dani808
03-18-2007, 03:22 PM
I have a question to someone with experience with tolerance issues. I am currently on the 30mg Oxycodone (Roxicodone) short acting (2 - 4 times a day), for pain from my back surgery. Everything was fine at first but the dosage keeps getting adjusted as my tolerance increases. When I had my first surgeries I was on Oxicontin and Actiq for breakthrough and it was horrible coming off of that so I asked not to be put on oxicontin. Instead, I chose the oxicodone with actiq. I have stopped taking the actiq and chose to just take the 30mg oxicdones. But that is now not working. I have been steadily increasing and find now that it takes 3 to get substantial pain relief. (120mg 3x a day) I have tapered back a few times but it only takes a few days for your tolerance to get right back where you left off. I only have a bout 2 more months of recovery and want to get through this period without oxicontin and without fentynl. At what level of this oxicodone can I go to before I have to quit taking this? I mean, can I just continue to climb steadily, and is there a point where I can't take it anymore? I am afraid to tell my doc because I know she will switch my to something stronger and I would rather just stay on this and increase the dosage as needed if that is okay. (under the docs supervision of course) I don't want to go through oxicontin WDs again. If there is room for me to still increase on this med, then I will go talk to her about doing it because then I can still say no to stronger meds.
Thanks for the help!:D
Thanks for the help!:D
Sponsor
Tripletmom
03-18-2007, 08:23 PM
Hi Dani~
First of all, you are aware that oxycodone and oxycotin are one in the same medication. There are many different names, brands, strengths and such, but the only difference in oxycodone and oxycotin is that one is IR Instant Release and the other is ER Extended or Slow Release...so if you had difficulty getting off of the oxycontin, you may find the same problem with the other, unless of course the strength is significantly less. As far as I know, w/d is w/d in any opiate, although some may find that different kinds are worse or better then others.
As far as tolerance goes...that's a given. And again, for each person, it is different. The problem is, that everytime we take an opiate, it multiplies the receptors in our brain...before ever taking an opiate, our recptors are like virgins and it only takes a small amount to cover those receptors, but with every opiate we take, they multiple and multiple to the point that we need more and more medicaton to fill all the receptors. I know that taking a "holiday" from meds, if possible can be helpful, although I am told that it only takes so long for one to get back to where they ended.
The reason that Dr's don't want to continually increase ones meds, especially for those that will might be on them long term, is that in the end, there will not be enough meds to control the pain b/c the receptors are saturated...I think some ppl think that the Drs are just being mean, and I know that there are some out there that are (been there, met them) but for the most part that is the reason why.
I know that I am in the same boat as you...and I actually am thinking of talking with my Dr tomorrow about tolerance and reshaping my med routine. I have been on the patches and oxy for breakthrough pain for the last 4+ years without a change or increase, but it is not doing what it is suppose to do any longer. Instead of increasing my dose, I might change meds for a couple months and see if that works, and then maybe go back...we'll see what she says.
I probably didn't answer your question, and maybe somebody else can help you better...I think with each of us, it's just such a personal situation and what fits well for one, doesn't always fit the other.
Good Luck,
Dani
First of all, you are aware that oxycodone and oxycotin are one in the same medication. There are many different names, brands, strengths and such, but the only difference in oxycodone and oxycotin is that one is IR Instant Release and the other is ER Extended or Slow Release...so if you had difficulty getting off of the oxycontin, you may find the same problem with the other, unless of course the strength is significantly less. As far as I know, w/d is w/d in any opiate, although some may find that different kinds are worse or better then others.
As far as tolerance goes...that's a given. And again, for each person, it is different. The problem is, that everytime we take an opiate, it multiplies the receptors in our brain...before ever taking an opiate, our recptors are like virgins and it only takes a small amount to cover those receptors, but with every opiate we take, they multiple and multiple to the point that we need more and more medicaton to fill all the receptors. I know that taking a "holiday" from meds, if possible can be helpful, although I am told that it only takes so long for one to get back to where they ended.
The reason that Dr's don't want to continually increase ones meds, especially for those that will might be on them long term, is that in the end, there will not be enough meds to control the pain b/c the receptors are saturated...I think some ppl think that the Drs are just being mean, and I know that there are some out there that are (been there, met them) but for the most part that is the reason why.
I know that I am in the same boat as you...and I actually am thinking of talking with my Dr tomorrow about tolerance and reshaping my med routine. I have been on the patches and oxy for breakthrough pain for the last 4+ years without a change or increase, but it is not doing what it is suppose to do any longer. Instead of increasing my dose, I might change meds for a couple months and see if that works, and then maybe go back...we'll see what she says.
I probably didn't answer your question, and maybe somebody else can help you better...I think with each of us, it's just such a personal situation and what fits well for one, doesn't always fit the other.
Good Luck,
Dani
dani808
03-18-2007, 11:39 PM
Tripletmom,
Actually you helped me very much. I did not know that oxicontin and oxicodone were the same thing. Now I at least I wont be thinking that being on oxicontin is so bad. (something I think the media does to us anyway by making us feel guilty about being on it) Like you, I used to be on the durgesic patches but I hated that sometimes I would feel fine and the mext minute, BAM, I would be all sedated. Plus, I travel a lot and had trouble goign into Italy. The seized my patches and Actiq and within 24 hours I was in a scarey Florence hospital going through WDs with nothing to help. That is why I am trying to be so careful this time. I truly hate the control these meds have over us, and am trying to find as many alternatives as I can.
I think I will go back to alternating between 2 different meds again. It seems that it confuses that body enough and doesn't allow your body to get too used to one or the other too quickly. I will talk to my doc tomorrow and see what she recommends as a secondary medication.
Thanks again!
Actually you helped me very much. I did not know that oxicontin and oxicodone were the same thing. Now I at least I wont be thinking that being on oxicontin is so bad. (something I think the media does to us anyway by making us feel guilty about being on it) Like you, I used to be on the durgesic patches but I hated that sometimes I would feel fine and the mext minute, BAM, I would be all sedated. Plus, I travel a lot and had trouble goign into Italy. The seized my patches and Actiq and within 24 hours I was in a scarey Florence hospital going through WDs with nothing to help. That is why I am trying to be so careful this time. I truly hate the control these meds have over us, and am trying to find as many alternatives as I can.
I think I will go back to alternating between 2 different meds again. It seems that it confuses that body enough and doesn't allow your body to get too used to one or the other too quickly. I will talk to my doc tomorrow and see what she recommends as a secondary medication.
Thanks again!
Tripletmom
03-19-2007, 04:48 PM
Hi Dani~
Glad I could help...it gets SO confusing with all the different types of medications...some are named by their generic name, some by brand name...I started to go online and look up everything I was getting...so that might be something to do as well.
I am so sorry about your trip to Italy...OMG, I travel a lot as well and can't even imagine that. Infact, we are leaving on a cruise at the end of the week, going through the Bahama's and such, and my Dr has always told me to make sure I keep all my meds in the bottle they came in. I also used to be a flight attendant and I had some friends that would keep their medications, everything from pain meds to vitamins in one bottle and several were taken away by customs....unreal!
I went to my Dr today, and finally got the courage to tell her that my meds weren't helping like in the past. I even admitted that I didn't want to "rock the boat", because I am fearful of loosing what I have. Thankfully, I have not had an adjustment since I came there 3 yrs ago and even before that, so we agreed that it might be time for some RFA injections that have helped in the past, and she also increased my breakthrough meds, giving me 2 extra a day....I am very thankful for that. She didn't want to "up" my Durgesic, and I was fine with that. It wasn't as if the pain was breaking through more, it's just when it did, it was hard to control.
Well, let us know how things go at your appointment...maybe you could look into some procedures like an RFA, if that is possible. It is when the nerve endings are burned to help control the pain signal. It sounds sooo much worse then it really is. I would rather have that done, then my teeth cleaned...LOL
Take Care,
Dani (yes...my name is Dani as well)
Glad I could help...it gets SO confusing with all the different types of medications...some are named by their generic name, some by brand name...I started to go online and look up everything I was getting...so that might be something to do as well.
I am so sorry about your trip to Italy...OMG, I travel a lot as well and can't even imagine that. Infact, we are leaving on a cruise at the end of the week, going through the Bahama's and such, and my Dr has always told me to make sure I keep all my meds in the bottle they came in. I also used to be a flight attendant and I had some friends that would keep their medications, everything from pain meds to vitamins in one bottle and several were taken away by customs....unreal!
I went to my Dr today, and finally got the courage to tell her that my meds weren't helping like in the past. I even admitted that I didn't want to "rock the boat", because I am fearful of loosing what I have. Thankfully, I have not had an adjustment since I came there 3 yrs ago and even before that, so we agreed that it might be time for some RFA injections that have helped in the past, and she also increased my breakthrough meds, giving me 2 extra a day....I am very thankful for that. She didn't want to "up" my Durgesic, and I was fine with that. It wasn't as if the pain was breaking through more, it's just when it did, it was hard to control.
Well, let us know how things go at your appointment...maybe you could look into some procedures like an RFA, if that is possible. It is when the nerve endings are burned to help control the pain signal. It sounds sooo much worse then it really is. I would rather have that done, then my teeth cleaned...LOL
Take Care,
Dani (yes...my name is Dani as well)
Query
03-20-2007, 05:35 AM
Tripletmom,
I think I will go back to alternating between 2 different meds again. It seems that it confuses that body enough and doesn't allow your body to get too used to one or the other too quickly. I will talk to my doc tomorrow and see what she recommends as a secondary medication.
Thanks again!
Hi
What meds did you alternate, and how does that work?
Thanks
I think I will go back to alternating between 2 different meds again. It seems that it confuses that body enough and doesn't allow your body to get too used to one or the other too quickly. I will talk to my doc tomorrow and see what she recommends as a secondary medication.
Thanks again!
Hi
What meds did you alternate, and how does that work?
Thanks
Shoreline
03-20-2007, 09:05 AM
Hi Dani, The confusing part is that you say this is for post op pain. Post op pain should improve dramaticaly after the first few weeks following surgery and tolerance never becomes an issue with post op pain. If your shooting for complete relief, which is unreralistic with ost up pain, that's why you would develop tolerance for what's considered acute pain and not chronic pain.
When did you have the surgery and why would you need more and more medication as more and more days pass. Post surgical pain sucks, usually the goal is to take the edge off untill you start feeling better and then the dose is decreased. Perhaps I'm missing something but if you had surgery even 4 weeks ago, you shouldn't need as much medication as you did the first few weeks you came home, why would you be increasing a dose for short term pain that should be improving each day. All 3 spine surgeries I came home with 5mg percocet, and that was dropped to hydrocdone in a matter of weeks before toelrance even became an isue. Even though I was flat o my back for 3 months following surgery, I didn't require more and more each day. Tolerance is an issue of chronic pain, not acute post op pain? If you need more and more following surgery, they should be looking at why, do you have an infection? did you slip and faland break hardware, otherwise it seems crazy to increase a dose following surgery unless you unwilling to tolerate any amount of pain and just keep increasing to obtain and unreasonable goal. I was luck t still have opiates after the 3rd fusion after 3 months when PT even started. Your talking about the aqtiq, which is the single most potent med available and ssecond to that is 30 mg roxicodone 3-4 at a time? You shouldn't need more and more as each day pasaes unless something is terribly wrong that justifies increasing the dose.weeks or months after surgery. You have the most liberal surgeon I have ever even heard of. My surgeons were telling me the day after a 6 level fusion they wanted to discontinue the PCA and go to oral meds which seemed absurd, but again I had no control over this. Were you taking meds in bewteen surgeries and did you ever discontinue meds because surgery relieved pain or stablaized or decompressed your spine? Or is no amount of pain aceptable and as long as you doc is willing, you are going to shoot for 0 pain and eat 3-4 30 mg roxi at a time. You mentioned a fear of Long acting oxycodone. You would need to take 180 mgs of oxyC every 8 hours to equate to 3 30's mg fast acting oxy every 4 hours. THere is no difference as far as oxy, the form, the name, it's all oxycodone and deveolping tolerance post uo doesn't make sense as surgery is supposed to relieve your pain and you should be feeling beeter as quickly as weeks after surgery and thinking about decreasing, not increasing. Tolerance takes months to ocur.
Just curious, dave
When did you have the surgery and why would you need more and more medication as more and more days pass. Post surgical pain sucks, usually the goal is to take the edge off untill you start feeling better and then the dose is decreased. Perhaps I'm missing something but if you had surgery even 4 weeks ago, you shouldn't need as much medication as you did the first few weeks you came home, why would you be increasing a dose for short term pain that should be improving each day. All 3 spine surgeries I came home with 5mg percocet, and that was dropped to hydrocdone in a matter of weeks before toelrance even became an isue. Even though I was flat o my back for 3 months following surgery, I didn't require more and more each day. Tolerance is an issue of chronic pain, not acute post op pain? If you need more and more following surgery, they should be looking at why, do you have an infection? did you slip and faland break hardware, otherwise it seems crazy to increase a dose following surgery unless you unwilling to tolerate any amount of pain and just keep increasing to obtain and unreasonable goal. I was luck t still have opiates after the 3rd fusion after 3 months when PT even started. Your talking about the aqtiq, which is the single most potent med available and ssecond to that is 30 mg roxicodone 3-4 at a time? You shouldn't need more and more as each day pasaes unless something is terribly wrong that justifies increasing the dose.weeks or months after surgery. You have the most liberal surgeon I have ever even heard of. My surgeons were telling me the day after a 6 level fusion they wanted to discontinue the PCA and go to oral meds which seemed absurd, but again I had no control over this. Were you taking meds in bewteen surgeries and did you ever discontinue meds because surgery relieved pain or stablaized or decompressed your spine? Or is no amount of pain aceptable and as long as you doc is willing, you are going to shoot for 0 pain and eat 3-4 30 mg roxi at a time. You mentioned a fear of Long acting oxycodone. You would need to take 180 mgs of oxyC every 8 hours to equate to 3 30's mg fast acting oxy every 4 hours. THere is no difference as far as oxy, the form, the name, it's all oxycodone and deveolping tolerance post uo doesn't make sense as surgery is supposed to relieve your pain and you should be feeling beeter as quickly as weeks after surgery and thinking about decreasing, not increasing. Tolerance takes months to ocur.
Just curious, dave
dani808
03-20-2007, 01:55 PM
Dave,
I should have clarified. My doc had me on narcotic therapy for chronic pain before this particular surgery. So, I had to up me meds to treat the more acute pain. I have had 12 surgeries so far just for the accident. (I call it the accident, but I was the victim of a violent crime, and was stabbed several times and thrown from a 3rd story parking structure) I have had Three surgeries on my back, 2 on my knee, 2 on my shoulder, and the rest were a series of surgeries as a result of a head injury that ranged from ENT to vascular surgeries. (This was before I was diagnosed with breast cancer) The first time I was given Actiq was when I got CMV after radiation, and it caused what they called, "bone pain", which was the worst thing I think I had ever felt in my life. I have some chronic pain issues in the areas I have had surgery, or at the wound areas, but I think the worst thing is, and this is the one thing I cannot get a handle on, is the headaches I get. They don't respond to Migraine meds although they do follow some patterns of migraines, and they are pretty bad. Most of the time injections of tramadol helps, but my doc would give me Actiq in cases where I had already gotten injections and taken some kind of narcotic pain medicine, the Actiq seemed to be the only thing that would give me some immediate relief (although it doesn't last long). This has all been going on over a 8 year period and only 3 of them I have been on some kind of narcotic therapy for chronic pain off and on. So that is where the tolerance issue comes in. I did a pretty good job of alternating meds, or going of and on to try and avoid it and up until recently that worked. Now, I am not sure what to do. My plan is to be off all meds by June, and that is IF, I don't need another vascular surgery since they can't figure out why I can hear my corotic vessel in my left ear! I am seeing a great osteopath who does pain management for me, but also does alernative treatments that have really helped me get through this as a mostly funtioning person. She knew about my situation because she remebers seeing it on the news, and she really has gone above and beyond what most docs would do for their patients. Before I found her, I was dealing with some of the issues people here mention about the scrutiny, and disrespect. Or I just would get pain docs who would tell me to just deal with the fact I would prob. be on pain meds the rest of my life. So, I am thankful I have the care I do now, I am just very conflicted over this medication thing.
Thanks again for your time and for sharing your experiences!:)
I should have clarified. My doc had me on narcotic therapy for chronic pain before this particular surgery. So, I had to up me meds to treat the more acute pain. I have had 12 surgeries so far just for the accident. (I call it the accident, but I was the victim of a violent crime, and was stabbed several times and thrown from a 3rd story parking structure) I have had Three surgeries on my back, 2 on my knee, 2 on my shoulder, and the rest were a series of surgeries as a result of a head injury that ranged from ENT to vascular surgeries. (This was before I was diagnosed with breast cancer) The first time I was given Actiq was when I got CMV after radiation, and it caused what they called, "bone pain", which was the worst thing I think I had ever felt in my life. I have some chronic pain issues in the areas I have had surgery, or at the wound areas, but I think the worst thing is, and this is the one thing I cannot get a handle on, is the headaches I get. They don't respond to Migraine meds although they do follow some patterns of migraines, and they are pretty bad. Most of the time injections of tramadol helps, but my doc would give me Actiq in cases where I had already gotten injections and taken some kind of narcotic pain medicine, the Actiq seemed to be the only thing that would give me some immediate relief (although it doesn't last long). This has all been going on over a 8 year period and only 3 of them I have been on some kind of narcotic therapy for chronic pain off and on. So that is where the tolerance issue comes in. I did a pretty good job of alternating meds, or going of and on to try and avoid it and up until recently that worked. Now, I am not sure what to do. My plan is to be off all meds by June, and that is IF, I don't need another vascular surgery since they can't figure out why I can hear my corotic vessel in my left ear! I am seeing a great osteopath who does pain management for me, but also does alernative treatments that have really helped me get through this as a mostly funtioning person. She knew about my situation because she remebers seeing it on the news, and she really has gone above and beyond what most docs would do for their patients. Before I found her, I was dealing with some of the issues people here mention about the scrutiny, and disrespect. Or I just would get pain docs who would tell me to just deal with the fact I would prob. be on pain meds the rest of my life. So, I am thankful I have the care I do now, I am just very conflicted over this medication thing.
Thanks again for your time and for sharing your experiences!:)
dani808
03-20-2007, 02:07 PM
Hi Dani~
Well, let us know how things go at your appointment...)
I have an appt. Thursday. I am going to talk to her about adding another med again to either alternate or back up the one. Maybe there is something new I haven't tried and that my body doesn't know about yet! I have heard about this new one called Fentura which is like Actiq but different somehow I am not sure.
I will ask about the RFA. Thanks for the info!
Well, let us know how things go at your appointment...)
I have an appt. Thursday. I am going to talk to her about adding another med again to either alternate or back up the one. Maybe there is something new I haven't tried and that my body doesn't know about yet! I have heard about this new one called Fentura which is like Actiq but different somehow I am not sure.
I will ask about the RFA. Thanks for the info!
madhatter
03-20-2007, 06:32 PM
I think just about everyone on this board has experienced tolerance etc.
.There is really no ceiling for pain meds.Its up to the doc. They say though that oxycodone out of any other med. you will grow a tolerance quicker.And every doc. has there own theory.My doc. rather perscribe oxycodone based med. than hydrocodone,she believes[her experience with people] hydro. is more addicting than any med. I would ask my doc.[in the past] instead of upping the dosage of the same med,to change the med entirely.[your body gets used to the same med. after a while]I'm very very lucky,i have an understanding doc. But i had to earn her trust.
.There is really no ceiling for pain meds.Its up to the doc. They say though that oxycodone out of any other med. you will grow a tolerance quicker.And every doc. has there own theory.My doc. rather perscribe oxycodone based med. than hydrocodone,she believes[her experience with people] hydro. is more addicting than any med. I would ask my doc.[in the past] instead of upping the dosage of the same med,to change the med entirely.[your body gets used to the same med. after a while]I'm very very lucky,i have an understanding doc. But i had to earn her trust.
Fibbles
03-21-2007, 02:00 AM
I'm pretty tolerant to Oxycodone, because I've been taking it in the same 5mg dose for the past 10 years or so. I'm still able to use it for BT pain by going off of it for around 3 months and then switching back. Even though that does reduce some of the overall tolerance, it comes back very quickly. I don't want to take more, because it makes me feel weird and makes me itch intensely behind my eyes (it's a screwy feeling to itch behind your eyes!)
After I started on LA Morphine I was given 10mg SA Morphine for BT and that scared me quite a bit because I was so afraid of becoming tolerant and having that tolerance hurt the LA Morphine's effectiveness. For me, 120mg of Avinza (a supposed 24 hour Morphine formulation; supposed because it doesn't last the full 24 for some people) is perfect. I've been on 120mg for the past year and it seems to be working just as well as when I started.
After I started on LA Morphine I was given 10mg SA Morphine for BT and that scared me quite a bit because I was so afraid of becoming tolerant and having that tolerance hurt the LA Morphine's effectiveness. For me, 120mg of Avinza (a supposed 24 hour Morphine formulation; supposed because it doesn't last the full 24 for some people) is perfect. I've been on 120mg for the past year and it seems to be working just as well as when I started.