shayna1962
01-24-2005, 05:44 PM
Hi - I just registered with this site. I've had chronic low back pain for over 2 years and was diagnosed with SI joint dysfunction. I was on Vicodin but was worried about too much Tylenol and I wasn't getting enough relief. My doctor put me on Duragesic which works good, but doesn't last the 3 days. She recently referred me to a pain management clinic as she thought I could get therapy and medication for break-through pain. I went to the appointment and was a bit shocked; the PM doctor agreed that I did have SI joint dysfunction, but said I should not be on Duragesic and he would not prescribe anything for BT pain. He said I was "too young" and would get addicted! He wants to do a SI joint injection, which I have had before and only helps temporarily, and he didn't mention therapy. This is a large, well-known hospital with a PM program that is rated very high. I told my doctor what he had said and she was shocked. When the patch wears off, the pain gets horrible. Sitting for prolonged periods, standing, lifting, etc. all makes the pain worse. Unfortunately my job requires me to sit for about 90% of the time which increases the pain. I don't know where else to go, most doctors seem to be very against narcotic use for chronic pain. This PM doctor also said it would be different if I was 80 instead of 42, then he would prescribe something for BT pain! It's very frustrating since I was always an active person, and now with this pain there's not too much I can do. My doctor did mention that she could possibly switch me from Duragesic to Oxycontin, but I have never had Oxy and I have heard it doesn't last 12 hrs just like the patch doesn't last 3 days. If anyone can offer any information it would be greatly appreciated. I'm thinking about switching to Oxy but would like info from someone who has been on it - such as how well it works, how long it will last, if it's better/worse/etc. than Duragesic.
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twisten
01-24-2005, 06:17 PM
First off, welcome to the site. Peeps in here are great so I hope you decide to stick around here with us.
I'm assuming it was your family doc that sent you to the pm doc?? If so I would ask her to refer me to a different one for another opinion. Is it not possible for the family doc to give you your scripts for pain meds every month?
As for the duragesic when I was on it it didn't last me the 3 days either. I had bt meds to help for the last day. Oxycontin also didn't last 12 hours for me and I didn't get adequate pain relief from it either. Right now I'm on Mscontin 30 mg in the morning and 60 at night. I also have 10 mg of oxyir for bt and can take 2 and if things are really bad 3 per day. Right now my doc is trying to lower my bt useage. Mscontin doesn't work for 12 hours for me either so I'm hoping to ask her to switch me to hydromorphcontin the next time I see her because its supposed to last longer. I saw her last week but she wasn't in a good mood so I chickened out!! Sorry this is so long, I get "talking" and don't know when to quit!!
Marcy
I'm assuming it was your family doc that sent you to the pm doc?? If so I would ask her to refer me to a different one for another opinion. Is it not possible for the family doc to give you your scripts for pain meds every month?
As for the duragesic when I was on it it didn't last me the 3 days either. I had bt meds to help for the last day. Oxycontin also didn't last 12 hours for me and I didn't get adequate pain relief from it either. Right now I'm on Mscontin 30 mg in the morning and 60 at night. I also have 10 mg of oxyir for bt and can take 2 and if things are really bad 3 per day. Right now my doc is trying to lower my bt useage. Mscontin doesn't work for 12 hours for me either so I'm hoping to ask her to switch me to hydromorphcontin the next time I see her because its supposed to last longer. I saw her last week but she wasn't in a good mood so I chickened out!! Sorry this is so long, I get "talking" and don't know when to quit!!
Marcy
mike j
01-24-2005, 09:51 PM
I am glad you joined us Welcome.I would recommend getting a second opinion for another pain management clinic. Ask your doctor for another referral. You're very fortunate to have a general practitioner with compassion. I would also recommend doing some research about pain. learning how to express yourself and filling out a pain diary would be very beneficial for you. I was also on the patch. It ornly lasted 48 . we are very fortunate to have a lot of good people on this board. I will be curious to see what shoreline would recommend. He is very knowledgeable and helpful. Take care of yourself. mike
BrittleBones
01-25-2005, 07:47 AM
Hi Shayna and welcome! I'm pretty new to this site as well. I've only been posting about 2 weeks now. So far I think I have found everything I've been looking for right here on this website. After searching through tons of bulletin boards and chatter rooms, this one is the best. My last operation was to fuse both my left and right sacral joints. They had started to move and this caused me so much pain. I couldn't do anything without screaming in pain. :eek: The doctor explained to me that when most of your back is fused and can't rotate or really move the way it was designed to move, something else will try to take over the functions of the impaired joints. He said that SI joints aren't designed to move like our vertabrae are, but in a small percentage of folks who have had as many fusions as I've had, they do move. So I had bilateral sacral fusions this past July. The left SI joint healed nicely and I'm without pain on that side. The right side is still giving me a great deal of pain. The fusion is healing well, but for some reason the pain is still there. It's very frustrating. :confused: I'm still on crutches and I can't get around without a wheelchair if I'm going to go any distances (the mall, etc.) How did you end up with SI problems? I'm very curious to know the history and progression of your joint disease. All the best - Kathy Mac :)
kds01
01-25-2005, 10:06 AM
Hi Shayna and welcome. I too am on the Duragesic patch and it does not last the full 72 hrs. My doctor has offered to write the prescription so that I can change it every 48 hours and I just got word that my insurance will pay for it. As you probably know, they are expensive. You can ask your dr. if you can change it every 48 hrs. Some people here have said that the side effects were too numerous with the change every 48 hrs but everyone is different. I am going to give it a shot. Good luck to you, let us know what you do.
Kimberly
Kimberly
kellyp
01-25-2005, 01:54 PM
Welcome,
I too had to change the duragesic at 48hrs instead of 72 while I was using it, but my doc did provide 5mg oxy tabs for breakthru pain, 90 per month. I used the 50's most of the time, 75's for a while when I was moving.
I agree with the others, ask for another referral. The first PM my PCP referred me too would only make an appt for an injection, no consult nothing. I chose not to go to that doc, so I did some checking on my own and found a better pain clinic I asked my PCP to refer me to that clinic which he did. Thankfully, it is one of the best PM practices in my area and I couldn't be happier. I am moving (although slowly at times) better than I have in the last 13 years since I first hurt my back.
Good luck,
Kelly
I too had to change the duragesic at 48hrs instead of 72 while I was using it, but my doc did provide 5mg oxy tabs for breakthru pain, 90 per month. I used the 50's most of the time, 75's for a while when I was moving.
I agree with the others, ask for another referral. The first PM my PCP referred me too would only make an appt for an injection, no consult nothing. I chose not to go to that doc, so I did some checking on my own and found a better pain clinic I asked my PCP to refer me to that clinic which he did. Thankfully, it is one of the best PM practices in my area and I couldn't be happier. I am moving (although slowly at times) better than I have in the last 13 years since I first hurt my back.
Good luck,
Kelly
shayna1962
01-25-2005, 10:40 PM
Hi everyone, thanks for the input- it is greatly appreciated. Acutually, the doctor I go to specializes in physical medicine and rehabilitation. She believes in meds for bt pain, but cannot prescribe them herself as she does go out of town often and is not available to monitor her patients. The PM clinic I went to does have other clinics, the one I went to was the closest, but maybe I need to see a doc at another location. The main location has everything there- physical therapy, psychologists, PM docs, acupuncturist, etc., where the satellite offices don't offer all that. I guess I just got lucky getting a doc who doesn't believe in narcotics for chronic pain, lol. My insurance doesn't require a referral, so I can go to anywhere that takes my insurance, which is good, it's just very hard finding the right place. My daughter, who is 21, has fibromyalgia, IBS, acid reflux, endometriosis, so is in extreme pain. She is also on Duragesic, and went to a different PM clinic, but the doc there said he didn't believe in fibromyalgia and definitely didn't agree with her being on Duragesic! I can't believe doctors being in the field of pain management with this kind of thinking! I know someone asked how I developed SI dysfunction, it came on gradually, but I'm pretty sure I know how it happened. I started working as a patient care assistant at the same hospital I work at now, and after a few months of being on my feet constantly and the heavy lifting, the pain started. It started out being off and on, and stayed in one place, but eventually worsened and I developed muscle tightness/pain in my low back, hip, buttock, thigh all the way to the knee. I was also in nursing clinicals at the time but had to drop because of the pain. I take Zanaflex at night, but the muscle tightness will not go away. I eventually went on light duty, and then another job came available on the floor I was working on, as a secretary, so I jumped at that. Then I found out that prolonged sitting is about as bad as being on your feet all the time. I've tried chiropractors (which seemed to help but insurance only allows so many visits), physical therapy (pain too extreme for that), SI joint injections (2x), massage therapy (great but too expensive), water therapy, heat, heat, heat, lol, SI belts, pillows, cushions, etc., etc. and some of those things help a little, but it's just getting worse. I drive 1 hour to get to work and that about kills me, been trying to find another hospital closer but no luck. About the only thing I can handle is some light yoga and swimming. Sorry to go on and on, I guess I haven't had many people to talk to about this. My doctor is going to try to find somewhere else for me to go, and I see her again on the 31st. Sometimes I change my patch after 48 hours instead of 72, but I can't keep doing that cause I'll run out too quick. From the way it sounds Oxycontin wouldn't be too much different than Duragesic, so I'm not sure if I want to switch or not. Thanks everyone for listening and take care, will talk soon
Streetcar
01-26-2005, 06:07 PM
Hey Shayna,
Welcome to the PM board. First of all the patient info package that you should have received form your dr. with your first Rx for duragesic states that they will last "up to 72 hours". No one that I know gets that long of relief. The norm is 48hrs and some getting 60 hours of good coverage. If you are getting good relief from the patches and have good insurance, I would talk to your dr about rxing the patch q48h. You already know it works and you are familiar with the side effects. Changing meds is always hard on you and your body. It is a rarity that the dr can get reasonablly close to dose thats right for you which leaves you suffering until they get the doseage right. On top of the suffering, you will also find yourself dealling with a whole different set of side effects. With that said, I think you would be much better off staying with the patch at q48h dosing.
As to switching to a different LA med, Oxycontin doesn't last 12 hours, no matter what Purdue Fredericks says; but they have to cover their legal butts. My PM dr knew they didn't last 12 hours so he had me taking them q8h instead of the standard q12h. Mscontin doesn't last 12 hours either and a higher percentage of docs are comfy dosing q8h where they're not comfy dosing the Oxy q8h. I had to stop the oxycontin because I could handle the anxiety (common side effect) that it caused me. The pain relief was good but the side effects were more than I could handle.
Got to go for now but good luck and keep us posted!
Welcome to the PM board. First of all the patient info package that you should have received form your dr. with your first Rx for duragesic states that they will last "up to 72 hours". No one that I know gets that long of relief. The norm is 48hrs and some getting 60 hours of good coverage. If you are getting good relief from the patches and have good insurance, I would talk to your dr about rxing the patch q48h. You already know it works and you are familiar with the side effects. Changing meds is always hard on you and your body. It is a rarity that the dr can get reasonablly close to dose thats right for you which leaves you suffering until they get the doseage right. On top of the suffering, you will also find yourself dealling with a whole different set of side effects. With that said, I think you would be much better off staying with the patch at q48h dosing.
As to switching to a different LA med, Oxycontin doesn't last 12 hours, no matter what Purdue Fredericks says; but they have to cover their legal butts. My PM dr knew they didn't last 12 hours so he had me taking them q8h instead of the standard q12h. Mscontin doesn't last 12 hours either and a higher percentage of docs are comfy dosing q8h where they're not comfy dosing the Oxy q8h. I had to stop the oxycontin because I could handle the anxiety (common side effect) that it caused me. The pain relief was good but the side effects were more than I could handle.
Got to go for now but good luck and keep us posted!