judi12
08-03-2008, 03:36 PM
for 6yrs ive been on pain meds about 3 years ago i went to my current dose 200mcg duragesic patches with dilaudid for bt. for the last couple of years ive been doing less and less and staying in bed longer w/o any change in my condition. Now ive been having more and more days of sweating/anorexia/nausea etc. Could i be in withdrawl by just not increasing my dose for several years?? thank you
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Executor
08-04-2008, 12:27 AM
for 6yrs ive been on pain meds about 3 years ago i went to my current dose 200mcg duragesic patches with dilaudid for bt. for the last couple of years ive been doing less and less and staying in bed longer w/o any change in my condition. Now ive been having more and more days of sweating/anorexia/nausea etc. Could i be in withdrawl by just not increasing my dose for several years?? thank you
Very possible. Have you changed brands by chance (of the same med)?
Ex
Very possible. Have you changed brands by chance (of the same med)?
Ex
cmpgirl
08-04-2008, 12:10 PM
Hi Judi, Welcome to the boards! I just wanted to comment on your question. Even though we all have different metabolisms and our bodies process pain meds in their own unique ways, I know for me, there have been a few times during my years of living with chronic pain that I have become tolerant of the current dose of meds and have felt mild to moderate withdrawl symptoms.
Luckily, I am blessed with a PM doc who has always been on board with any changes or modifications that were needed in my PM regimine. If anything, I have been the one who has held off on increases or additions, because I never wanted to find myself "maxed out" in the med department.
When I finally expressed my fears to my PM regarding the reason for turning down some of the increases that he offered, he helped me to understand that I was not on that high of a dose to begin with and that because of changes in my pain and tolerance, the occasional increase was perfectly normal. He gave me a really good explaiation about how it works. I have finally become comfortable accepting or even suggesting that an increase might be needed.
If your doc is as proactive and open minded as mine is, I would think he/she would not have a problem with adjusting your dose(s), especially after 3 years. I know some docs are not as quick to increase meds, but I think you should at least communicate your need for a med adjustment. The way I look at it is, if your doc doesn't know that your needs have changed, he/she can't help.
I hope this was helpful. Please let us know how you are doing. And again, Welcome to the "family"! Take care, CMP/MM
Luckily, I am blessed with a PM doc who has always been on board with any changes or modifications that were needed in my PM regimine. If anything, I have been the one who has held off on increases or additions, because I never wanted to find myself "maxed out" in the med department.
When I finally expressed my fears to my PM regarding the reason for turning down some of the increases that he offered, he helped me to understand that I was not on that high of a dose to begin with and that because of changes in my pain and tolerance, the occasional increase was perfectly normal. He gave me a really good explaiation about how it works. I have finally become comfortable accepting or even suggesting that an increase might be needed.
If your doc is as proactive and open minded as mine is, I would think he/she would not have a problem with adjusting your dose(s), especially after 3 years. I know some docs are not as quick to increase meds, but I think you should at least communicate your need for a med adjustment. The way I look at it is, if your doc doesn't know that your needs have changed, he/she can't help.
I hope this was helpful. Please let us know how you are doing. And again, Welcome to the "family"! Take care, CMP/MM
judi12
08-04-2008, 11:54 PM
wow what a welcome! and right on the money. My Dr. is very good I'm the one holding back on any increase for all the same reasons and another - denial. Before they found the tumors on my spine I was very active/atheletic. Even after the surgeries they said i probably wouldn't walk again so the first thing i did was prove them wrong but now i do nothing and wonder if the meds contribute to that. When i suggested tapering off the meds my Dr. strongly advised against it. A little acceptance will go a long way-i'm glad to be here. And to Executor same meds but i switch between sandoz and brand w/o much difference. Thanks all..
Executor
08-05-2008, 12:27 AM
And to Executor same meds but i switch between sandoz and brand w/o much difference. Thanks all..
Ahhhh....Here lies a big part of your problem...As I suspected. I didn't want to say anything however, until I heard back from you.
I strongly suggest you do a search on this board for a thread called "brand vs. generic- major findings." I won't rehash everything here, but long story short, there is often a difference between a "brand" and it's generic. The Hatch-Waxman act of 1999 was passed in response to escalating drug prices in the 90s.....According to the FDA, the act pretty much created the current generic system/market.
Generics are permitted a 20% window of the active ingredient, which helps keep costs to the consumer down. A med that is +/- 20% is considered "close enough" or "bioequivalent." While this is true for most meds, it creates an issue with pain meds. Not only is 20% difference a lot for pain meds, but especially so for potent meds, like fentanyl. The generics must stay within 20% of the brand....But brands must be dead on across the board as part of the truth and labeling via the FDA. If a pill says 10mg, it must be 10mg. But, generics are given leeway as a way to control costs and prices to the consumer.
When I was on the patch, I noticed huge differences between the brand, Duragesic, and Sandoz. I never tried Watson or Mylan, so I can't comment there. My Doc forbid me from using Mylan, however. He told me that if I filled it and had problems, to not call for a replacement because he warned me...How about that for a statement! I found the Duragesic to be much more potent, and stuck better too (I assume, higher quality glue). I would suggest trying to stay on one or the other if you can. This way, you won't have the yo-yo effect of up and down.
Hope this helps, and let me know what you think after you read the other thread...There's lots of good info in there by many people.
Take care, and I hope you feel better.
Regards,
Ex
Ahhhh....Here lies a big part of your problem...As I suspected. I didn't want to say anything however, until I heard back from you.
I strongly suggest you do a search on this board for a thread called "brand vs. generic- major findings." I won't rehash everything here, but long story short, there is often a difference between a "brand" and it's generic. The Hatch-Waxman act of 1999 was passed in response to escalating drug prices in the 90s.....According to the FDA, the act pretty much created the current generic system/market.
Generics are permitted a 20% window of the active ingredient, which helps keep costs to the consumer down. A med that is +/- 20% is considered "close enough" or "bioequivalent." While this is true for most meds, it creates an issue with pain meds. Not only is 20% difference a lot for pain meds, but especially so for potent meds, like fentanyl. The generics must stay within 20% of the brand....But brands must be dead on across the board as part of the truth and labeling via the FDA. If a pill says 10mg, it must be 10mg. But, generics are given leeway as a way to control costs and prices to the consumer.
When I was on the patch, I noticed huge differences between the brand, Duragesic, and Sandoz. I never tried Watson or Mylan, so I can't comment there. My Doc forbid me from using Mylan, however. He told me that if I filled it and had problems, to not call for a replacement because he warned me...How about that for a statement! I found the Duragesic to be much more potent, and stuck better too (I assume, higher quality glue). I would suggest trying to stay on one or the other if you can. This way, you won't have the yo-yo effect of up and down.
Hope this helps, and let me know what you think after you read the other thread...There's lots of good info in there by many people.
Take care, and I hope you feel better.
Regards,
Ex
cmpgirl
08-05-2008, 01:38 AM
Judi,
I absolutely agree with Ex. I don't use the fent patch. I take Oxycontin. But I found there is a significant difference between the old generics and the brand name. You may not realize that this has been an issue for you, because it sounds like you have gone back and forth over the years, but I would not be surprised to find that this has contributed to your feelings of withdrawl. (Trust me, Ex is one of our best med researchers!) I also still think that the 3 years of the same dose probably isn't helping like it used to. Unfortunately, tolerance is just one of the many givens of long term opiate/opioid use.
I'm glad you're here too. I hope you get an opportunity to read through this board. I go back and do board searches all the time to get different perspectives and info. And even though we don't all have the exact same conditions, we all share the one thing that binds us...... Pain. I can't even begin to tell all that I've learned here. And the people are amazing, compassionate, caring individuals. So, please post often and feel free to tell us your story. I'm sure you'll find as many good friends as I have. There is even a sub-board up at the top to post your "story".
Take care. I look forward to getting to know you better. CMP/MM
I absolutely agree with Ex. I don't use the fent patch. I take Oxycontin. But I found there is a significant difference between the old generics and the brand name. You may not realize that this has been an issue for you, because it sounds like you have gone back and forth over the years, but I would not be surprised to find that this has contributed to your feelings of withdrawl. (Trust me, Ex is one of our best med researchers!) I also still think that the 3 years of the same dose probably isn't helping like it used to. Unfortunately, tolerance is just one of the many givens of long term opiate/opioid use.
I'm glad you're here too. I hope you get an opportunity to read through this board. I go back and do board searches all the time to get different perspectives and info. And even though we don't all have the exact same conditions, we all share the one thing that binds us...... Pain. I can't even begin to tell all that I've learned here. And the people are amazing, compassionate, caring individuals. So, please post often and feel free to tell us your story. I'm sure you'll find as many good friends as I have. There is even a sub-board up at the top to post your "story".
Take care. I look forward to getting to know you better. CMP/MM
forginon
08-05-2008, 11:08 PM
...but now i do nothing and wonder if the meds contribute to that...
Judi,
About doing nothing.
Is that related to the symptoms you wondered were withdrawals, or has the inactivity just developed over time? Are you able to be active?
Activity is very, very important. Not to the point of damaging yourself, of course, but some level of activity. Chronic pain is hard enough on the body, so it's critical to get the pain under control and find whatever level of activity you can handle.
What levels of pain are you experiencing? If you used a pain scale where 0=no pain and 10=the worst pain you can imagine, what would you say is your average daily pain level? Don't think about this scale too much, just make a good guess.
There are lots of ways to add activity to your lifestyle, probably more than you think, without adding to your pain. And the benefit to your health is immeasurable.
steve
Judi,
About doing nothing.
Is that related to the symptoms you wondered were withdrawals, or has the inactivity just developed over time? Are you able to be active?
Activity is very, very important. Not to the point of damaging yourself, of course, but some level of activity. Chronic pain is hard enough on the body, so it's critical to get the pain under control and find whatever level of activity you can handle.
What levels of pain are you experiencing? If you used a pain scale where 0=no pain and 10=the worst pain you can imagine, what would you say is your average daily pain level? Don't think about this scale too much, just make a good guess.
There are lots of ways to add activity to your lifestyle, probably more than you think, without adding to your pain. And the benefit to your health is immeasurable.
steve
judi12
08-06-2008, 12:15 PM
that makes so much sense i feel like a fool believing "same patch-different box" thats a good start i'll go back to name brand and stick with it. Im very lucky to have insurance and my Dr. will check do not sub.. if i ask him. Thanks Judi
judi12
08-06-2008, 12:30 PM
Thats what i'm confussed about is it my condition or the treatment? but you made me think by just asking the scale question because the answer is not bad maybe a 3/4 so its prob not my condition? You and my doc agree staying in bed too much is not good...I'll try and walk a little more Thank you
judi12
08-06-2008, 12:36 PM
i guess i should have posted 1 response to everyone :) the true benefits of my finding this site will be my friends and family. i'm sure they're tired after 6 yrs of my pain/med stuf (though they'll never say so) but heres a place i can vent and question with people who have long term pain thank you