milwood353
01-22-2008, 12:18 PM
Hello,
I have been on Norco, Zanaflex, Lyrica and Cymbalta for lumbar discs pain over the last year and so far we can’t find the right meds to work and I need some help with what to suggest to the PM doc. Norco still gives relief but it is short lived; a couple of hours after taking it and I’m back to a 6 on the scale. I take the Zanaflex and Norco before I try and sleep at night and I can get 3-4 hrs of solid sleep. The Lyrica (spl) gave no relief at all so I stopped taking it after 30days. Some of you may have read my post regarding the Cymbalta but for those that haven’t I will say I had a reaction that caused the PM doc to have me stop taking it. I have had several ESI and in the midst of my second round of PT because I am trying to do everything I can to avoid a 3 level fusion.
I am just tried of the relentless aching and I don’t know what to ask the doc for or even how to ask for something different with out sounding like a junky or a burden. I was told yesterday to call the PM doc office this morning because he wanted to make sure I was over the adverse effects of the Cymbalta and the PA asked if I was still uncomfortable and I told her that the current pain med was not working as well as it once did and she went to ask the doc about a different type to prescribe and she came back with "use ice or heat when it is hurting bad". I told her that I don’t want to be a burden but I do do the ice or heat just about everyday (everyday that I have PT, 3-4 days a week) but while I’m at work I don’t have that luxury. Look at me it appears that Woody is having a pity party, sorry guys.
Any ideas on a better, longer lasting pain med would really be helpful.
Woody,
I have been on Norco, Zanaflex, Lyrica and Cymbalta for lumbar discs pain over the last year and so far we can’t find the right meds to work and I need some help with what to suggest to the PM doc. Norco still gives relief but it is short lived; a couple of hours after taking it and I’m back to a 6 on the scale. I take the Zanaflex and Norco before I try and sleep at night and I can get 3-4 hrs of solid sleep. The Lyrica (spl) gave no relief at all so I stopped taking it after 30days. Some of you may have read my post regarding the Cymbalta but for those that haven’t I will say I had a reaction that caused the PM doc to have me stop taking it. I have had several ESI and in the midst of my second round of PT because I am trying to do everything I can to avoid a 3 level fusion.
I am just tried of the relentless aching and I don’t know what to ask the doc for or even how to ask for something different with out sounding like a junky or a burden. I was told yesterday to call the PM doc office this morning because he wanted to make sure I was over the adverse effects of the Cymbalta and the PA asked if I was still uncomfortable and I told her that the current pain med was not working as well as it once did and she went to ask the doc about a different type to prescribe and she came back with "use ice or heat when it is hurting bad". I told her that I don’t want to be a burden but I do do the ice or heat just about everyday (everyday that I have PT, 3-4 days a week) but while I’m at work I don’t have that luxury. Look at me it appears that Woody is having a pity party, sorry guys.
Any ideas on a better, longer lasting pain med would really be helpful.
Woody,
Sponsor
Executor
01-22-2008, 03:36 PM
Sounds like you've built up a litter tolerance which in normal, and need a more long acting med. I'd go back to the Doc and tell him/her that it just isn't working and you need something better. I'm also betting the ups and downs are bothering you too....Another issue with short acting meds. I know NOTHING about your situation, but on the surface, it sounds like you may need a patch, or Oxy. If all else fails, go to another Doc. As you probably know or have read, there is WIDE opinion bases on how to treat pain....Plainly put, some Docs are just more aggressive than others. Good luck in whatever you do.
milwood353
01-22-2008, 03:52 PM
Thanks Professor,
I do have a couple of questions a) what is “litter tolerance b) are you referring to the “ups and downs” as in attitude swings of the highs and lows? The doc told me that the Cymbalta would help with the highs and lows as well as the pain. If I decide to go to another doc is it expected to take with you your medical records from the pain mgnt doc I am currently seeing or are they not likely to give that info to me? I know there are 3 sets of full MRIs and a set of xray plus, discogram data and CT scans, in al the folder is about 4 inch 5 thick of papers and DVDs.
I do have a couple of questions a) what is “litter tolerance b) are you referring to the “ups and downs” as in attitude swings of the highs and lows? The doc told me that the Cymbalta would help with the highs and lows as well as the pain. If I decide to go to another doc is it expected to take with you your medical records from the pain mgnt doc I am currently seeing or are they not likely to give that info to me? I know there are 3 sets of full MRIs and a set of xray plus, discogram data and CT scans, in al the folder is about 4 inch 5 thick of papers and DVDs.
Director
01-22-2008, 04:27 PM
Woody, if I can jump in here, I think what Professor was saying was you're building a little tolerance to the medication you've been taking. The up and downs are most likely referring to your pain cycles going up and down. This means when you're medicated you are doing up, but when it starts to wear off, you're down.
I would think your next medication if your doctor wants to stay with short acting meds, would be Oxycodone (like Percoset), but you could go to a long acting med if your doctor tends to be aggressive in his treatment. It doesn't sound like he is when he says ice and heat, so the next step would probably be Oxy.
There are several LA drugs out there like Oxycontin, several Morphine, and Duregesic (Fentanyl) patches. My guess would be you doc would probably not want to go with one of those though. Good luck and keep us updated what happens when you see your doctor.
I would think your next medication if your doctor wants to stay with short acting meds, would be Oxycodone (like Percoset), but you could go to a long acting med if your doctor tends to be aggressive in his treatment. It doesn't sound like he is when he says ice and heat, so the next step would probably be Oxy.
There are several LA drugs out there like Oxycontin, several Morphine, and Duregesic (Fentanyl) patches. My guess would be you doc would probably not want to go with one of those though. Good luck and keep us updated what happens when you see your doctor.
Executor
01-22-2008, 10:38 PM
Very sorry for the typo....I meant to say "built up a little tolerance" not "litter."
What I mean by the "ups & downs" is the effect of medication in your system. When you first start taking narcotics for pain, most 4 hr meds (like Loratab or percs) will control moderate pain for at least 4 hours, if not more. Not unusual for them to last even 6-8 hours.
However, over time, you build up tolerance and the meds that once lasted 4-6 hours, may only last a couple of hours (2-3 max). Eventually, they won't work well at all. The "ups are the meds entering your system...The "downs" are the meds leaving. The short acting meds are in and out. So, you have "ups and downs" depending on when you took the meds last.
More long lasting meds, like the patch or oxycontin, are long acting in nature. The patch lasts 48-72 hours (the literature says change every 72, but some patients report that it doesn't last that long and need to change every 48). The Oxycontin is every 12 hours...but again, some report the same, and must take more frequently. Tolerance is to blame, as well as one's own individual metabolism. The faster your natural metabolism, the faster you'll burn through the long acting med (in your system).
The point being is that these type of meds stay in your system long and help "level you out" and therefore, decreases the ups and downs. Then, if have breakthough pain, or flareups, another med (usually stronger in nature) can be given for it on a periodic basis. So, your regime would be a long acting med for stability, then another drug (whatever your doc thinks is best) for "breakthrough pain" or flareups.
As far as going to another Dr comment....I was referring to it as a last ditch thing. If your pain is as unbearable as you describe and is going to be a long term type thing, I'd think seriously about getting a new Doc. I'm being crass when I say "are you to ice regularly from here on out on for a good part of your life"?? There has to be a better way. To me, there isn't much worse than uncontrolled pain.
Almost all the long term PM patients I know are eventually put on some type of long acting meds and then the breakthrough pain is addressed on a more individual basis.
Best of luck to you! I feel your pain....Literally.
Good luck!
What I mean by the "ups & downs" is the effect of medication in your system. When you first start taking narcotics for pain, most 4 hr meds (like Loratab or percs) will control moderate pain for at least 4 hours, if not more. Not unusual for them to last even 6-8 hours.
However, over time, you build up tolerance and the meds that once lasted 4-6 hours, may only last a couple of hours (2-3 max). Eventually, they won't work well at all. The "ups are the meds entering your system...The "downs" are the meds leaving. The short acting meds are in and out. So, you have "ups and downs" depending on when you took the meds last.
More long lasting meds, like the patch or oxycontin, are long acting in nature. The patch lasts 48-72 hours (the literature says change every 72, but some patients report that it doesn't last that long and need to change every 48). The Oxycontin is every 12 hours...but again, some report the same, and must take more frequently. Tolerance is to blame, as well as one's own individual metabolism. The faster your natural metabolism, the faster you'll burn through the long acting med (in your system).
The point being is that these type of meds stay in your system long and help "level you out" and therefore, decreases the ups and downs. Then, if have breakthough pain, or flareups, another med (usually stronger in nature) can be given for it on a periodic basis. So, your regime would be a long acting med for stability, then another drug (whatever your doc thinks is best) for "breakthrough pain" or flareups.
As far as going to another Dr comment....I was referring to it as a last ditch thing. If your pain is as unbearable as you describe and is going to be a long term type thing, I'd think seriously about getting a new Doc. I'm being crass when I say "are you to ice regularly from here on out on for a good part of your life"?? There has to be a better way. To me, there isn't much worse than uncontrolled pain.
Almost all the long term PM patients I know are eventually put on some type of long acting meds and then the breakthrough pain is addressed on a more individual basis.
Best of luck to you! I feel your pain....Literally.
Good luck!
badoldback
01-23-2008, 10:43 AM
Hey milwood,
As the others have mentioned, with Norco they are just beginning to scratch the surface as far as Opioid pain medications go. The PM's recommendation to use ice and heat is borderline insulting in my opinion. (This is a pet peeve of mine) If Aspirin and a Band-Aid would help with our problems we would not be wasting our time and money with even a regular doctor, let alone a Pain Management specialist.
As the others have mentioned, with Norco they are just beginning to scratch the surface as far as Opioid pain medications go. The PM's recommendation to use ice and heat is borderline insulting in my opinion. (This is a pet peeve of mine) If Aspirin and a Band-Aid would help with our problems we would not be wasting our time and money with even a regular doctor, let alone a Pain Management specialist.
Fabrashamx
01-23-2008, 02:45 PM
Hi,
I myself have just now switched from short acting meds (tramadol and Lortab 7.5's) to a long acting (methadone) and I can't begin to tell you how much better my life is on the methadone. I started at 10 mgs twice a day, and today he moved me up to 10 mgs 3X a day, and I think that will end up being the magic number, I already felt better, but I was still in some pain, so I think this new dose will put me there.
I agree with Jon, If you want to stay with short acting, your next step is the oxy, if you want to move to long acting, you have many choices, limited only by your doctors willingness and possibly your insurance, if you have no insurance for scripts and want to go with long acting, methadone is probably your cheapest bet.
HTH, Fabby
I myself have just now switched from short acting meds (tramadol and Lortab 7.5's) to a long acting (methadone) and I can't begin to tell you how much better my life is on the methadone. I started at 10 mgs twice a day, and today he moved me up to 10 mgs 3X a day, and I think that will end up being the magic number, I already felt better, but I was still in some pain, so I think this new dose will put me there.
I agree with Jon, If you want to stay with short acting, your next step is the oxy, if you want to move to long acting, you have many choices, limited only by your doctors willingness and possibly your insurance, if you have no insurance for scripts and want to go with long acting, methadone is probably your cheapest bet.
HTH, Fabby
milwood353
01-23-2008, 06:35 PM
I have good news today.
Because of the insight from the those of you that have responded to my cry for help I was able to speak on the same level as my PM doc when he called my this afternoon to see how things were going. I must tell you the conversation was much different than those of the past, thank you all. On Friday the 25th I will be seated with the PM doc and his PA and hopefully when I leave I will be on a LA pain control program.
I am very grateful that someone has the ability to keep this board up and running for those who really need help and for those who can provide it and monitor the cleanliness.
Because of the insight from the those of you that have responded to my cry for help I was able to speak on the same level as my PM doc when he called my this afternoon to see how things were going. I must tell you the conversation was much different than those of the past, thank you all. On Friday the 25th I will be seated with the PM doc and his PA and hopefully when I leave I will be on a LA pain control program.
I am very grateful that someone has the ability to keep this board up and running for those who really need help and for those who can provide it and monitor the cleanliness.
brianpain33
01-23-2008, 06:53 PM
Woohoo celebrate good times come on. :D
Director
01-23-2008, 07:18 PM
Remember Fabby, you have to take Methadone for five days to reach it's maximum serum levels. So, at the end of five consecutive days you will have the true feeling of the pain control you will have with Methadone. I hope this works for you.
Executor
01-23-2008, 11:53 PM
Director is correct.....It takes a little while for the your blood serum levels to elevate and stay elevated. Also, don't forget about the "breakthrough pain." You may have a false sense of security when you first go on long acting meds, but after a little while, your pain sensors in your body will fight through the meds and you'll have "flare ups." For those times, you'll need some other med (whatever your Doc recommends) for the flare ups or breakthrough pain.
What a lot of people don't understand is that with pain control, the meds quiet the sensors in our body. Over time though, the brain keeps sending those sensors and slowly elevates them because it doesn't like to be tricked. So, in theory, pain meds can actually make one more sensitive to pain (over time). There isn't any formula or standard time frame for everyone....It's very individualized based on your condition, meds, & other factors. So my point is that initially, the long acting meds may control ALL your pain, but more than likely, it won't after a while, and you'll need something for breakthrough. Just ask your Doc what he/she recommends for breakthrough. This will be especially true if the strength of the long acting med isn't high enough.
Good luck!:angel:
What a lot of people don't understand is that with pain control, the meds quiet the sensors in our body. Over time though, the brain keeps sending those sensors and slowly elevates them because it doesn't like to be tricked. So, in theory, pain meds can actually make one more sensitive to pain (over time). There isn't any formula or standard time frame for everyone....It's very individualized based on your condition, meds, & other factors. So my point is that initially, the long acting meds may control ALL your pain, but more than likely, it won't after a while, and you'll need something for breakthrough. Just ask your Doc what he/she recommends for breakthrough. This will be especially true if the strength of the long acting med isn't high enough.
Good luck!:angel:
Executor
01-24-2008, 12:02 AM
As a quick follow-up, there are three primary long acting meds that most PM Docs use:
(1) Methadone
(2) Fentanyl Patch
(3) Oxycontin
All three come in varying degrees of strength. Standard protocol is to start the patient at the lowest dose and work up from there, unless the patient is on heavy narcotics already. You may want to do some research ahead of time and learn about the three options.
Due to widespread abuse around the country, the patch has become a big weapon against diversion. After all, it's tamper proof, and you can't get high off it like you can the other two.....So, there isn't much demand for it on the streets. Therefore, A LOT of pain Docs are moving to the patch as the primary long acting med. I say this because you may want to think long and hard about how it would affect you. Personally, I found the patch to be the best of the three in terms of pain control, but I had some issues with it itching and etc. I did much better on it in the winter months due to much less overall body sweat. Each person is different though. I use the patch in the winter months and Oxy the rest of the year. My pain Doc also thinks it helps to rotate meds every so often. Think about the above three options so you'll be prepared once they start making recommendations.
Again, good luck.
(1) Methadone
(2) Fentanyl Patch
(3) Oxycontin
All three come in varying degrees of strength. Standard protocol is to start the patient at the lowest dose and work up from there, unless the patient is on heavy narcotics already. You may want to do some research ahead of time and learn about the three options.
Due to widespread abuse around the country, the patch has become a big weapon against diversion. After all, it's tamper proof, and you can't get high off it like you can the other two.....So, there isn't much demand for it on the streets. Therefore, A LOT of pain Docs are moving to the patch as the primary long acting med. I say this because you may want to think long and hard about how it would affect you. Personally, I found the patch to be the best of the three in terms of pain control, but I had some issues with it itching and etc. I did much better on it in the winter months due to much less overall body sweat. Each person is different though. I use the patch in the winter months and Oxy the rest of the year. My pain Doc also thinks it helps to rotate meds every so often. Think about the above three options so you'll be prepared once they start making recommendations.
Again, good luck.
Fabrashamx
01-24-2008, 03:07 AM
Proff, I would like to respectfully disagee with you about the patch, it certainly is abusable, I have read of ways I would rather not share here, but it certainly is diverted, abused, and in fact is highly desirable to street drug users.
I wonder if you are confusing it with the numbing patch? Fentynyl is bar none, the strongest opiate on the market, and is very very dangerous when diverted, because even at lower doses it can kill someone who is not already opiate tolerant.
I would like to ask Dave or Jon or Kathy to chime in on this one, I am pretty sure I am right, but I dont want to disreguard your statement if I misunderstood something, and I certainly mean no disrespect, your posts are always so friendly and helpful.
Your Friend, Fabby
I wonder if you are confusing it with the numbing patch? Fentynyl is bar none, the strongest opiate on the market, and is very very dangerous when diverted, because even at lower doses it can kill someone who is not already opiate tolerant.
I would like to ask Dave or Jon or Kathy to chime in on this one, I am pretty sure I am right, but I dont want to disreguard your statement if I misunderstood something, and I certainly mean no disrespect, your posts are always so friendly and helpful.
Your Friend, Fabby
milwood353
01-25-2008, 12:28 PM
Back from the PM doc and he was very open to the LA meds however; we decided to go with percocet 10/325 until we see how I am doing after the current round of ESI.
Last night I had a full 7 hours of sleep and that is the first time in several months I have slept month than a couple of hours at a time. I can tell a big difference in the relief between the norco 10/325 and the percocet 10/325.
Again thanks everyone for the information.
Last night I had a full 7 hours of sleep and that is the first time in several months I have slept month than a couple of hours at a time. I can tell a big difference in the relief between the norco 10/325 and the percocet 10/325.
Again thanks everyone for the information.
forginon
01-25-2008, 07:54 PM
Fabby,
You are absolutely correct about the patch and abuse. But I wonder about the two different kinds of patches. I know for sure that the Duragesic type patch with the reservoir is getting abused left and right, and there's growing concern about it. However, aren't there other patches that work a little different (sorry, I just don't know much about them), like the Mylan or other maker's patches? Are they as easy to abuse?
steve
You are absolutely correct about the patch and abuse. But I wonder about the two different kinds of patches. I know for sure that the Duragesic type patch with the reservoir is getting abused left and right, and there's growing concern about it. However, aren't there other patches that work a little different (sorry, I just don't know much about them), like the Mylan or other maker's patches? Are they as easy to abuse?
steve
Fabrashamx
01-25-2008, 10:02 PM
Hi Steve, Yeah, I am not sure about all types, either, but Dave has said before, where there is a will, theres a way, and other than specific ways I have heard of to abuse them, I'm sure there are more I have never heard of.
But I have read they are almost as highly used and expensive on the streets as the actiq pops, which can also kill people not used to a daily opiate.
:)
But I have read they are almost as highly used and expensive on the streets as the actiq pops, which can also kill people not used to a daily opiate.
:)
Executor
01-26-2008, 12:53 AM
Fab- Yes, where there is a will, there is a way, and I guess anything is possible. However, what I mean by much less potential is a couple of things:
(1) It is very difficult to extract the fentanyl from the patch, especially since it's mixed with facilitators. Additionally, there's only so much in there. Yes, fentanyl is much more powerful than other narcotics, but it's also given in much lower doses or mcg...micrograms (instead of milligrams). Conversely, the pops you referenced are much higher doses and meant for quick, immediate pain relief for Cancer patients. If you read the insert, you'll see where peak blood plasma levels are within 20-30 minutes! It's almost all gone within 3-4 hours. Yes, Docs use the pops for off label uses, but it's not meant for that. Most insurance companies will only pay for it if you have cancer. It's expensive as you know what!
(2) Furthermore, when I made my reference to less abuse potential, I was primarily comparing it to Oxys. As you probably know, Oxys are the drug of choice for most abusers. Trust me on this....PM Docs would much rather prescribe 10 patches (one every 72 hours) than 60 Oxys (every 12 hours).
Hope this helps clear up what I meant.
Mill- Sounds like you are on the right track now. Good luck!
(1) It is very difficult to extract the fentanyl from the patch, especially since it's mixed with facilitators. Additionally, there's only so much in there. Yes, fentanyl is much more powerful than other narcotics, but it's also given in much lower doses or mcg...micrograms (instead of milligrams). Conversely, the pops you referenced are much higher doses and meant for quick, immediate pain relief for Cancer patients. If you read the insert, you'll see where peak blood plasma levels are within 20-30 minutes! It's almost all gone within 3-4 hours. Yes, Docs use the pops for off label uses, but it's not meant for that. Most insurance companies will only pay for it if you have cancer. It's expensive as you know what!
(2) Furthermore, when I made my reference to less abuse potential, I was primarily comparing it to Oxys. As you probably know, Oxys are the drug of choice for most abusers. Trust me on this....PM Docs would much rather prescribe 10 patches (one every 72 hours) than 60 Oxys (every 12 hours).
Hope this helps clear up what I meant.
Mill- Sounds like you are on the right track now. Good luck!