones in different plac- them for long-term use.
December 1918 heavyweight boxing match in es). My problem is that my pain medicine isn’t ***
New Orleans? working anymore. Will I have to keep raising
5. The NFL’s 1979 rule banning tear-away jerseys the dosage? I can’t take it easy as I’m my hus- DEAR DR. ROACH: I’m an 82-year-old
was inspired by and informally named after band’s sole caregiver. He’s had multiple strokes, woman with sluggish gut issues. I recently heard
what Cleveland Browns running back? a doctor say, “Don’t take fiber supplements be-
6. In December 2021, which team defeated the and his leg was just amputated. Is there any oth- cause they mess up your gut,” and “Don’t take
er medication I can add to my current list that
Oklahoma City Thunder 152-79, making the laxatives. Take stool softeners, and it’s OK to
73-point win the biggest blowout in NBA his- might help? Or is there a better pain medicine take them every day.” I’m skeptical of both state-
tory? than oxycodone? -- A.S. ments. What do you say? Thank you. -- E.G.
7. In 1974, Ted Giannoulas first donned the cos- ANSWER: I’m very sorry to hear about your ANSWER: The only statement I wholeheart-
tume of which world-famous sports mascot? predicament. Being a full-time caregiver while edly agree with is that it’s OK to take stool soft-
Answers: trying to deal with your own medical problems eners (such as docusate) daily. I disagree with
is a very difficult situation that many of my pa- the recommendation against fiber supplementa-
tients (and their caregivers) have been in. The tion. Fiber is very helpful for both diarrhea and
7. The San Diego Chicken.
most important advice I have is that opiates like constipation, and it also has other benefits, in-
6. The Memphis Grizzlies.
4. Jack Dempsey. 5. Greg Pruitt.
hydrocodone (Vicodin is a brand name for hy- cluding modestly lowering cholesterol.
be). 2. Diamond Vision. 3. South Africa.
drocodone and acetaminophen) and oxycodone However, when fiber supplementation isn’t
1. AVUS (Automobil-Verkehrs- und Ubungsstra-
aren’t good long-term options for most people. enough, then laxatives such as polyethylene
As you’ve found, the dose often needs to be in- glycol 3350 (MiraLAX) are a very reasonable
creased just to maintain the same pain relief. choice. People who need laxatives every day
The body gets used to the dose of opiates -- a should still discuss this with their physicians to
response that is called “tachyphylaxis,” which is be sure that there’s not some other medical rea-
caused by decreasing the sensitivity of the recep- son for the constipation.

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