I was first put on 15mg of ms contin twice a day, then two or three months later I had to increase the dose to 30mg of ms contin three times a day. It has been four months since I was put on the 30mg and it's failing to manage my pain. The last time this happened the doctor increased my dose to 30mg, but I do not want to increase it anymore. For one thing I don't want to look like an addict looking for stronger drugs. I am actually scared of increasing the dose, and it is something I want to avoid at all costs. I was wondering if there is anything I can do, other than getting an increase in my dose. Is there any way to decrease my resistence to the dose I am on, thereby making it more effective? I can take one 30mg pill in the morning, but later in the afternoon I need to take two in order to manage the pain. I know what to expect from pain meds, I know I will not get full relief and I know what to expect. But I am finding it difficult to do anything but sit in bed from about 4:00 until bed time. If I take two 30 mg pills in the afternoon I am able to carry on with my regular activities. The only thing I can think to do is to stop taking the meds for a while, but I can't do that because the pain would KO me. Any help or info would be greatly appreciated.

I'm sorry you are in so much pain. My fun time happens in the middle of the night. Does you doc know you are doubling up? Be sure to tell him. You might ask for something for "breakthrough" pain that will get you through till medication time. God bless

Hi CPTPOO, Tolerance is expected just like physical dependnece.There are more ways to deal with it than simply oubling your dose every 3-4 monthss. The quickest way to increase your tolerance is to expect the meds the doc gives to relieve your pain so you can continue on as normal. They don't make a stronger version of MSIr so the next steop would be to take 3 then 4 then 5 etc etc etc.

The idea of pain management is to manage your pain, not eliminate it. When it's being managed well enough to cary on with your normal activities, What are you doing for yourself to hep your situation.? That's probably the most important question any doc should ask while he's prescribing. IF someone expects the doc to do all the work and find the right med , combuinations of meds or dose so theat they don't have to deal withtheir problem as in, daily stretching, excercise to strengthen the weak area wether it's blow back, neck or just about any part, there should be some things you can do at home to strengthen a bad back.

Have you ever seen a PM psychologist to learn any technique to manage pain from a flair without first reaching for an extra pill. There are meds that can increase the effectivenss of pain meds that are not addicting or habit forming that work at different points to block the pain circut. Wether it's using nemanda to block the NMDA receptor which does have an impact on tolerance, pain threshold and effectivenes of your present dose. Antidepressants reduce substance P a potent neuro toxin which is part of the chemical changes and reaction to chronic pain. Anti seizure meds are another way to block pain at a different point in transmission and persception. Tens units,help some folks.

I can see where if these meds were used alone and din't make an impact you might feel they have no benefit. But when used in conjunction with the opiates you take if they increase the effectiveness of your present dose even 10% your that much better off. After an increase if that allows you to function n0ormal, than part of your daily fuinction is to rehab an injured area, if that helps another 10% your that much closer to avoiding an increase. If your looking for the magic cure that relieves your pain without having to change you daily routine, opiates can only do that for so long. I'm sure you can do the math and calculate where you will be in 2 years or 4 years if you do nothing but take pain meds to keep on keepin on. PM isn't entirely about what a doc can do for you, it's a group efort that the patient has to contribute too. Using meds once reserved for cancer and post op only is an extreme way too manage pain, asking someone to start walking or excercising or stretching or trying different modalities that might have failed on their own isn't extreme at all, it's what makes the most sense.

Everyone with pain would like a quick fix, but if you have a chronic or progressive problem, you do have to do your part in maintaining what you do have as far as strength, flexabilityy, core stabilkity, mental health, understanding of CP and these things don't ocome in the form of a pill. It's ikind of like diet pills. IF loosing weight was as easy as taking suOne super fat loss capsule at night and loosing weight, why would anyone every excercise if there was an easier way to loose weight. But loosing weight doesn't equate to being stronger having more endurance. So folks drawn to a quick fix for a weight loss program usually tend to be disapointed with any advertised claim of easy rapid weight loss. PM works the same way sure opiates relieve pain, but the goal of managing your pain is not just to make you feel more comfortable, but to enable you to work on yourself and do the excercises and stretches and take what works and put it to use.

I don't even know what your pain generatoris off the top of my head but everything from nutrition, to stresshas an effect on pain and we can't expect docs to substitute opiates for common sense that says my back hurts and I would have to feel better if I lost the weight, avoided foods known to trigger pain, excercised daily to increase endurance and learning when it's stress that's casuing an increase in pain and not knowing how to manage stress other than with another pill. Guided imagry, self hypnosis, bio feedback are all tools that canbe used to relieve stress. Even if it only helps get through a flair up or reduces your over all pain level by 5% you that much better off.

All these things can be learned or tought at comprehensive pain management clincis or through working with a doc that manages your meds, a doc or PT that oversees your rehab of an injury, someone to explain the basics of nutrition and sleep and how stress effects us daily. These things are out there, but they aren't the quick fix that an increase in opiates are. If you have reason to suspect your going to have pain the rest of your life, Opiates will slowly loose their effectivenees despite increases in dosage and strength.

Unfortunately, too many PM docs just write scripts, It's like expecting to cure major depression caused by some traumatic moment in your past with an anti depressant. An anti-dressant doesn't deal with the cause of the depression or anxiety, it just masks the problem leaving the underlying problem festering away. PM is the same way. Opiates just mask pain. combined with no other therapies or efforts it's very easy to predict the outcome and where you wil be in 2, 3 or 5 years from now if the only tool you have been given or use is opiates to mask the pain generator. . Masking pain so you can go on with life without making needed changes will actually do more harm than good. CP isn't a problem that can be cured, If there was a potential cure available, that should be tried long before you end up using the last resort which is the most potent pain meds vaialable. You have to deal with every aspect of your mental and physical health to find maximum function without complete dependence on the doc that writes the scripts we become dependnet on and that slowly loose effectiveness.

I can't tell you exactly what will help but I can tell you that opiates alone can only do so much before they become more impairing than the reason your taking them and they becomeless effective.

Good luck and try and think of what you can do to improve your situation, whether it's changing jobs, changing your lifestyle, starting an excercise program you won't give up on the first time you have pain you can't manage. Seek alternative therapies or counseling to learrn to cope with what the pills can't do and if you doc can only offer a script, find a real PM doc that specializees in interventional pain medicine, rehabilitation or uses a multi faceted aproach that includes counseling to deal with all your conerns about only having opiates to manage a lifelong problem.

Any doc that can write a script can hang a sign out front proclaiming they manage pain, but are they masking a problem and creating a monster or actually helping the patient in some way other than drugs that allow a patient not to put any work or make any changes into their own health and lifestyle.. There is a lot more that can be done or changed to improve your condition, but it doesn't all come in an easy to swallow pill that's only efective untill your tolerance grows.

Good luck, Dave

Thank you for your posts. Please allow me to expound on my situation, as many of the things you mentioned I have tried. About five or six years ago I was jumping in a track meet. The pit I was jumping into hadn't been properly looked after, so I ended up seriously injuring my back. After that summer I went to a University called BYU. I had earned a track scholarship there and was excited to start my NCAA career. However, the back pain continued to bother me until finally I couldn't train anymore.

The university staff had there best people look at my back, it was decided surgery would be the last option. So we tried numerous physiotherapy techniques, at one point my physiotherapist was a man named dave sikich, he was the head physiotherapist for the U.S.A ski and snowboard team (the olympic teams). After a while I got really depressed and moved back home. My back seemed to only get worse. Two years later I joined the track team at my local university, hoping that more exercise and training would be the answer. I ended up injuring myself again and went through the same events as I did at BYU. That is to say I saw all the physiotherapists at the university. Nothing seemed to help.

Two years ago I retired from track and field, in hopes that if I just concentrated on my back it would get better. I went to many different doctors, this would end up being the worst period of my back pain. Not because the pain got worse, but because the doctors got worse. When I got home from BYU I was diagnosed with depression and anxiety disorders. I live in a small town and I know all the doctors here. The first doctor I talked to told me I may just have to learn to live with it. Being a family friend this doctor also talked to my mother. He told her he thought I was faking this in order to get some drugs to help with the depression. The next doctor I saw thought the same thing and when I refused to leave without some kind of action being taken, he got me a appointment for an MRI. In Canada this can take up to six months so I was on a long waiting list.

While waiting I was given every type of anti-inflammitory imaginable. None of them did a thing. Next we tried drugs that are supposed to help nerve pain. Some are actually used as anti-seizure medicine, but for some reason they sometimes help chronic pain. None of this worked. Finally the results of my MRI came back, and it was seen that I had a bulging disc at L5. I know this is common and that it might not be the reason my back is hurting so much. This was great for me because it showed I wasn't faking anything and the doctors would have to do something. My doctor had finally admitted to me that he couldn't think of any drug that we hadn't tried, (drugs other than painkillers). And he told me there was nothing he could do for me, as he wouldn't prescribe pain killers. Finally I went to the last doctor in town. He got me an appt. with a pain specialist close by and he gave me some tylenol 4 to help with the pain. I tried the pain specialist for a year and it turned out he hurt more than he helped.

He gave me an epidural than injected me with something that is supposed to help. This ended up making it worse and my doctor told me he thought the pain specialist injected the medicine in the wrong place. After one of my appt. with my pain specialist he told me I was too young to have depression and to stop taking my anti-depressents. That was it for the pain doc.

I then got into a spine specialist center and after a thourough exam he told me he had a couple ideas. One of them was to get a procedure that helps to identify the problem. They inject the disc above the problem disc and then the problem disc if the problem disc hurts and the other one doesn't it means your disc is bad, and if that is the case he said he would give me surgery. In the meantime he gave me exercises and a physiotherapist to see until september. So I have been doing these exercises and they are not helping, it always hurts after I do them, and if I do them at night the next day is usually pretty bad.

After I left the pain doc, my doc prescribed ms contin 15mg twice a day, this helped for three or for months, then we had to up it to 30mg three times a day. Now that isn't helping much. I have been told by a few doctors what to expect with pain meds. I don't expect them to take the pain away, far from it, I just expect to be able to get out of bed each day and do a few minor jobs around the house, right now I am lucky to get out of bed.

I have tried everything I or any other doctor can think of, the physio has had little to no effect on the pain, all the other alternate drugs did nothing. The only thing that ever helped was ms contin. Now it is starting to not work. I do not want to up the dose. I am not using this drugs for any other reason than prescribed, I have social anxiety and as a result always think people are thinking the worst of me, and any time I post something like this I feel like people are just thinking I want more drugs to use to get high. Thats why I don't like to talk about this to my doctor I am afraid he will say I am trying to get too many drugs, and then he wouldn't give me anything, and that would be awful.

If anyone has any ideas or info I would greatly appreciate it, if anyone knows how to lower ones resistance to these meds please let me know this is beginning to ruin my life, and I desperately need help.

Hi CPT, Every doc has their own opinion. I had one PM doc tell me I was an addict simply for asking for pain meds. I wasn't an active addict because nobody had prescribed anything other than immediate post op, but my actions were those of a "dry addict???". I've had 3 surgeries fail and docs won't admit the surgery failed until something catastrophic occurs like snapping screws and rods and pulling them out of bone. So I would go 2 or 3 years before they could actually find evidence that the complaints I was making from about 3 months post op out were actually true. The last surgery was a revision of a failed fusion and broken hardware and of course it was deemed a success buy the surgeon, right up untill the first screw broke and since then it's been one piece of hardware after another either breaking or toggling out of the vertebrae, Now they can see all the donor bone that was placed for fusion has been completely absorbed and only 1 of 12 points they tried to fuse was an actual success. But it took 3 years to reach the point where they could tell the fusion was a complete failure once hardware began to snap. Hardware wouldn’t break and becomes a redundant stabilizer once you have a solid fusion. IF you don’t have a solid fusion then the hardware is doing all the work and it wasn’t designed for that..

Being labeled an addict or told it's all in your head or any of the stuff any doc has said is just their opinion. It may very well be that the disco-gram, where they inject the dye into the discs in September will show there is a definitive need for surgery. Unfortunately after living with pain this long, relieving pain isn't even the goal of surgery, correcting instability or reliving nerve impairment like loss of reflexes, muscles atrophy, foot drop, loss of sensation or correcting any actual measurable defect is what they base their decision to call a surgery a success on. Say they replace the disc with an artificial disc. If the disc is stable and in place under flexion and extension, the surgery is called a success, despite what you report about pain. Same goes for fusions, as long as the hardware they use holds things in place and prevent movement under flexion and extension, the fusions are called a success. There is no diagnostic they can do to tell if implanted bone is alive and thriving or dead and just waiting to be reabsorbed by the body. As long as the hardware is holding you in place, the fusion is a success by medical standards.

All the things you tried that failed prior to surgery may need to be tried again one they correct the problem. Regardless of how much exercise or PT or procedures you have, it's not going to seal up a shredded or ruptured disc that is leaking fragments into the spinal canal. If you do have surgery and it doesn’t relieve your pain, you pretty much start over with all those modalities with the hopes that now that the mechanical defect has been corrected, the other methods used will now be more effective. That just makes common sense. So like I said, what didn't work before, may work at a later time . Either after the problem is corrected or when used in conjunction with other modalities. If opiates happen to be one of the modalities that's fine, you just don't want to have only one method to manage your pain.

I know Canada is different and things take a bit longer to get things done, but your still young, first time surgery has much greater odds of success than your 2nd or 3rd, You don't have scar tissue problems, you were an athlete so you know how to train and push yourself. The PT your doing now isn't a waste of time. The better shape you’re in going into surgery, the quicker you will recover after surgery. For some, surgery will be the answer you wonder why they didn't just take care of in the first place, but we base our decisions on information given by the doc based on his POV.

As far as surgery being the last step, that's a matter of opinion too, I would think determining at the age of 22 that you have to live the rest of your life dependent on opiates is your last resort, not surgery,. If surgery fails and all the other methods you tried before and try again fail, than it gets al little easier to justify the need for these meds and can jstify the consequenes of using opiates for the next 50 or so years.. The problem with being dependant on LA opiates prior to surgery is that's going to be the surgeons first agenda, to get you off opiates. The more your taking now, the farther you get from a surgeons comfort zone as far as treating post op pain.

UP untill 96 or even later, The standard post of med once you come home was 5 mg percocet “oxycodone”. 1 or 2 every 4-6 hours. Wether you had a hip replaced or a 6 level fusion or a tooth extraction. There wasn’t anything stronger they would send you home with. If you go into surgery taking 10 times the dose of opiates that a surgeon would ever prescribe for the most invasive and complex surgeries, he’s going to have a hard time managing post op pain and basically tell you that’s it’s your fault your so tolerant and depndent on opiates when you have to tell him what works for 90% of all his other patients doesn’t come close to touching your pain..

Obviously you were talking about the LA version of morphine rather than the short acting version. 30mg is the strongest SA version but MSContin and many others come in strengths up to 200 mgs per dose. There are plenty of folks that can work a dose up beyond a couple hundred mgs a day before they have ever even consulted with a surgeon, which IMO is crazy. I would never let a GP or PM doc condemn me to a life of chronic pain without being certain
there wasn’t a way to correct the problem for good. Only a surgeon can make that call.

The idea of using opiates to manage pain is to make the pain tolerable and allow you to continue rehabbing the injured area, not relieve your pain entirely. When you shoot for complete relief, you may find it the first few days of an increase but after that it takes another increase to reach close to the same level of relief you got during the honey moon from doubling the previous dose.

I know many factors are ou of your control, but you also have to realize that some docs would give you nothing before the diagnostics were complete and the potential for a complete recovery was ruled out by a surgeon, other will manage up until they have a solid DX and know if the problem can be fixed. Why make you dependant and tolerant on opiates a couple months before surgery when SA meds will take the edge off and would be much easier to taper and more in line with the meds that would be used post op if your lucky enough to have a potential cure available.

. You may not be able to work, but if the problem is bad enough to require these meds and they allow you to function on a minimal level, you have to do you part and do what’s best for you. Doping up so you don’t have to change a thing in your life does more harm than good if surgery is an option. I understand you had t make major changes in your schooling and lifestyle, but if your only getting through class by using so many pain meds, what are you really retaining from the college experience. You will remember going, but as far as actually learning, that’s a different topic.

I do wish you the best and I also wish docs would explain the consequences of their method of practice. Obviously if you have a mechanical defect, untill it’s corected, all the anti seizure meds and anti depressants aren’t going to mask a ruptured disc heal. IT would be like breaking your leg and saying don’t cast or splint it, just give me enough pain meds to walk where I need to go and I’ll just take it easy. Some people are so afraid of surgery they will make ridiculous requests like that but it only leads to one place. Every day it will take more and more to manage the pain and your leg wouldn’t heal unless it was set and stabilized.

I do wish you luck and there have been several posts about discograms that you may find interesting if you use the forum search tool.

Good luck and take it easy, Dave