StMishl
03-16-2005, 03:26 PM
Hi. I usually post on the back board. I have a question re: oxycontin.
I currently take 20 mg at 6:00 am/6:00 pm and 10mg at noon (My surgeon is my perscribing doctor still, had a TLIF fusion 12/13/04, which is not fusing, and I have a "possible" lose screw which is pressing on a nerve...) I am still in pain around the 6-7 "pain level" even in the "middle" of the dose - I feel like this is making my pain tolerable, but in no way is it controlled. Is this the best I can expect from such a powerful med or can I ask for more relief? I don't want to be unconcious, but ??
Originally (pre-op) I was taking 10mg am/10mg pm and he bumped it to 20/20 post op, and then added the 1 mid-day about 6 weeks ago. I am not getting the same relief that I previously was.. although I very much notice that they DO help (ie if I miss a dose I am in absolute agony - unable to function). I don't know if my pain is getting worse or if I am building tolerance to the meds. Either way, although I like the way the LA meds work (I have Rheumatoid Arthritis & osteoporis = many broken bones in past, so have experience with narcotic pain meds) and DON'T want to return the short acting meds (pre-oxycontin I was on roxicet), I am concerned that I may need to increase my dose and do not want to get into a cycle of increasing the dose regularly. I am allergic to the adhesive on the patches (tried them... I am also allergic to bandaids- they cause raised burning welts within minutes) and demerol.
Does anyone have a suggestion for a long acting (preferably) med that will not require as frequent bumps in dose? I think my doctor thinks this stuff should work for everyone, and it just isn't... It appears my back is more screwed up then previously expected (the fusion appears to be failing), and I seem to be in this for the long road. Additionally, oxycontin is causing extreme constipation (I realize this is a side effect of most narcotics, but is there one w/ less of this effect??). My doctor seems willing to listen to suggestions, but is of the mindset that if a little oxycontin isn't working lets try some more... I read about all the other meds available on here and just wonder if there isn't a better choice for me. I did see a PM doctor pre-op (who did the ESI -which made things worse) and assume at sometime in the near future I will be returning to his care... but would like to have my "basic" med under control first. My relationship w/ my surgeon is good- he does listen to me, and I think if I ask him about a specific med he will let me try. But then how do I change from 1 to another? Luckily I do have pretty good insurance...
I really appreciate any advice...and thank you in advance :angel:
Michelle
I currently take 20 mg at 6:00 am/6:00 pm and 10mg at noon (My surgeon is my perscribing doctor still, had a TLIF fusion 12/13/04, which is not fusing, and I have a "possible" lose screw which is pressing on a nerve...) I am still in pain around the 6-7 "pain level" even in the "middle" of the dose - I feel like this is making my pain tolerable, but in no way is it controlled. Is this the best I can expect from such a powerful med or can I ask for more relief? I don't want to be unconcious, but ??
Originally (pre-op) I was taking 10mg am/10mg pm and he bumped it to 20/20 post op, and then added the 1 mid-day about 6 weeks ago. I am not getting the same relief that I previously was.. although I very much notice that they DO help (ie if I miss a dose I am in absolute agony - unable to function). I don't know if my pain is getting worse or if I am building tolerance to the meds. Either way, although I like the way the LA meds work (I have Rheumatoid Arthritis & osteoporis = many broken bones in past, so have experience with narcotic pain meds) and DON'T want to return the short acting meds (pre-oxycontin I was on roxicet), I am concerned that I may need to increase my dose and do not want to get into a cycle of increasing the dose regularly. I am allergic to the adhesive on the patches (tried them... I am also allergic to bandaids- they cause raised burning welts within minutes) and demerol.
Does anyone have a suggestion for a long acting (preferably) med that will not require as frequent bumps in dose? I think my doctor thinks this stuff should work for everyone, and it just isn't... It appears my back is more screwed up then previously expected (the fusion appears to be failing), and I seem to be in this for the long road. Additionally, oxycontin is causing extreme constipation (I realize this is a side effect of most narcotics, but is there one w/ less of this effect??). My doctor seems willing to listen to suggestions, but is of the mindset that if a little oxycontin isn't working lets try some more... I read about all the other meds available on here and just wonder if there isn't a better choice for me. I did see a PM doctor pre-op (who did the ESI -which made things worse) and assume at sometime in the near future I will be returning to his care... but would like to have my "basic" med under control first. My relationship w/ my surgeon is good- he does listen to me, and I think if I ask him about a specific med he will let me try. But then how do I change from 1 to another? Luckily I do have pretty good insurance...
I really appreciate any advice...and thank you in advance :angel:
Michelle
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scotty12
03-16-2005, 03:34 PM
Michelle,
20 mg really isnt much for someone whos been on meds say a year or more.although the oxy is 20mg it only sustains 10mg in your bloodstream,or atleast thats what it is supposed to do.
so if you were taking 2(10mg)oxycodone short acting per dose then it actually is a step down from that.
whatever the dose of oxycontin pill is equal to 1/2 the actual amount when comparing it to roxicet or roxicodone.
if you were taking 20 mg of roxicet then an equivilent dose of oxycontin would be 40MG
scott
20 mg really isnt much for someone whos been on meds say a year or more.although the oxy is 20mg it only sustains 10mg in your bloodstream,or atleast thats what it is supposed to do.
so if you were taking 2(10mg)oxycodone short acting per dose then it actually is a step down from that.
whatever the dose of oxycontin pill is equal to 1/2 the actual amount when comparing it to roxicet or roxicodone.
if you were taking 20 mg of roxicet then an equivilent dose of oxycontin would be 40MG
scott
SheSparkles
03-16-2005, 04:44 PM
Hi,
Since you have insurance, why not try some of the long acting morphines? Kadian, Avinza, MSContin, or Palladone, LA hydromorphone (Dilaudid)? Lots of people really like Methadone. There is a new generic fentanyl patch made in a different way by Mylan, you might think about that. Different adhesives.
OK my brain is now mush.
SS
Since you have insurance, why not try some of the long acting morphines? Kadian, Avinza, MSContin, or Palladone, LA hydromorphone (Dilaudid)? Lots of people really like Methadone. There is a new generic fentanyl patch made in a different way by Mylan, you might think about that. Different adhesives.
OK my brain is now mush.
SS
Streetcar
03-16-2005, 04:59 PM
Hi Michelle,
Welcome to the PM board. Considering what you've been through and with what you're going thru with the screw, I wouldn't be concerned about needing a regular doseage increase. It might take several adjustments to get you where you need to be comfort wise. You (right along with most of us CPers) probably also need a short acting med for breakthru pain even after they get your base med right and especially until they get the base right.
You ask if Oxycontin is the best there is. That all depends on the individual. What works best for me might not do anything for you and what works great for you might only give me marginal relief. There are several LA morphine products available. But any time you change med types, it's a long (usually painful) process getting the doseage correct. If you change meds the dr is going to want to start you off on a conservative doseage to be on the safe side and then work the doseage up slowly till you reach the agreed level of comfort. Plus with a change in med type, you also have a whole new set of side effects to deal with that you may or may not be able to handle.
Welcome to the PM board. Considering what you've been through and with what you're going thru with the screw, I wouldn't be concerned about needing a regular doseage increase. It might take several adjustments to get you where you need to be comfort wise. You (right along with most of us CPers) probably also need a short acting med for breakthru pain even after they get your base med right and especially until they get the base right.
You ask if Oxycontin is the best there is. That all depends on the individual. What works best for me might not do anything for you and what works great for you might only give me marginal relief. There are several LA morphine products available. But any time you change med types, it's a long (usually painful) process getting the doseage correct. If you change meds the dr is going to want to start you off on a conservative doseage to be on the safe side and then work the doseage up slowly till you reach the agreed level of comfort. Plus with a change in med type, you also have a whole new set of side effects to deal with that you may or may not be able to handle.
StMishl
03-16-2005, 08:21 PM
Thank you all for the reply. If I go in and suggest that perhaps I would like to try a different long acting med (instead of the oxycontin) should I expect that he will say "sure okay" or not? Are the LA morphines similar to the oxy - in that I mean is my pain "bad enough" for them? Is there a relativity between oxycontin is = to the LA morphine? In the hospital the morphine seemed to do a much better job of pain relief then the oxycontin does (but that was in an IV). Is it really just hit and miss? How long should I have to be at each dose before realizing it works or not? Getting BT pain meds seems to be a problem, as I can't seem to get anything consistantly other then the oxycontin (I think that he feels it was a big deal to up the oxycontin, so I shouldn't need anything for BT).
Thanks.
Michelle
Thanks.
Michelle
Streetcar
03-17-2005, 01:12 PM
Hi Michelle,
The dr shouldn't have problem with putting you Morphine. Morphine is MUCH more effective thru an IV than it is taken orally by a factor of three. In other words a 5Mg Morphine injection is as effective as Short Acting 15Mg Morphine taken orally. Add to that the fact that taken orally 40% of the morphine crosses the blood/brain barrier while about 70% of Oxycontin crosses the blood/brain barrier. Basically what this means is that Mg for Mg Oxycontin is about twice as potent as Morphine. Of course this is an average taken in clinical trials. Since every person is different in how they react to any med so you may receive better analgesia with the morphine. Since you are currently taken 50Mg of Oxycontin daily a conservative starting dose of Mscontin would be 75Mg daily. 30Mg -15Mg -30Mg repersenting a 24 hour schedule.
The dr shouldn't have problem with putting you Morphine. Morphine is MUCH more effective thru an IV than it is taken orally by a factor of three. In other words a 5Mg Morphine injection is as effective as Short Acting 15Mg Morphine taken orally. Add to that the fact that taken orally 40% of the morphine crosses the blood/brain barrier while about 70% of Oxycontin crosses the blood/brain barrier. Basically what this means is that Mg for Mg Oxycontin is about twice as potent as Morphine. Of course this is an average taken in clinical trials. Since every person is different in how they react to any med so you may receive better analgesia with the morphine. Since you are currently taken 50Mg of Oxycontin daily a conservative starting dose of Mscontin would be 75Mg daily. 30Mg -15Mg -30Mg repersenting a 24 hour schedule.
serendip
03-18-2005, 03:28 PM
your PM doc may be the one who should help you fine-tune dosage. they truly understand that BREAKTHRU Rx are really a requirement for someone in as much pain as you.
that said, i started at 10mg oxycontin 2x daily, moved up to 20mg and then 40mg (both twice daily)...and all along, my breakthru Rx has been 5/325 Percocet. I'm thinkng of asking for bigger breakthru Rx, as the 5s don't seem to do much for me anymore.
still, you can and SHOULD have breakthru meds, no matter what the dosage of oxycontin you all decide is right for you. pain flares, and we must demand the tools to manage it without going to ER.
i've had people from national pain foundation suggest to me that it wouldn't be at all unheard of for me to have gone up to the 80mg twice daily range of oxycontin a LOT sooner (10mg first year, 20mg 1.5 years more, 40mg now for a bit over a year). it really depends on what *you* can tolerate. i'm fairly ok with a 6or7 pain level all the time (which is the relief i get from oxycontin from the beginning), some people are not. you've got to decide for you, and help your docs make the right decisions for you.
i've not tried any of the morphines or methadones, but i *do* notice that when i go for epidurals, the *only* time i feel almost no pain is while short-acting fentanyl by iv is on board. hmmm, maybe i should ask my PM doc about that?
good luck in your search! as a kind neurosurgeon informed me once, after telling me there was nothing he could do for me currently...don't stop searching until you find the right doctor and combination of therapies!
---pam, always hopeful
that said, i started at 10mg oxycontin 2x daily, moved up to 20mg and then 40mg (both twice daily)...and all along, my breakthru Rx has been 5/325 Percocet. I'm thinkng of asking for bigger breakthru Rx, as the 5s don't seem to do much for me anymore.
still, you can and SHOULD have breakthru meds, no matter what the dosage of oxycontin you all decide is right for you. pain flares, and we must demand the tools to manage it without going to ER.
i've had people from national pain foundation suggest to me that it wouldn't be at all unheard of for me to have gone up to the 80mg twice daily range of oxycontin a LOT sooner (10mg first year, 20mg 1.5 years more, 40mg now for a bit over a year). it really depends on what *you* can tolerate. i'm fairly ok with a 6or7 pain level all the time (which is the relief i get from oxycontin from the beginning), some people are not. you've got to decide for you, and help your docs make the right decisions for you.
i've not tried any of the morphines or methadones, but i *do* notice that when i go for epidurals, the *only* time i feel almost no pain is while short-acting fentanyl by iv is on board. hmmm, maybe i should ask my PM doc about that?
good luck in your search! as a kind neurosurgeon informed me once, after telling me there was nothing he could do for me currently...don't stop searching until you find the right doctor and combination of therapies!
---pam, always hopeful
LibraBalancer
03-22-2005, 03:09 PM
I say methadone...just give it a try. 1st of all it's SO cheap, it's not even funny. And it's VERY powerfull and long lasting take it like q8 or 12 hours. Although it's in your body for longer than that...the pain can come crepping back after like 8 hrs, but the price is out of sight. I mean oxycontin, which I've never tried, but have had oxycodone, is good for tons of people, but it's like making a house or car payment every month...and thats just Ridiculous. xo
pedden
03-22-2005, 09:46 PM
Me myself wear the Duragesic patches, which you cant wear. but they also have the suckers which could provide the in between relief that your looking for. now if im not mistaking its called Aqtif or something of that nature, but Ive found for pain relief that the Fentanyl is the best for pain relief. GOOD LUCK
darkmantis
03-26-2005, 07:11 PM
Michelle,
20 mg really isnt much for someone whos been on meds say a year or more.although the oxy is 20mg it only sustains 10mg in your bloodstream,or atleast thats what it is supposed to do.
so if you were taking 2(10mg)oxycodone short acting per dose then it actually is a step down from that.
whatever the dose of oxycontin pill is equal to 1/2 the actual amount when comparing it to roxicet or roxicodone.
if you were taking 20 mg of roxicet then an equivilent dose of oxycontin would be 40MG
scott
Roxicet is Oxycodone/aceteminophen its not stronger than Oxycontin
20 mg really isnt much for someone whos been on meds say a year or more.although the oxy is 20mg it only sustains 10mg in your bloodstream,or atleast thats what it is supposed to do.
so if you were taking 2(10mg)oxycodone short acting per dose then it actually is a step down from that.
whatever the dose of oxycontin pill is equal to 1/2 the actual amount when comparing it to roxicet or roxicodone.
if you were taking 20 mg of roxicet then an equivilent dose of oxycontin would be 40MG
scott
Roxicet is Oxycodone/aceteminophen its not stronger than Oxycontin
trowftd3
03-27-2005, 01:27 AM
Roxicet is Oxycodone/aceteminophen its not stronger than Oxycontin
I think Scott meant that if you're taking 40mgof oxy only 20mg would be maintained in the bloodstream. That's what he meant by 20mg of Roxi being equivalent to 40mg of oxy....because roxi is a short acting drug and oxycontin is long acting.
Correct?
~Mush
I think Scott meant that if you're taking 40mgof oxy only 20mg would be maintained in the bloodstream. That's what he meant by 20mg of Roxi being equivalent to 40mg of oxy....because roxi is a short acting drug and oxycontin is long acting.
Correct?
~Mush