backgirl
01-20-2005, 03:07 PM
Hey guy's. I hope everyone is well. It's extremely cold here in Ontario. It was -20 degrees this morning. I would love to be with some of you 's down south. Anyway's, at my last PM appt my doc raised my Oxycontin dosage from 160mg 3 times a day to 200mg 3 times a day. This was after a severe fall and a trip to the ER. The Dr. at the hospital said that it's very important that my PM doc send me for an MRI, so I mentioned it to my PM doc and he said "we already know what's wrong with your back, telling us that there is further damage won't solve anything". I kind of see his point, but I don't like the fact that all he did was raise the dose. So now the dose isn't any more effective as it was previously. What I really wanted to ask was about Opioid Rotation. I've heard of people switching Long Acting meds for 2 or 3 months to bring their tolerance down or just keep it from going up. The drug that was mostly used was Methadone. Does anyone have any experience with this or just some knowledge about it ? I would love to try it because the Oxy's are becoming ridiculous. The pain relief is going away faster and faster and my tolerance is shooting through the roof. I would love some info to go to my Dr.'s with. He's pretty open about trying different things.
I would appreciate any help because I'm really starting to get nervous about my tolerance.
Thanks alot for your help and have a great day, backgirl
I would appreciate any help because I'm really starting to get nervous about my tolerance.
Thanks alot for your help and have a great day, backgirl
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Marg001
01-22-2005, 02:55 AM
[QUOTE=backgirl]Hey guy's. I hope everyone is well. It's extremely cold here in Ontario. It was -20 degrees this morning. I would love to be with some of you 's down south. Anyway's, at my last PM appt my doc raised my Oxycontin dosage from 160mg 3 times a day to 200mg 3 times a day. This was after a severe fall and a trip to the ER. The Dr. at the hospital said that it's very important that my PM doc send me for an MRI, so I mentioned it to my PM doc and he said "we already know what's wrong with your back, telling us that there is further damage won't solve anything". I kind of see his point, but I don't like the fact that all he did was raise the dose. So now the dose isn't any more effective as it was previously. What I really wanted to ask was about Opioid Rotation. I've heard of people switching Long Acting meds for 2 or 3 months to bring their tolerance down or just keep it from going up. The drug that was mostly used was Methadone. Does anyone have any experience with this or just some knowledge about it ? I would love to try it because the Oxy's are becoming ridiculous. The pain relief is going away faster and faster and my tolerance is shooting through the roof. I would love some info to go to my Dr.'s with. He's pretty open about trying different things.
I would appreciate any help because I'm really starting to get nervous about my tolerance.
Thanks alot for your help and have a great day, backgirl
Hi Backgirl,
I'm from Ontario too. I know a lot of the Doc in the States practise a lot different that here in Ontario. I myself have Spondylolesthesis and a partial Scoliosis frm when I was 16 and Disc Degeneration, and Osteoporeosis, sorry if there is any spelling mistakes, it's late!!! :yawn: I was on Oxycontin for my back pain but it wasnt doing the job. I switched to the Duragesic Patch of 50 mcgh's. It took me a while to get the dosage right for my pain level and the time I should change the patch, but now I have total pain relief. I have never have opiod rotation or really heard of it. I hope you find what you are looking for!!
Take good care.
M.S.
:angel:
I would appreciate any help because I'm really starting to get nervous about my tolerance.
Thanks alot for your help and have a great day, backgirl
Hi Backgirl,
I'm from Ontario too. I know a lot of the Doc in the States practise a lot different that here in Ontario. I myself have Spondylolesthesis and a partial Scoliosis frm when I was 16 and Disc Degeneration, and Osteoporeosis, sorry if there is any spelling mistakes, it's late!!! :yawn: I was on Oxycontin for my back pain but it wasnt doing the job. I switched to the Duragesic Patch of 50 mcgh's. It took me a while to get the dosage right for my pain level and the time I should change the patch, but now I have total pain relief. I have never have opiod rotation or really heard of it. I hope you find what you are looking for!!
Take good care.
M.S.
:angel:
Shoreline
01-22-2005, 10:37 AM
Hi backgirl, I've read dentica post dozens and dozens of times. Whe you reach doses that are extremely high and your not getting relief it is time to change meds.
Different meds bind to different receptors, so I don't agree with the thoeries about cross tolerance, which basically say if you tolaerant to 600 mgs of oxycontin your would be equally tolerant to 900 mgs of MSContin "LA morphine" But hese are 2 different drugs in 2 distinct classes of popiates, ones a synthetic opioid and morphine is a naturally occuring opiate, they have some similarities in the receptrs thy bind to and some differences You may even respond better to a lower dose than what some chart or table suggests and still get better pain relief.
It's defnitely time to switch meds. You also have to undertsand that with mechanical instability, they can set your dose acording to he worst pain you experience. I have the same grade 2 spondy from a failed fusion and broken hardware, 5 partially fused vertabrea will shift almost 50% of my sacrum which sends a jolt through my body and I have to find a place to sit and sweat it out. If they adjusted my meds to the point my spine would shft and I wouldn't feel it or I didn't care, I would be oversedated 95% of the time .
Instability can't be masked with opiates. You ether fix it, wear a brace to prevent it or learn to deal with the flair up when it does shift. BY the time an Oral BT med is working things have lkely already shifted back and I'm feeling better before the med even takes effect. Then I'm over sedated for the next 3-4 hours. I still crunch and squeek all the time and the pain is the same anyway.
As far as getting a new MRI, Start back at your GP or surgeon. Some PM docs are not great diagnostic guys. You likely arived at PM with your DX in hand so it was never a questuion at what point do I need to think about true stabilzation.
If your spine is that unstable, then you do need to frequently monitor things to be sure that things haven't progressed to the point of shearing off a nerve root, or damaging your spinal cord, once that happens your are truley screwed.
So if yor PM doc isn't willing to do continous follow up to track the instability, you need to find someone that will. Or you may step off a curb one day and shear a nerve root off or do permananet damage to your spinal cord. You can't go through life thinking the worst has happened evertime you have a flair, or increasing your dose evertime you have a flair, otherwise I would need a dose increase twice a month. That's what my doc prescribes BT meds for, to deal with flairs, not to incorporate them into my daily routine so that they are no more effective today than they were last week when you took the same amount you always take simply because the doc allows you to have BT meds and will refill them monthly like LA meds.
Having a script for BT meds that reads 90 pills take 3 a day for rescue pain, doesn't mean take 3 a day whether you need it or not, It's for rescue pain, flairs and increased pain from activity. Not just part of the daily routine, otherwise they do loose all their effectiveness and you find yourself in the ER and needing dose increases beyond your own comfort level and pushing the docs own comfort level to the max.
But a change at this point sounds reasonabale and you may find you get better relief from another med at a lower dose.
Good luck, Dave
Different meds bind to different receptors, so I don't agree with the thoeries about cross tolerance, which basically say if you tolaerant to 600 mgs of oxycontin your would be equally tolerant to 900 mgs of MSContin "LA morphine" But hese are 2 different drugs in 2 distinct classes of popiates, ones a synthetic opioid and morphine is a naturally occuring opiate, they have some similarities in the receptrs thy bind to and some differences You may even respond better to a lower dose than what some chart or table suggests and still get better pain relief.
It's defnitely time to switch meds. You also have to undertsand that with mechanical instability, they can set your dose acording to he worst pain you experience. I have the same grade 2 spondy from a failed fusion and broken hardware, 5 partially fused vertabrea will shift almost 50% of my sacrum which sends a jolt through my body and I have to find a place to sit and sweat it out. If they adjusted my meds to the point my spine would shft and I wouldn't feel it or I didn't care, I would be oversedated 95% of the time .
Instability can't be masked with opiates. You ether fix it, wear a brace to prevent it or learn to deal with the flair up when it does shift. BY the time an Oral BT med is working things have lkely already shifted back and I'm feeling better before the med even takes effect. Then I'm over sedated for the next 3-4 hours. I still crunch and squeek all the time and the pain is the same anyway.
As far as getting a new MRI, Start back at your GP or surgeon. Some PM docs are not great diagnostic guys. You likely arived at PM with your DX in hand so it was never a questuion at what point do I need to think about true stabilzation.
If your spine is that unstable, then you do need to frequently monitor things to be sure that things haven't progressed to the point of shearing off a nerve root, or damaging your spinal cord, once that happens your are truley screwed.
So if yor PM doc isn't willing to do continous follow up to track the instability, you need to find someone that will. Or you may step off a curb one day and shear a nerve root off or do permananet damage to your spinal cord. You can't go through life thinking the worst has happened evertime you have a flair, or increasing your dose evertime you have a flair, otherwise I would need a dose increase twice a month. That's what my doc prescribes BT meds for, to deal with flairs, not to incorporate them into my daily routine so that they are no more effective today than they were last week when you took the same amount you always take simply because the doc allows you to have BT meds and will refill them monthly like LA meds.
Having a script for BT meds that reads 90 pills take 3 a day for rescue pain, doesn't mean take 3 a day whether you need it or not, It's for rescue pain, flairs and increased pain from activity. Not just part of the daily routine, otherwise they do loose all their effectiveness and you find yourself in the ER and needing dose increases beyond your own comfort level and pushing the docs own comfort level to the max.
But a change at this point sounds reasonabale and you may find you get better relief from another med at a lower dose.
Good luck, Dave