OK...I've posted here b4 several times, as AncientTowers, but I've had to change emails, so I changed user name as well...that being said, lets catch up.

-Last I spoke I was dealing w/ my herniation again. This time worse off than the 1st. My surgeon told me to go get a Epideral Steroid Injection @ L5-S1. It took almost a month to finally get seen by the office that performs it. Well I went yesterday for my 'ESI' appt. Turns out it's a pain managment/interventional therapy office. As I started fillling/reading/signing papers required for new patients there was an awfull lot of information and promises towars Rx drugs. Random urine tests will be performed, drug counts can be requested at any times notice, etc. I was thinking why am I signing and reading all this when I'm just here for a quick injection. Well after geting back and talking to the Dr. She's telling me that my Dr. is handing me over to Pain Managment to try and prevent surgery. I was so confused! Here I am thinking I'm just hear for a quick inn and out. I told her my Dr.'s office was vague w/ me then, because I was takin by surprise with this info. In the end it's what I was looking for a Dr. that specialized in pain and could treat it totally...not just medicine. Needless to say, she seemed very hip, attractive and pleasant. She asked what pain medicine I was on. Told her percocet about 30 mg's daily. She said 'I want you off of that, it's too addicting, lets get you on OraMoprh' She said it would be better for me. Then went on to talk to her assistant and said 'we just got in some vouchers for Kadian, lets give him one for 2 weeks....50mg's.' Before this she looked at my MRI and pointed things out to me (which my Dr. never did before) and did some physical exams. And off to the procedure room I went. Meanwhile I'm getting more scared, it's getting more real. I've read some stories on ESI's from this site, mostly bad ones, so they got to me at that point. But I walk in the room and they have classic rock playing on the radio and everyone was SOOO nice, for real, sooo very sweet and comforting. They really help put me at ease. She did this w/ fluroscopy (sp) and step by step told me what she was doing. It WAS a little uncomfortable (wasn't sedated) but deff. tolerable. The worst part was when she entered the epideral space w/ the needle. It sent a SHOCK WAVE down my leg that was FIERCE! I was amazed at how quick the whole thing went. 5 minutes I was on the table for. After the injection in recovery chair I was a little shaky as the discharge nurse was going over after care w/ me (exercises, med info, etc.)
So this is the start of my pain managment. I'm thrilled! I feel like I'm being taken seriously. I'm pumped to get better and I feel safe there, thus far. So it's a good thing. And to top it off I got 2 weeks worth of EXPENSIVE 50mg Kadian for free. Since I'm not working at the moment I'm going to try the Kadian patient assistance program to see if I qualify for free medication. I belive she mentioned OraMorph in the begining because it's cheaper than Kadian? Is that true? Also, has anyone had luck w/ patient assistance programs? Shorline, didn't you say you did w/ a medication??? I can't fully remember.

- James

Hey James, NO I haven't qualified for the PAP's but you can go to needy meds.com and that site tells you the manufacturer and some list the qulifiers, mainly, lack of script insurance, not on medcaid and a household income cap.

Sounds like you found a good full service PM clinic, Thay have more than one thing to offer, don't slam everyone into one procedure and expect the same results and are equiped to do procedures on site which is ncice. Especially whenbecause you don't have to pay an office visit for the recomendation and then be sent to the hopospital for the procedure, thus another copay. Now that you in with them , did they et a follow up apt.

I thought Kadaian was great when properly titrated but if you take it once a day you have to rememeber that's 50mgs spread over a 24 hour perriod, not a constant 50mg being delievered. It's 50 devided by 24 or to get a better idea of the strength devide 50 by 6 doses "like with 4 hour dosing with SA meds". It's more like 8 mgs of MSIR every 4 hours or a 5mg perc every 4 hours.

Pain from ESI comes from increased pressure in the epidural space, but that depends on how much space you have. If you have plenty of space around the spinal cord the pressure isn't bad, but putting the same amount in a tight space can be more painful and take a couple days to disperse. Fortunately most people have more room at L5-S1 than anywhere else in their spine. The true test is when it starts working and how long it provdes relief.

Some docs want to set you up for 3 ESI's initally 3-4 weeks apart, then your maxed on ESI's for a year. IF the first 2 don't help, You can always refuse another which just makes sense. IF the first 2 didn't work, it's not likely the 3rd will either and there is no point in subjecting you to the risks , like infection or loss of spinal fluid from a nicked dura.

I hope it does offer relief and you get relief from the kadian. Personaly I preferred twce a day dosing just so you don't wake up each morning starting fresh. With BID dosing, at each interval you still have half of the previous dose and your not starting from scratch with each dose, It's just easier to maintain a smoother serum level with BID dosing of Kadian. At one pont I had to switch from Kadina because beni's ddn't cover name brand and I did just as well with the samedaily dose of generic LA morphine taking it TID. Oramorph isn't as expensive as MSContin and has a different and smoother release system, but it's a name brand product too. Have them check the generic box and compare prices between oramorph and genric LA morph if you end up going with a generic for some reason. But the genric release is modeled after the contin release.

Take it easy this weekend, you can use ICe on the site if it's painful and it's not abnormal to take a few days to see the benefit.
Take care, Dave

Dave - Thank you for the advise. And yes, Doc. want's to see me 2 weeks from my injection. And I DO think that taking the 50mg's twice daily would be more bennificial, becuase after 12 hrs. last night, it just seemed to go down hill. And when I woke up, pain was back to it's annoying self. I'll mention it to her, and see what happens. Now I checked on Wallgreens site (which I HATE wallgreens btw) for prices on ER morphines. And there pretty much all in the same ball park. 100-200 for 30 tablets of Kadian and 100-200 for 60 tablets of the 12 hr. doses. Honeslty, what do you think is better Dave...taking a 12 hr MS contin type morphine or a 24 hr Kadian twice a day? I know that Kadian is know for it's nice smooth flow, but honestly I still feel the waves throughout the day, so it's not like there not there all together w/ Kadian. I suppose I could care less about the ups and down feeling, but I just want the best pain relief level (even) over the day. And from what I gather from this office, they don't prescribe short acting medication. Which I'm not sure if that's true, because don't some people NEED BT medication? Not saying I do, but there have been some moments thus far on Kadian where I've flat out felt the pain bad. And then other moments I'm just right. Maybe I just needed a higher dose from the begining, but she titrated my dose based on my old percocet mg-p.d.
All in all, this is such a good thing. I've been on top of my home exercises and am extremly motivated. I also claimed my roomates Colace Rx that he had from some hemeroids a couple mnths ago. HOPE THEY WORK, i'm already constipated!!! LOL - TTYL

- James

Hey James,

You didn't mention what strength MScontin you priced @ the Walgreen site, but when I was taking MScontin(name brand by Purdue) 15Mg q8h which would be 45Mg daily 90 tablets would've cost me $95.00 at costco and generic would have been less than that. If you have a costco or Sam's club in your area they are definatky worth looking into their prices since they have very little markup on pharmacy meds. You don't have to be a member to use the pharmacy at either place (it's not legal for them to exclude non-members from their pharmacy), just tell them at the door you're goung to the pharmacy and your in.

Be comfortable!