Long term opiate use - problems?

At 52, I was injured in a severe accident at 20. I have been on many opiates throughout the years, long acting, short acting etc. Morphine derivates cause way too much sedation for me and therefore I was on OxyContin for 20 years. It is critical that while taking narcotics that you take the minimal dose possible at all times. I never took the prescribed amount in less I was in critical distress. This system worked for me for 20 years and allowed me to finish college and engage in a meaningful career for 20 years however rebound headaches are very real on OxyContin, and I now refuse to take it. I use short acting Hydrocodone and Tylenol to manage my chronic pain and again, take the minimal amount possible. Fluctuating dosing seems like a critical aspect of keeping yourself functional (take less whenever possible, snap pills in half, extend dosing timings when possible). Continual increase in dosing (titration) is a huge red flag; I would avoid that at all costs. At some point you will have to cut back and then deal with the pain again and withdrawal pain is very real. Hydrocodone is by far perfect, opiate treatment is not intended to reduce all of your pain, it is intended to cut the edge on your pain so you can use additional strategies to manage. I have had 13+ spinal surgeries, stimulators, failed stimulators, fusions, adjacent segment disease and high-grade spinal stenosis. Like a financial investment, diversify your treatments. Bio Feedback, deep breathing, exercise, distraction (music, meditation), psychotherapy (critical 1 x a week) are all super helpful. Have a pain therapist to talk to, it does really help. Opiates have been gaining a bad reputation for years, but super responsible usage can have great efficacy and be a lasting PART of an overall treatment plan. It takes some discipline. Never titrate up before surgeries, you will suffer terribly. Just my opinions, I hope this can help someone, thanks for letting me share.

@dkpffdp I would never belittle or devalue your personal experience in any way and I hope you do not feel that this reply does so. As with yourself this is a personal opinion and experience and should be considered by others as just one possible source of information along with others.
I too have had a poor experience with spinal cord stimulation but this was due to a very specific factor. At the time mine was implanted, the types of anchor used for the tips of the wires inserted were still being developed. Whilst pain was completely blanked out on the operating table, it returned as I was moved from the table to the trolly. One of the anchors had failed. The whole thing was with drawn two days later. I would add that since then the anchors have been improved quite a bit and failures are now far more unusual.
I would personally not dream of altering the dose prescribed for me by a medical professional except in consultation with them. Your answer was unclear as to whether you reduced doses on your own or in consultation with your doctors. Don’t get me wrong, although I e been on morphine for 27 years I’m not complaining about it. I have managed to prevent my dose from increasing over time and have in fact decreased it slightly. I know from decreasing my morphine on occasion that I am still getting a lot of benefit from it and it allows me to have a full and exciting life. The trade off for not gradually increasing the morphine is a gradual increase in pain but no more than my increasing age and declining general health might explain and I’m ok with that.
I have worked within a pain management team and have personally published research myself as well as assisting others with theirs. This gives me more of an insight into some forms of treatment than an average patient might have. I was involved in some research because I could give informed consent which is always difficult to obtain
by health researchers.
I wish you well with your future as your health problems seem to be much worse than mine. Good luck.

@grr78 thank you. I am the patient of a supportive Pain Management department in a hospital and am the patient of a Pain Consultant who I meet with regularly.
I have also been a member of an award winning pain management team as a patient. I supported others awaiting implantation of an intrathecal pump and have published my own research (with much help). I supported PhD students working as researchers at my hospital and the organising Professor was my own pain consultant.

@dkpffdp I took Oxycodone for approximately 10-12 years. Started with 5mg ending with 20 mg. Then it stopped working at all. I went thru withdrawal and after a year tried taking it again. Oxy and other opioids simply won’t work on me anymore! Standing and walking cause pain.

I’ve been reading the posts on Mayo Clinic Connect for
Chronic Pain and Osteoporosis (both of which I have) for over a year now. I have gleaned an enormous amount of information about osteoporosis medications and their success, limitations, and correct dosage sequencing. I have an excellent rheumatologist treating me and the information I learned from the Mayo blogs afforded me the knowledge to ask my doctor pertinent questions to better individualise my treatment.
The Chronic Pain blogs have been an entirely different experience for me. I have found them to give me such strong sadness for so many folks. An accident close to 30 years ago left my right shoulder very damaged - anatomically and dead nerves. Over the years I’ve culminated my treatment with a reverse shoulder procedure. I have some range of motion but remain in “chronic pain”. Prior to the “Opiate Crisis” and during my working years, I received monthly prescriptions for heavy opiate pain medication. When the “Opiate Crises” impacted my pain management clinic I had a 50mg Fentanyl patch and 10-30mg OxyContin pills for breakthrough pain. I probably was over medicated. My pain was definitely lessened by these meds, but it’s a miracle I managed to work until retirement, though I did retire as soon as possible- something I would not have done were it not for my condition.
So my prescriptions were drastically reduced and the process of pharmacies and doctors making me feel like a druggie began. After many years I now have a doctor who understands my chronic pain and treats me accordingly. My pain responds to opioids. My pain is NOT inflammation, so it’s silly to be prescribed that drug class. I take a daily dose (3x) of OxyContin 30mg , Extended Release. I don’t experience any euphoria, only the pain going from Suffering to Ouch/this is a bitch. I can function and Live.
I have shared all this to say the biggest, only problem I have now is the snarky attitude of the pharmacy and some of the staff. When I have to go out of town or travel when my refills are affected it’s ridiculous the hoops they want me to go through. The “Opiate Crisis” hurt folks like me who are opiate dependent.
Though reading some posts from people in Canada and other states makes me feel fortunate I live where I do.
Anyway, best wishes to those suffering. Hurting all the
time can take years off your life and affect your mental well being. It’s work to stay positive and active. My opiate meds help me and I am in excellent health in all areas except my bones. My osteoporosis med and my opioid meds help are the only meds I take.

@deirdrer it sounds like you’re on top of the situation at least at the moment. I’m glad you made it to retirement still in work and seem to have a very positive attitude like myself. I hope this situation continues for us both. Best wishes.

When considering what drug to switch to look into buprenorphine patch which can provide 24/7 pain relief similar to a pump. You’ll need to work with the pain specialist in titration to match the relief you were getting previously.
https://pmc.ncbi.nlm.nih.gov/articles/PMC4675640/

I didn't quite understand the question. Are you asking if you can take an "analgesic" after surgery?
If that is the question then it is up to your doctor. I can take analgesics but I only take one: acetaminophen, because the others are damaging. I take only one opioid to limit damage as well. Only one worked and allowed me a stable life over the many years. But it all depends on your unique situation. I would suggest you find a supportive doctor to help you with the management of opioids and analgesics.

@barbarav1 I take 10 mg hydrocodone 3 times a day and worry about what I would do if it stopped working. It doesn't remove the pain, but gives me a few hours each day where I can get up and move around to do essential things. I don't know what I would do if my meds no longer worked.

@heisenberg34 hi. The third pump replacement was botched. It had to be removed due to infection and my local authority refused to fund another pump. I’m now on tablets and have been for quite a few years now.
My pump worked well (there was the odd hiccup) but generally good for 16 years (2 pumps).
No complaints about the the oral medication either. The pain is managed and the dose is not increasing. Life is
not perfect but at 67 I don’t expect it to be.
A nurse warned me that should I have an accident or operation I would not be able to have any additional analgesia on top of my morphine dose.
1. I was seeking to test the validity of this statement which I think is false.
2. Having been on morphine for 27 years I was wondering if there were any long term problems.