RSD Puzzle #045

H. Hooshmand, M. D.

DIPLOMATE AMERICAN BOARD OF PSYCHIATRY AND NEUROLOGY

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INTRACTABLE NEUROLOGY

EPILEPSY, PAIN, MS

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RSD PUZZLE #45
Agonists and Antagonists

The addictive narcotics are called morphine agonists because they mimic the side effects of morphine. The non-addictive narcotics are to some extent morphine antagonists because the brain does not recognize them as morphine.

The ultimate morphine antagonist is Naloxone. However, even though we have seen somebody using Naloxone for treatment of RSD it is useless because it suppresses the natural endorphin. The natural endorphin is not just another pain medicine. Non- Endorphin (morphine agonists) narcotics cause stress, shock, hypothermia, low blood pressure and suppression of sex hormone. Where as the natural endorphins are just the opposite, they do not cause suppression of the hormones. Gram per gram endorphins are hundreds to thousands times stronger than narcotic medications. They are formed in extremely small amounts all over the brain as needed to counteract pain and to facilitate the sex hormones and natural tranquilizers. When a patient takes percodan or vicodin, the amount of medicine is so large that in combination with strong natural endorphins it can cause drowsiness or breathing problems so the brain shuts off the formation of its own endorphin. As a result the patient is on his own and has to keep taking pain medication in the face of the lack of endophorins. If he skips one dose he will have pain in every part of his body. This is the way the brain lets us know it is in trouble due to the brain not secreting endorphins.

To prevent the above phenomena of addiction one can take medications that are not purely morphine agonists (meaning act like morphine and stop the formation of natural endorphin). The alternative is not Naloxone, but the so-called agonists/antagonists. It means this group of pain medicines at least partially do not suppress the formation of natural endorphins. This group consists of Stadol and Ultram. These two pain medicines do not cause withdrawal because they do not totally get rid of endorphin. For this reason they are not even classified as controlled drugs. When you read the PDR you notice that Stadol causes psychological dependence in only two out of 3000 people taking it. Certainly sugar or hamburger have a higher percentage of psychological dependence. If Stadol and Ultram would have caused physical withdrawal as seen with the addicting narcotics they would also have been classified as controlled drugs. The reason people think that Stadol and Ultram are addicting is because they try to overlap them with other addicting narcotics. The combination of Stadol or Ultram with other narcotics causes vomiting and no pain control .The patient should be cold turkey from other Narcotics and they are put on these drugs. Ultram and Stadol can be abused as street drugs, but that is not equivalent of a medical addiction. One can sell contraband, endangered species meat, in the street but that does not mean the meat is addictive.

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