twisten
01-11-2004, 07:08 PM
Shoreline, I'm going to ask my doc to put me back on oxycontin and dilaudid for breakthrough but I can't remember what dose I was on before and I think my base med has been increased since I was last on it. I am currently on 30mg of MSC in am and 60 in pm and oxycodone 10mg of which I can take 3 a day. What would the conversions to these be? I know my base med should be higher because of needing so much breakthrough med but I don't think I will be able to get her to raise it.
Sponsor
Shoreline
01-11-2004, 07:17 PM
Hey Twist, the standard conversion is that Oxy is 1.5 times stronger than morphine. If your doc prescribes 20 am and 40 pm that woukld pretty much be the standard conversion. HE wouldn't go to TID "3 times a day with the MSC, I ewwould think he wouldbe less likely to go TID on OXYC becausze of all the negative press and Purdue's stand that it lasts 12 hours.
If you got all 20 mg pills wich would likely be chaeper or one less copay, you could go TID and save the BT for the evening and see if it works. Again, this is just my opinion.
He may go 1:1 ON the conversion, that would be great, just like an increase since your present dose isn't working anyway.
I would remind him that when he's doing his conversion, that he's not doing a conversion from an effective dose. Anything he can do to relieve a little more pain would be great. If it's too much you can always back down.
Good luck, Shore
If you got all 20 mg pills wich would likely be chaeper or one less copay, you could go TID and save the BT for the evening and see if it works. Again, this is just my opinion.
He may go 1:1 ON the conversion, that would be great, just like an increase since your present dose isn't working anyway.
I would remind him that when he's doing his conversion, that he's not doing a conversion from an effective dose. Anything he can do to relieve a little more pain would be great. If it's too much you can always back down.
Good luck, Shore
Shoreline
01-11-2004, 07:20 PM
PS, Your pharmacy should have records and I wouldn't go into this and end up taking a step back when you do find your old dose. Some docs will do this claiming your tolerance may have dropped while you were on another med but lets not worry about any negatives, Hope for a 1:1 and be clear on how long you should wait if it's not working before you call him back. You can move oxy up much quicker than once a month very safely.
Good luck, Shore
Good luck, Shore
twisten
01-11-2004, 07:42 PM
Great Shore thanks. What about the dilaudid? Would 4 mg of that be comparable to 10 of oxycodone?
wirry1422
01-11-2004, 08:45 PM
I belive i read in the purdue literature, that the conversion from oxycodone to hydromorphone (dilaudid) is 4:1 Shore, correct me if i'm wrong.
Shoreline
01-12-2004, 12:50 PM
Hey Twist, Although Dilaudid is very effective IV when used in PCA post op, My experience with oral Dilauadid was somewhat less satisfying. It has a short hald life and a short duration when taken orally. I do think using a different BT med from your Base is a great idea. It covers a wider range of receptors and will likely give you better relief when you use BT meds.
Morphine is the gold standard to which all opiates are compared to in strength. Most conversions have Dilauadid 7.5 to 8 x more potent than morphine. So 4 mgs of "D" would be equal to about 30mgs of morphine which would be equal to about 20 mgs of Oxy.
THose equienanelgesic charts are just guides though and try not to live and die by a chart. You may need more or less than what some chart says that tries to lump all patient responses together. You may respond better to Oxy than morph or better to Dilauadid than Oxy. 4 mgs of Dilaudid would be a significant increase from 10mgs of OXYIR. However you may find it doesn't last as long. It takes time to find the right dose and med. I hate to see when a doc won't give a med a fair shake by properly titrating to an effective level. Switching from a low dose of one med to a low dose of another doesn't give any med a fair shake.
Unfortunately some docs have a magic number in their head and won't exceed a specific dose of MSC or OXYC. You had plenty of room to play with the MSC but if the doc won't go there all you can do is hope to obtain better relief with a different med. Or start the unpleaseant task of looking for a new PM doc if he just won't titrate to an effective dose.
Again, the most important thing to iron out is how long to give this new dose before you are allowed to contact him about making a dose change if it's not effective. Docs should understand that they are needed more often during the titration phase of any med , once you are dose stable then you can go back to monthly or bimonthly visits. But excepting less than adequate relief when a new med is initiated and then asking for an increase 2-3 months down the road may appear to be rapid tolerance when you never had the dose right in the first place.
Every med I have tried took several, 3-4 adjustments before we reached a theraputic dose. I know we don't want to be a pest, but during titration, reporting how your doing isn't being a pest. Get the titration right and then settle back into being the model patient that flys under the radar with minimal requests.
Let us know how you do,and what the doc does.
Fortunately, if the doc is ballpark close in his conversion it should prevent any withdrawal symptoms. Oxy and MSC both bind pretty much to the same receptors so it's not like you would experience differential withdrawal, like some folks do when switching away from methadone or away from Duragesic.There is enough difference that using both meds would have a combined effect but not enough difference to cause a problem switching from one to the other. Good luck, Shore
Morphine is the gold standard to which all opiates are compared to in strength. Most conversions have Dilauadid 7.5 to 8 x more potent than morphine. So 4 mgs of "D" would be equal to about 30mgs of morphine which would be equal to about 20 mgs of Oxy.
THose equienanelgesic charts are just guides though and try not to live and die by a chart. You may need more or less than what some chart says that tries to lump all patient responses together. You may respond better to Oxy than morph or better to Dilauadid than Oxy. 4 mgs of Dilaudid would be a significant increase from 10mgs of OXYIR. However you may find it doesn't last as long. It takes time to find the right dose and med. I hate to see when a doc won't give a med a fair shake by properly titrating to an effective level. Switching from a low dose of one med to a low dose of another doesn't give any med a fair shake.
Unfortunately some docs have a magic number in their head and won't exceed a specific dose of MSC or OXYC. You had plenty of room to play with the MSC but if the doc won't go there all you can do is hope to obtain better relief with a different med. Or start the unpleaseant task of looking for a new PM doc if he just won't titrate to an effective dose.
Again, the most important thing to iron out is how long to give this new dose before you are allowed to contact him about making a dose change if it's not effective. Docs should understand that they are needed more often during the titration phase of any med , once you are dose stable then you can go back to monthly or bimonthly visits. But excepting less than adequate relief when a new med is initiated and then asking for an increase 2-3 months down the road may appear to be rapid tolerance when you never had the dose right in the first place.
Every med I have tried took several, 3-4 adjustments before we reached a theraputic dose. I know we don't want to be a pest, but during titration, reporting how your doing isn't being a pest. Get the titration right and then settle back into being the model patient that flys under the radar with minimal requests.
Let us know how you do,and what the doc does.
Fortunately, if the doc is ballpark close in his conversion it should prevent any withdrawal symptoms. Oxy and MSC both bind pretty much to the same receptors so it's not like you would experience differential withdrawal, like some folks do when switching away from methadone or away from Duragesic.There is enough difference that using both meds would have a combined effect but not enough difference to cause a problem switching from one to the other. Good luck, Shore
Kayley
01-12-2004, 01:51 PM
Shore, when you brought up switching away from methadone, it reminded me of something that happened about a year ago. My pm doctor tried switching me frome methadone to oxycontin, thinking I might get better pain relief, and as a result, I went into withdrawal. According to him, that should not have happened, as he said they are similar. Well, it did happen, and I decided to go back to the methadone instead of doing a gradual switch as he suggested. This same doctor also told me it was unusual that I had withdrawal when I was better for a time and was in the process of weaning off methadone. Unfortunately, my pain returned, and I had to increase again. I don't understand why I'm being told these things, which I know to be untrue. This is one reason why I'm afraid to let this doctor install a morpine pump, as he wants to do. Twistin, I wish you luck finding a medicine that works for you. And thank you, Shore for all the valuable information.
Shoreline
01-12-2004, 03:28 PM
Hey kayle, I don't understand why PM docs don't have a better understanding of the meds they prescribe either. The biggest part of the problem is that there is no medical specialty designed to create pain management docs.
Anyone that can write a script can practice pain management. They may be Internal medicine, Neurology ,Anesthesiology,Physiatrists or psychiatrist. But there is no such thing as a pain manologist.
The average doc, regardless of what field he chooses to intern in or complete a fellowship in gets the same basic medication training during med school. One semester of pharmacolgy. Many PM docs learn of new meds simply by listening and reading material brought by the manufacturer reps. Purdue's marketing started a pain management revolution. I commend them for that but the price gouging is absurd. Canada doesn't allow it. OxyC is about 1/3 the price and so is MSC.
But because most people prescribe or take the generic version of meth when used in pain management.
I serriously doubt a representative from the company that makes Dolophine , Name brand Methadone has called on a pain management physician in our lifetime. It's not a new med, it's dirt cheap. So there is no incentive to pay pharmacuetical reps to get the word out on how to use and prescribe Dolophine/methadone.
There is an absolute clinical explanation as to why you would experience withdrawal switching from methadone to another drug but not experience withdrawal switching from another drug to methadone. Basically, without getting to technical, Methadone has the same properties as all other opiods or opiates. Fentanyl "Duragesic" may be a slight exception.
So you can take a patient off just about any opiate and put them on meth and prevent withdrawal. However methadone does have properties that all the others don't, which is why It's called Differencial withdrawal.
The only med I can think of that you wouldn't have a problem switching from meth to is
Levo dromoran/Levorphanol and that's because it's in the same family as Methadone and has the same unique characteristics.
Why docs think we can just flip flop around really tells you they don't have any additional pharmacological training than your average GP. There philisophy may vary and they may be willing to prescribe these meds because they have the understanding that in most cases opiates don't cause internal organ damage. There is no ceiling in which patients reach where nothing works anylonger and they truly want to help people manage their pain.
Live with it doesn't sit well with them when there true purpose on earth is to relieve suffering, I guess they do their best. Anesthesiologists probably have the best understanding of clinical pharmacology and the most training. They also have more training in some of the spinal injections many docs are willing to do.
I've met physiatrists that will do blind epidurals. Meaning no flouroscopy to guide the needle. This type of pain management, along with doing nerve blocks, nerve ablation, pump and SCS management and implant, medication infusions like Lidodocaine for RSD or Robaxin for Fibro is called pain intervention and the docs like to call themselves pain interventionalists.
However when you compare how much training and how many epidural injections a doctor of physical medicine may do compared to an anesthesiologist that may do 20 a day on a buisy maternity ward, there is no question who I want near my spine with a needle.
I'm not saying only anesthesiologist should practice PM but there needs to be a fellowship program or an Internship program for doctors that are going to be prescribing high dose potent medications and invasive modalities that have the potential for harm that these do. The same meds and modalities also have the same great potential to end suffering and can be used safely when the doctor has been educated to practice his actual specialty.
However, pharmcuetical reps should not be our doctors educators. I can't even guess how many times I have heard a patient on the net that has been told by their doc, they aren't allowed to prescribe methadone and it's only dispensed at clinics for addicts. Even doctors and surgeons still think this is true, and how dare we argue with them.
I know in Canada you need a special licence to write meth scripts but in the US any GP can prescribe meth but I doubt many truly know how potent it is and how to comfortably taper a patient completely off or on to another opiate. But anyone can hang the sign Pain mangement out in front of their office and Pain interventionalist sounds even more impressive.
We have one group of docs that call themselves "Advanced pain magement of XX"" locally. I've seen several of their docs and they won't prescribe a tylenol 3 to a cancer patient at that office.They treat every patient with the same meds and the same philosopy. Anti depressants, mild muscle relaxers like skelaxin and you have to participate in their Psychologists hypno and relaxation therapy.
However, there is a newer doc there that was doing his internship in Physical medicine when I saw them years ago. He does recognize the need of some patients and will refer patients out the back door and across the water to my doc. Personally I see something really wrong with that scenario. A doc that recognizes a patients need, but his partners will have a fit if he treats you, but keep things quiet and He will refer you to a doc that will treat you with compassion.
THere are several different societies of docs that practice pain management. Some have mission statements and use of opiate statements. But there is no concencsus on the right way to treat pain, what's considered low, moderate and high dose, the prper use of BT meds, and minimal training oportunities and no ciriculum for young docs that want to practice pain management.
OH well, That's why we have docs that think you can jump from meth to oxy or morphne without a problem. At least my opinion.
Sorry to get so off topic, But you experiencing withdrawal switching from meth is expected. I went through it switching to Kadian when i had insurance. It was miserable even when replaced with what seemed to be an adequate amount of morphine. Basically the withdrawal has to runs it's course and try to limit it with a slow crossover taper. It was a miserable 3 weeks and didn't even start untill the 5th day when all the meth was pretty much gone from my system. I even comented on the 4th day how well the switch was going. Silly me. LOL
Again., sorry to get off topic. Take care, Shore
Anyone that can write a script can practice pain management. They may be Internal medicine, Neurology ,Anesthesiology,Physiatrists or psychiatrist. But there is no such thing as a pain manologist.
The average doc, regardless of what field he chooses to intern in or complete a fellowship in gets the same basic medication training during med school. One semester of pharmacolgy. Many PM docs learn of new meds simply by listening and reading material brought by the manufacturer reps. Purdue's marketing started a pain management revolution. I commend them for that but the price gouging is absurd. Canada doesn't allow it. OxyC is about 1/3 the price and so is MSC.
But because most people prescribe or take the generic version of meth when used in pain management.
I serriously doubt a representative from the company that makes Dolophine , Name brand Methadone has called on a pain management physician in our lifetime. It's not a new med, it's dirt cheap. So there is no incentive to pay pharmacuetical reps to get the word out on how to use and prescribe Dolophine/methadone.
There is an absolute clinical explanation as to why you would experience withdrawal switching from methadone to another drug but not experience withdrawal switching from another drug to methadone. Basically, without getting to technical, Methadone has the same properties as all other opiods or opiates. Fentanyl "Duragesic" may be a slight exception.
So you can take a patient off just about any opiate and put them on meth and prevent withdrawal. However methadone does have properties that all the others don't, which is why It's called Differencial withdrawal.
The only med I can think of that you wouldn't have a problem switching from meth to is
Levo dromoran/Levorphanol and that's because it's in the same family as Methadone and has the same unique characteristics.
Why docs think we can just flip flop around really tells you they don't have any additional pharmacological training than your average GP. There philisophy may vary and they may be willing to prescribe these meds because they have the understanding that in most cases opiates don't cause internal organ damage. There is no ceiling in which patients reach where nothing works anylonger and they truly want to help people manage their pain.
Live with it doesn't sit well with them when there true purpose on earth is to relieve suffering, I guess they do their best. Anesthesiologists probably have the best understanding of clinical pharmacology and the most training. They also have more training in some of the spinal injections many docs are willing to do.
I've met physiatrists that will do blind epidurals. Meaning no flouroscopy to guide the needle. This type of pain management, along with doing nerve blocks, nerve ablation, pump and SCS management and implant, medication infusions like Lidodocaine for RSD or Robaxin for Fibro is called pain intervention and the docs like to call themselves pain interventionalists.
However when you compare how much training and how many epidural injections a doctor of physical medicine may do compared to an anesthesiologist that may do 20 a day on a buisy maternity ward, there is no question who I want near my spine with a needle.
I'm not saying only anesthesiologist should practice PM but there needs to be a fellowship program or an Internship program for doctors that are going to be prescribing high dose potent medications and invasive modalities that have the potential for harm that these do. The same meds and modalities also have the same great potential to end suffering and can be used safely when the doctor has been educated to practice his actual specialty.
However, pharmcuetical reps should not be our doctors educators. I can't even guess how many times I have heard a patient on the net that has been told by their doc, they aren't allowed to prescribe methadone and it's only dispensed at clinics for addicts. Even doctors and surgeons still think this is true, and how dare we argue with them.
I know in Canada you need a special licence to write meth scripts but in the US any GP can prescribe meth but I doubt many truly know how potent it is and how to comfortably taper a patient completely off or on to another opiate. But anyone can hang the sign Pain mangement out in front of their office and Pain interventionalist sounds even more impressive.
We have one group of docs that call themselves "Advanced pain magement of XX"" locally. I've seen several of their docs and they won't prescribe a tylenol 3 to a cancer patient at that office.They treat every patient with the same meds and the same philosopy. Anti depressants, mild muscle relaxers like skelaxin and you have to participate in their Psychologists hypno and relaxation therapy.
However, there is a newer doc there that was doing his internship in Physical medicine when I saw them years ago. He does recognize the need of some patients and will refer patients out the back door and across the water to my doc. Personally I see something really wrong with that scenario. A doc that recognizes a patients need, but his partners will have a fit if he treats you, but keep things quiet and He will refer you to a doc that will treat you with compassion.
THere are several different societies of docs that practice pain management. Some have mission statements and use of opiate statements. But there is no concencsus on the right way to treat pain, what's considered low, moderate and high dose, the prper use of BT meds, and minimal training oportunities and no ciriculum for young docs that want to practice pain management.
OH well, That's why we have docs that think you can jump from meth to oxy or morphne without a problem. At least my opinion.
Sorry to get so off topic, But you experiencing withdrawal switching from meth is expected. I went through it switching to Kadian when i had insurance. It was miserable even when replaced with what seemed to be an adequate amount of morphine. Basically the withdrawal has to runs it's course and try to limit it with a slow crossover taper. It was a miserable 3 weeks and didn't even start untill the 5th day when all the meth was pretty much gone from my system. I even comented on the 4th day how well the switch was going. Silly me. LOL
Again., sorry to get off topic. Take care, Shore
Kayley
01-12-2004, 09:29 PM
Thank you so much for the information, Shore. At least now I know I'm not crazy, and the withdrawal was to be expected. I didn't mention this, but before I was on methadone, I had the Duragesic patch, and did not have any withdrawal going to the methadone. You really know your meds, Shore....I'm impressed! I also didn't mention that this pm doctor is an anesthesiologist. When I first went to him, he did epidural blocks, and I thought I was home free. I was actually pain free for two months! That's when we started tapering my meds. But unfortunately, my pain returned, and not only in the chest wall, which was the original site, but also in my upper back, which was a new place. We don't know if that pain is from all the cutting they did to put a large paddle lead in when I had my stimulator, or if it is from the herniation at t6 and t7. This pain doc removed the stimulator, but I still have the lead in, which also could be causing the upper back pain. But the neurosurgeon doesn't think it is. So he didn't think I should have it removed. Now here I am going off topic! LOL I do have one more question for you, Shore. What is a trigger point injection? You mentioned it in another post, and I'm not sure if I've tried that or not. I know I've had lots of needles stuck in my back, though! Thank you so much for your help. :angel:
Kayley
Kayley
Shoreline
01-13-2004, 10:04 AM
Hey Kayey, A TP injection is usually an injection of a numbing agent and an inti inflamatory, some use Steroids and some use naturally occuring NSAIDS, which should be less harmful in the long run, at least no risk of steroid induced osteo perrosis.
Anyway, It's done with a very fine needle placed directly into a muscle spasm. A spasm occurs to prevent further injury to an area when the body senses or falsly senses an injury and uses the muscle contraction and increased blood supply to acually protect the area.
Muscle spasms are often just the body's response to injury and a way for the bpody to brace itself from further injury.The increased blood flow to the area brings extra oxygen and natural antiinflamatories to the area and carries away waste product like lactic acid away from the spasm area.
TP's are the areas of spasm that can often criss cross up or down the entire length of the back in an effort to brace itself and protect itself. By releasing just one or two of the trigger points with numbing agents and antiinflamatories you can break the cycle of spasm along the entire length of the back or in a particular area.
They are rarely painful because they are done with a fine gage needle and a numbing agent is used.I've seen some folks complain after TP injections and the only cause for increased pain would be improper placement of the needle and the posibility of actually going through a nerve. The sciatic nerve actiuually passes through that same area of the glute min, max and periformis. If the needle is misplaced a shot directly into the sciatic can cause weeks of pain if not months. So a very fine and experienced touch is needed for these deep tissue injections.
Often that freezing spray is used in conjunction with the numbing agent to reduce any pain caused by insertion of a ultra fine needle.
Doing acurate and effective TP's is much like doing acurate and effective acupuncture. You can teach anyone the actual site in which to place a needle , but having the gift or the touch and the ability to find the right TP or spasm that will lead to stopping the process of spasm really takes a doc with the touch.
I've had very effective TP's and ones where the doc clearly missed the mark. I've had physiatrist do great jobs at TP's but still wouldn't want them doing an ESI in there office. An injection so close to the spinal cord that it could possibly nick the cord, cause a fluid leak which requires a blood patch and can possibly cause a seizure should be done as an out patient procedure where the doc has the ability to deal with any problem that may arise.
An ESI done in a docs office can turn into an ambulance trip to the ER very fast. Then they want an anesthesiologist to follow behind them and repair the damage they did with a blood patch. IMO, The guy or gal doing the ESI should also have the ability to do a blood patch and repair the damage they may cause during the ESI. IF they nick the Dura it can cause a a leak which causes a severe spinal headache or can cause a seizure and they need to be prepaired for that possibility too.
A blood patch is when they repair a nick or hole in the spinal cord with blood drawn from your own arm. They inject it as close to the original whole as possible and as the blood trickles out the whole it seals the dura, the extra blood also tops off the lost spinal fluid. Spinal fluid has no clotting ability so a nicked dura and a spinal fluid leak can go on for weeks if not properly DX and treated. When you loose spinal fluid your brain crashes down onto your skull everytime you stand upright and the spinal headache it causes is pretty unmistakable.
This is why they often want you to lay down flat for several hours after an ESI or meylogram to prevent a spinal headache.
The most effective TP's I have had have been in the Glute region. I've had TP spasms that flat out stop you in your tracks that will lock so bad you can't stand in line at the bank. Now it's the docs job to find the right spot to place the needle without playing cross stich with your hiney. You have the Glute minimus, maximus, and periformis all coming together at the same spot. If the problem is perriformis and the TP is placed in the glute, it does no good. So it's really a matter of finding the exact spot, knowing anatomy well enough to isolate which muscle group is causing the problem and then numbing it to break the spasm and constant flow of blood to the area that spasms invite.
Sorry again, way off topic but interesting stuff. Take care, Shore
Anyway, It's done with a very fine needle placed directly into a muscle spasm. A spasm occurs to prevent further injury to an area when the body senses or falsly senses an injury and uses the muscle contraction and increased blood supply to acually protect the area.
Muscle spasms are often just the body's response to injury and a way for the bpody to brace itself from further injury.The increased blood flow to the area brings extra oxygen and natural antiinflamatories to the area and carries away waste product like lactic acid away from the spasm area.
TP's are the areas of spasm that can often criss cross up or down the entire length of the back in an effort to brace itself and protect itself. By releasing just one or two of the trigger points with numbing agents and antiinflamatories you can break the cycle of spasm along the entire length of the back or in a particular area.
They are rarely painful because they are done with a fine gage needle and a numbing agent is used.I've seen some folks complain after TP injections and the only cause for increased pain would be improper placement of the needle and the posibility of actually going through a nerve. The sciatic nerve actiuually passes through that same area of the glute min, max and periformis. If the needle is misplaced a shot directly into the sciatic can cause weeks of pain if not months. So a very fine and experienced touch is needed for these deep tissue injections.
Often that freezing spray is used in conjunction with the numbing agent to reduce any pain caused by insertion of a ultra fine needle.
Doing acurate and effective TP's is much like doing acurate and effective acupuncture. You can teach anyone the actual site in which to place a needle , but having the gift or the touch and the ability to find the right TP or spasm that will lead to stopping the process of spasm really takes a doc with the touch.
I've had very effective TP's and ones where the doc clearly missed the mark. I've had physiatrist do great jobs at TP's but still wouldn't want them doing an ESI in there office. An injection so close to the spinal cord that it could possibly nick the cord, cause a fluid leak which requires a blood patch and can possibly cause a seizure should be done as an out patient procedure where the doc has the ability to deal with any problem that may arise.
An ESI done in a docs office can turn into an ambulance trip to the ER very fast. Then they want an anesthesiologist to follow behind them and repair the damage they did with a blood patch. IMO, The guy or gal doing the ESI should also have the ability to do a blood patch and repair the damage they may cause during the ESI. IF they nick the Dura it can cause a a leak which causes a severe spinal headache or can cause a seizure and they need to be prepaired for that possibility too.
A blood patch is when they repair a nick or hole in the spinal cord with blood drawn from your own arm. They inject it as close to the original whole as possible and as the blood trickles out the whole it seals the dura, the extra blood also tops off the lost spinal fluid. Spinal fluid has no clotting ability so a nicked dura and a spinal fluid leak can go on for weeks if not properly DX and treated. When you loose spinal fluid your brain crashes down onto your skull everytime you stand upright and the spinal headache it causes is pretty unmistakable.
This is why they often want you to lay down flat for several hours after an ESI or meylogram to prevent a spinal headache.
The most effective TP's I have had have been in the Glute region. I've had TP spasms that flat out stop you in your tracks that will lock so bad you can't stand in line at the bank. Now it's the docs job to find the right spot to place the needle without playing cross stich with your hiney. You have the Glute minimus, maximus, and periformis all coming together at the same spot. If the problem is perriformis and the TP is placed in the glute, it does no good. So it's really a matter of finding the exact spot, knowing anatomy well enough to isolate which muscle group is causing the problem and then numbing it to break the spasm and constant flow of blood to the area that spasms invite.
Sorry again, way off topic but interesting stuff. Take care, Shore
Kayley
01-13-2004, 11:17 AM
Thank you for the explanation, Shore! I know very well what a spinal headache is, I had one after my first mylogram, and it was so bad, I couldn't even talk, and threw up all the next day. Never want to go through that again...no no no!!!!! Twisten, I know you started this thread, and I'm sorry I went and got off topic. How are you doing? Did you get your meds straightened out?
And Shore, I hope you are not having too much pain. I really appreciate you answering all my questions.
Take care
Kayley
And Shore, I hope you are not having too much pain. I really appreciate you answering all my questions.
Take care
Kayley
twisten
01-13-2004, 02:03 PM
No problem Kayley, I learnt a lot too, like I'm never having one of those injections heehee. Seriously I can't have them anyway. I'm doing okay, I don't see my doc til next week so won't know what she will do until then. The smartest thing for me to do would be to go back on the duragesic. I know that. Its just its so expensive, makes me throw up and I get a minor rash sometimes. I remember now why I stopped the dilaudid, it was driving my tolerance to high. I have no idea what meds to try next, guess it will all be up to doc, sigh.
Shoreline
01-13-2004, 04:52 PM
Hey Twist, Are you switching from LA morphine because it's not working or you don't think your doc will make a needed increase and be more comfy switching you back to OxyC. There is a generic version coming out soon made by Endo, It was actually already on the market and Purdue went to court and had it removed claiming first it was too close and infringed on their patent and second it wasn't close enough to be called a generic.
That's when Purdue really started standing strong on their claim of OxyC lasting 12 hours. But even the full prescribing info put out by Purdue recognizes the need for more frequent dosing of their LA morphine product.
I'm pretty sure you guys do have Kadian up north. It's cheaper than Purdue's OxyC and MSC in equal doses. A little more than generic LA morphine but I'm almost positive you guys can get it. It's made by Faulding and marketed by Elan, I think. Sure about Faulding, not 100% on Elan.
Anyway, I can get you the NDC # for your pharmacist to order it if you want to try. It pretty much ends the whole twice a day dosing debate. It's a 24 hour pill but Faulding recomendstwice a day to maintain a smoother level. This way only half is loosing it's effectiveness when it's time for the next dose. Apposed to being bone dry and trying to play catch up when it's time for the next 12 hour dose of MSC or OXyC.
If you know you do OK with Oxy For BT then you can try OxyFast a liquid version of Oxy withoit tylenol and there is a generic called Oxydose. 20mgs per ml with a metered dropper for exact dosing, or you can try Roxicodone, It's a name brand that comes in 15mg and 30mg pills.
That one was recently sold and may be hard to find for the next couple months if the wholesalers keep low inventory. Likely there is enough out there to keep folks supplied during the transition.
You still have options and ask your doc about Kadian. A simple search will get you info to take to the apt. If you live in a Rural area, the reps just haven't made it that far out but I'm 99% sure you can get it in Canada You still have options and Kadian is a great one. You even have options we don't in the US. Purdue markets HydromorphContin in Canada. LA Dilauadid and
CodeineContin but codeine is dose retrictive, hard on the tummy and not meant for severe pain.
As far as Duragesic, Many US docs are prescribing the steroidal inhalers and sinus sprays to pre treat the area where the patch is placed to prevent that blister reaction. Prescribing something to take for nausea is pretty common down here too. Phenergan "Promethazine" , and Visterill "Hydroxzine are the more common ones and both are actually in the antihystamine family and can help with itching and other opiate side effects.
Nothing wrong with trusting the doc but be informed. Take care, Shore
I'll get the NDC # for Kadian "national drug code" How it's ordered.and try to check on availability in Canada.
That's when Purdue really started standing strong on their claim of OxyC lasting 12 hours. But even the full prescribing info put out by Purdue recognizes the need for more frequent dosing of their LA morphine product.
I'm pretty sure you guys do have Kadian up north. It's cheaper than Purdue's OxyC and MSC in equal doses. A little more than generic LA morphine but I'm almost positive you guys can get it. It's made by Faulding and marketed by Elan, I think. Sure about Faulding, not 100% on Elan.
Anyway, I can get you the NDC # for your pharmacist to order it if you want to try. It pretty much ends the whole twice a day dosing debate. It's a 24 hour pill but Faulding recomendstwice a day to maintain a smoother level. This way only half is loosing it's effectiveness when it's time for the next dose. Apposed to being bone dry and trying to play catch up when it's time for the next 12 hour dose of MSC or OXyC.
If you know you do OK with Oxy For BT then you can try OxyFast a liquid version of Oxy withoit tylenol and there is a generic called Oxydose. 20mgs per ml with a metered dropper for exact dosing, or you can try Roxicodone, It's a name brand that comes in 15mg and 30mg pills.
That one was recently sold and may be hard to find for the next couple months if the wholesalers keep low inventory. Likely there is enough out there to keep folks supplied during the transition.
You still have options and ask your doc about Kadian. A simple search will get you info to take to the apt. If you live in a Rural area, the reps just haven't made it that far out but I'm 99% sure you can get it in Canada You still have options and Kadian is a great one. You even have options we don't in the US. Purdue markets HydromorphContin in Canada. LA Dilauadid and
CodeineContin but codeine is dose retrictive, hard on the tummy and not meant for severe pain.
As far as Duragesic, Many US docs are prescribing the steroidal inhalers and sinus sprays to pre treat the area where the patch is placed to prevent that blister reaction. Prescribing something to take for nausea is pretty common down here too. Phenergan "Promethazine" , and Visterill "Hydroxzine are the more common ones and both are actually in the antihystamine family and can help with itching and other opiate side effects.
Nothing wrong with trusting the doc but be informed. Take care, Shore
I'll get the NDC # for Kadian "national drug code" How it's ordered.and try to check on availability in Canada.
twisten
01-13-2004, 08:41 PM
Hey, Shore that would be great if you could get me that. Have I told you lately that you're indispensable to us on here?? I want to switch back because yes I'm not getting good enough coverage with the MSC. I got better coverage with OXYC. I will mention the Kadian to her but I bet she won't want to go that route or will only prescribe it once a day. I've only heard of roxycodone on here, never heard of it up here in Canada. I also doubt she'll go hydromorphcontin (or similar) because she'll say it will drive my tolerance up to high. I told my rep through disability insurance that I was seriously thinking of switching docs so they are trying to help find me one who is familiar with my medical conditions so hopefully after this month I will be with a new one. Codeine does nothing for me other than plugging me up solid. I actually say I'm allergic to it so I'm not given it. I am going to write down all these names you've given me, otherwise I'll never remember, and have her go through them all with me. I don't see her again until the 23rd but hopefully after that things will improve. Thanks again.
Shoreline
01-14-2004, 02:29 PM
Hey twist, Here is alink toa database of drugs available in canada with your tracking number system. This info can be given to your pharmacist to order it and also list several other drugs you may or may not be aware of that are available in Canada.
Take care, Shore
http://www.hc-sc.gc.ca/hpb/drugs-dpd/company/c10890.html
Take care, Shore
http://www.hc-sc.gc.ca/hpb/drugs-dpd/company/c10890.html
Shoreline
01-14-2004, 02:38 PM
I can't seem to navigate this site, but have seen the same page layout for purdue products in Canada, perhaps doing a search of Purdue to see what products they have available in canada would work.
Shore
That worked. Here is Purdue's list.
http://www.hc-sc.gc.ca/drug2/company/c7054.html
Roxanne, Endo, Watson, Elan are are major manufacturer of pain management products. You could probably spend some time at this site seeing what's available in Canada.
Sorry, None of those manufacturers produced any rsults but you can search by active ingredient and other methods too. Enjoy
Shore
That worked. Here is Purdue's list.
http://www.hc-sc.gc.ca/drug2/company/c7054.html
Roxanne, Endo, Watson, Elan are are major manufacturer of pain management products. You could probably spend some time at this site seeing what's available in Canada.
Sorry, None of those manufacturers produced any rsults but you can search by active ingredient and other methods too. Enjoy