scotty12
04-04-2004, 02:47 PM
i know how quickly my tolerance has developed on short acting meds in the past.my question is if i were to switch to a long acting med would tolerance develop at a slower rate?............scott
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surgicaldisaster
04-04-2004, 04:59 PM
Hey Scott, I'm not sure of the answer to your question for sure, because I think it may be kinda an individual thing. But, again, not sure. I have found that my tolerance(once titrated properly)has not shot up terribly at all. I think the key here is being titrated to the right level though...does not mean you won't need another bump up at some point but certainly not like you do during titration. So, I guess my answer is, at least for me, I have not had my tolerance increase real fast at all since being on long acting meds. Hope this helps at least a little...Love, Surgical Disaster :wave:
scotty12
04-04-2004, 05:14 PM
thanks,i,ll just call you surge for short.
you did answer my question.it really is not a case of titration as upon switching meds in the past i did have good results.its just how short lived those results have been.
in april last year i was taking hydrocodone7.5
july 10mg
sept7.5percs
and now just switched to 15mg roxi.
i was wondering if short acting meds increase tolerance faster than having a steadier serum level as with la meds.the more i read on these boards the more i think i should be on a la med.dependence is dependence right.so why should i have to live with all the ups and downs ive been going thru every few months.not to mentioned waking every night when my meds wear off.
im going to raise the subject of LA meds when i see my pain dr next month i just hope he is sympathetic to my situation.he never hesitated to make changes when i was in pain before but when i told him i was waking in the night with withdrawels he didnt seem to give it much thought.
thanks....................scott
you did answer my question.it really is not a case of titration as upon switching meds in the past i did have good results.its just how short lived those results have been.
in april last year i was taking hydrocodone7.5
july 10mg
sept7.5percs
and now just switched to 15mg roxi.
i was wondering if short acting meds increase tolerance faster than having a steadier serum level as with la meds.the more i read on these boards the more i think i should be on a la med.dependence is dependence right.so why should i have to live with all the ups and downs ive been going thru every few months.not to mentioned waking every night when my meds wear off.
im going to raise the subject of LA meds when i see my pain dr next month i just hope he is sympathetic to my situation.he never hesitated to make changes when i was in pain before but when i told him i was waking in the night with withdrawels he didnt seem to give it much thought.
thanks....................scott
surgicaldisaster
04-04-2004, 06:52 PM
Scott, I would think in your case a Long acting med. is in order. It will keep you from having that type of problem. You will need a short acting med for breakthrough pain, but with the long acting med. it really will help tremendously! I would think you pm Dr. would o.k. it especially if you tell him how this is interfering with your sleep among other things. Once your short acting med wears off...it's playing catch up with the pain and that's not easy to do, whether it be day or night. If you don't mind my asking, what kind of pain are you dealing with? Take care and hang in there...when is your next appt.? Surg.
scotty12
04-05-2004, 01:45 AM
spondylolethesis L5 S1 and two her. discs above,and torn annulus.basically problems from L3-S1.the instability is believed to be the main pain generator.
Shoreline
04-05-2004, 09:50 AM
Hey Scot and Surg, You guys look like your doing fine without me.LOL I spent 12 hours on a science fair project with my daughter yesterday, now she's sick so I will get to go turn it in.LOL
Anyway, Looks like between yourself and surge you guys know the answer. LA meds would be the way to go if you know your condition is not going to improve anytime soon, The longer you take short acting meds the higher your tolerance will grow, especially with improper dosing. Once on a working dose of LA meds folks can go years without needing an increase. The pinnacle of success is returning to work and higher level of function.
IT's kinda hard to function when your only granted a couple hours of relief with each dose. Take a SA med , wait 45 minutes, scramble to get stuff done in the next 3 hours before it wears off and start all over. The first thing you notice is that the LA meds free you from clock watching and waiting for tha next dose. It's also easy to over do things when your trying to cram activity into little bits of relief you get from each dose
of short acting medication.
LA meds allow you at least twice as much time between doses which could mean going through an entire work day without the need to redose, if your physically able . There are too many advantages of LA meds and too many disadvantages SA meds to keep on a course that you know isn't working.
Good luck, Gotta go to elementary school now.LOL
Shore
Anyway, Looks like between yourself and surge you guys know the answer. LA meds would be the way to go if you know your condition is not going to improve anytime soon, The longer you take short acting meds the higher your tolerance will grow, especially with improper dosing. Once on a working dose of LA meds folks can go years without needing an increase. The pinnacle of success is returning to work and higher level of function.
IT's kinda hard to function when your only granted a couple hours of relief with each dose. Take a SA med , wait 45 minutes, scramble to get stuff done in the next 3 hours before it wears off and start all over. The first thing you notice is that the LA meds free you from clock watching and waiting for tha next dose. It's also easy to over do things when your trying to cram activity into little bits of relief you get from each dose
of short acting medication.
LA meds allow you at least twice as much time between doses which could mean going through an entire work day without the need to redose, if your physically able . There are too many advantages of LA meds and too many disadvantages SA meds to keep on a course that you know isn't working.
Good luck, Gotta go to elementary school now.LOL
Shore
feelbad
04-05-2004, 10:29 AM
Hi scotty, hows goes the struggle today? I just wanted to say that you are all so very right about the fact that yes,yes, yes you should be on a strong LA med.I am experiencing pain levels I never thought were possible since my spinal cord surgery.it is nubelievably intense sometimes.When she flares, look out.the ONLY bit of relief I have ever had with the pain is when I started using the oxycontin,the way it should be.By that I mean that my NS is rather phobic when it comes to any narcotics,and had me on just 10mgs of oxycontin for some really incredible type pain.It wasn't until my primary referred me to a pain doc that they started to treat my pain much more aggressively.I have only been going there since feb 6th of this year and in that time I have been slowly titrated up from only 10mgs every twelve hours(woefully inadaquate)to where i am now,at 40-40-40.I was rather suprised at the philosophy of the pain clinic that I go to as they really really don't believe much in treating BT pain.Their theory is that if you are having BT pain, the Oxy isn't high enough to actually attack the overall pain,so when it keeps on happening, they raise my oxy dose.The only problem is that for me not to have any BT pain, with the central pain syndrome that I have, they would have to give me enough OC to completely knock me out sometimes.The types of flares I get with this syndrome can only be treated as acute nothing else.the pain levels are just unbelievably high.so after speaking with my PM doc regarding this delemma, he RXed me oxy IR for BT pain.I am only allowed to have two per day so i use my BT meds very carefully.
the point that I am trying to make here(finally lol)is that it seems that the way that my pM clinic is thinking is becomming very prevelant now.I can see there thinking on this and also the problem of addiction to your pain meds as with having to repeat dosing repeatedly throughout your day, every four or six hours, just the act of doing this, your brain kind of starts to get used to more of a patterned type thinking in that it feels it "needs" something every few hours.With the LA meds, your dosing isn't quite so much and you don't set as much of a pattern in your brain.Does that make any kind of sense?You really need to dicuss the LA meds with your doc as this would really solve your WD problem in a snap and give you more even control over your pain and finally put to rest those hidious ups and downs..i am thankful that this drug is avaiiable to me as i don't know just how bad i would be without it.Good luck scotty, I hope your doc goes along with this as I really do feel this would be your best shot right now. take care, Marcia
the point that I am trying to make here(finally lol)is that it seems that the way that my pM clinic is thinking is becomming very prevelant now.I can see there thinking on this and also the problem of addiction to your pain meds as with having to repeat dosing repeatedly throughout your day, every four or six hours, just the act of doing this, your brain kind of starts to get used to more of a patterned type thinking in that it feels it "needs" something every few hours.With the LA meds, your dosing isn't quite so much and you don't set as much of a pattern in your brain.Does that make any kind of sense?You really need to dicuss the LA meds with your doc as this would really solve your WD problem in a snap and give you more even control over your pain and finally put to rest those hidious ups and downs..i am thankful that this drug is avaiiable to me as i don't know just how bad i would be without it.Good luck scotty, I hope your doc goes along with this as I really do feel this would be your best shot right now. take care, Marcia
scotty12
04-05-2004, 12:08 PM
Thanks marcia,
im hangin in there.just so tired.i havent had a decent nights sleep in almost a week.its become very difficult not to alter my daily dosing schedule.ive been taking half a pill when i wake,leaving me something for late night and its working out ok.just doesnt take the early morning pain down enough to function very well.
i am going to raise the subject of LA meds at my next visit which is 3 weeks away.i dont want to call for an earlierier appt.when i see him ill tell him what ive been doing to manage under the circumstances and hopefully he will make a change.if not i have some thinking to do.
he must realize that dependancy is an issue for me now and make the necessary changes.its a quality of life issue.what good is the pain relief i obtain from the meds during the day if im too tired to function due to lack of pain control and sleep depravation every night?................................ta ke care scott
im hangin in there.just so tired.i havent had a decent nights sleep in almost a week.its become very difficult not to alter my daily dosing schedule.ive been taking half a pill when i wake,leaving me something for late night and its working out ok.just doesnt take the early morning pain down enough to function very well.
i am going to raise the subject of LA meds at my next visit which is 3 weeks away.i dont want to call for an earlierier appt.when i see him ill tell him what ive been doing to manage under the circumstances and hopefully he will make a change.if not i have some thinking to do.
he must realize that dependancy is an issue for me now and make the necessary changes.its a quality of life issue.what good is the pain relief i obtain from the meds during the day if im too tired to function due to lack of pain control and sleep depravation every night?................................ta ke care scott
Shoreline
04-05-2004, 12:26 PM
Hi Marcia, Your absulutely right about adjusting your base med to handle your worst pain so you don't need BT meds. I would be over sedated 75% of the time If I cranked my dose up to the point to handle my worst pain all the time.
Even without BT meds there are ways to obtain the additional relief you may need in the evening. That's when the bulk of my BT pain occurs, most likely from the activity from the day.
Instead of using BT meds or increasing every dose, you could do something like
40-40-60 this way you have a higher serum level at night which manages your BT pain and helps you g through the night with as much sleep as posible. The extra in the evening will wear down to your standard dose by the next morning so you don't have to stay as medicated in the day as you may need at night.
It can also be reversed as some folks are in more pain upon waking, then you could do 60-40-40. That extra 20 mg pill can be used as a BT med for whatever part of the day you need.
The use of BT meds are contraversial, just because it means more class 2 scripts and higher pill counts dispensed to each patient. Although the literature on every long acting med speaks of BT pain and how to treat it. Straight from Purdue, "If the patient requires more than 2 BT doses per day the overall base dose should be reevaluated."
My PM practce recently had a policy change so that they will no longer Provide more than 60 unit doses a month. I was fortunate to be grandfathered because they don't make a BT med strong enough that only one tablet helps, whether it's 30mgs of MSIR or 30mgs of Roxi or 8 mgs of Dilaudid, I need twice that much to bring my pain down so we have stuck with 100 30mg MSIR tablets a month. Sometimes I use one, sometimes I use 2 at a time and for the worst I can use 3 at a time. proportionally to my base dose these BT meds really aren't a high dose.
60-90 mgs of MSIR for BT is only 1/6 of my total daily intake so it's not like I'm doubling my daily intake with BT meds but you need enough proportionally to actually help. If you base dose was 600mgs of Avinza a day, a 10 mg norco would be 1/60th of your daily intake and feel no different from a tic tac. The formula most docs use for BT meds are usually 20-30% of your BID dose. So you take the 600mgs of morph daily, devide it by 2 = 300mgs BID. Taking 60-90mgs of MSIR is still in that 20%-30% range that is needed to provide effective BT releif.
My first doc that used LA meds didn't use BT meds, she wanted to use a technique tought at the clinic she ran, Bio feedback, stretching or other non opiate methods. Personally I think not using BT meds is more lkely to increase your overall daily dose but we really don't have much of a chance to change our docs views on BT meds unless you can communicate your desire not to increase your daily dose to the point of managing your worst pain.
That should never be the goal. If you can drop a pain level down 40-60% any spike can be managed with a BT med, But that's just my opinion. Every PM doc has their own idea when it comes to BT meds.
Take care, Shore
Even without BT meds there are ways to obtain the additional relief you may need in the evening. That's when the bulk of my BT pain occurs, most likely from the activity from the day.
Instead of using BT meds or increasing every dose, you could do something like
40-40-60 this way you have a higher serum level at night which manages your BT pain and helps you g through the night with as much sleep as posible. The extra in the evening will wear down to your standard dose by the next morning so you don't have to stay as medicated in the day as you may need at night.
It can also be reversed as some folks are in more pain upon waking, then you could do 60-40-40. That extra 20 mg pill can be used as a BT med for whatever part of the day you need.
The use of BT meds are contraversial, just because it means more class 2 scripts and higher pill counts dispensed to each patient. Although the literature on every long acting med speaks of BT pain and how to treat it. Straight from Purdue, "If the patient requires more than 2 BT doses per day the overall base dose should be reevaluated."
My PM practce recently had a policy change so that they will no longer Provide more than 60 unit doses a month. I was fortunate to be grandfathered because they don't make a BT med strong enough that only one tablet helps, whether it's 30mgs of MSIR or 30mgs of Roxi or 8 mgs of Dilaudid, I need twice that much to bring my pain down so we have stuck with 100 30mg MSIR tablets a month. Sometimes I use one, sometimes I use 2 at a time and for the worst I can use 3 at a time. proportionally to my base dose these BT meds really aren't a high dose.
60-90 mgs of MSIR for BT is only 1/6 of my total daily intake so it's not like I'm doubling my daily intake with BT meds but you need enough proportionally to actually help. If you base dose was 600mgs of Avinza a day, a 10 mg norco would be 1/60th of your daily intake and feel no different from a tic tac. The formula most docs use for BT meds are usually 20-30% of your BID dose. So you take the 600mgs of morph daily, devide it by 2 = 300mgs BID. Taking 60-90mgs of MSIR is still in that 20%-30% range that is needed to provide effective BT releif.
My first doc that used LA meds didn't use BT meds, she wanted to use a technique tought at the clinic she ran, Bio feedback, stretching or other non opiate methods. Personally I think not using BT meds is more lkely to increase your overall daily dose but we really don't have much of a chance to change our docs views on BT meds unless you can communicate your desire not to increase your daily dose to the point of managing your worst pain.
That should never be the goal. If you can drop a pain level down 40-60% any spike can be managed with a BT med, But that's just my opinion. Every PM doc has their own idea when it comes to BT meds.
Take care, Shore