skip89
11-30-2008, 09:51 PM
Over a couple year period I have been treated for disc problems, spinal stenosis, degeneration problems and a basic diagnosis of cronic pain. boy, did I just shorten and simplify my problems. Anyway, I am now at oxycontin in the morning, mid day (8 hrs), and in the eve. I have up to 4 hydrocodone a day for break through pain if needed. I need all of it to be at a 5-6 pain level.
I would like to go for maybe a 3 level if possible. How to approach my Pm doc. He is really good but does not want to give me more bk meds. Honestly, any more oxy and I won't function very well. Any opinions? Thanks:)
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I would like to go for maybe a 3 level if possible. How to approach my Pm doc. He is really good but does not want to give me more bk meds. Honestly, any more oxy and I won't function very well. Any opinions? Thanks:)
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skip89
12-10-2008, 10:38 PM
Is the new trend away from break through meds? I never abuse any of my meds and really feel that you get better results with the right combination of medications. I do feel like more hydrocodone and less tylenol would work better. Comments?
katlin09
12-10-2008, 11:12 PM
I don't know that it's the trend...but people rely on breakthru meds as daily pain meds. And that totally misinterprets the definition of "break thru". These meds are meant to be used only occasionally if your long term pain meds are not covering pain spikes or flare ups. If you're having to use your break thru meds at max. capacity everyday, then perhaps it's a better idea to talk to your PM about upping your long term pain meds.
Kat
Kat
Shoreline
12-11-2008, 07:37 AM
Hey Skip, It's best to simply discusss the goals of PM with your doc. A 3 may never be reasonable given the condition of your back, I have a pump and an unstable fusion and at at best, I can get in the 5 or 6 range. If I take more or they increase the dose, I'm at the point where I really don't want to deall with additional side efects. But untill you know the goal of treatment you will never know if it's reasonable to ask or expect more. Of course more pain meds means more pain relief, But there has to be a middle ground where you can function and aren't simply taking as much as posible every day so that you don't have to to learn to cope with any residual pain.
If you take the max amount of BT medication every day just to keep your pain as low as possible, are the meds really for BT pain or simply part of your regemine to live as pain free as possible. By definition, It doesn't sound like the Hydro is a BT med any longer, just part of your every day routine, Whart hapens if you slip down the last 3 stairs or the weather drops 30 degrees over night and your pain increases for a couple days? That's what the BT meds are for, But since they have become a part of your routine, any increase in pain from weather or a slight slip or fall, and you have nothing extra to take, just the same dose you take every day.
There are some general rules about BT meds and your doc is already exceeding that. If your need BT meds more than twice a day, your doc should consider increasing your dose, If your goals simply aren't realistic, your doc should make the goals clear so that your both working towards and satisfied with the same goal. There are some docs that won't use BT meds because they believe your going to take the max regardless of how many they give you. If they give you 2 doses a day your take it, If they give you six you will take that and still not have an actual BT med that allows you to take extra when your having true BT pain or have caused a flair from activity or the weather or whatever the case may be.
What's it going to take to satisfy you and how long wil you be satisfied given the fact you will get used to and tolerant to whatever you are given for BT if you take the max dose every day. There are people that are given extremely potent BT meds like aqtiq and still end up in the ER wanting the BT pain treated with aditional meds. Isn't that what the doc prescribed BT meds for, so you don't have to go to the ER or increase your dose everytime the weather changes or your activity causes aditional pain? Talk to your doc and be honest about your BT med use and be clear your both on the same page as far as goals of treatment.
Good luck Dave
If you take the max amount of BT medication every day just to keep your pain as low as possible, are the meds really for BT pain or simply part of your regemine to live as pain free as possible. By definition, It doesn't sound like the Hydro is a BT med any longer, just part of your every day routine, Whart hapens if you slip down the last 3 stairs or the weather drops 30 degrees over night and your pain increases for a couple days? That's what the BT meds are for, But since they have become a part of your routine, any increase in pain from weather or a slight slip or fall, and you have nothing extra to take, just the same dose you take every day.
There are some general rules about BT meds and your doc is already exceeding that. If your need BT meds more than twice a day, your doc should consider increasing your dose, If your goals simply aren't realistic, your doc should make the goals clear so that your both working towards and satisfied with the same goal. There are some docs that won't use BT meds because they believe your going to take the max regardless of how many they give you. If they give you 2 doses a day your take it, If they give you six you will take that and still not have an actual BT med that allows you to take extra when your having true BT pain or have caused a flair from activity or the weather or whatever the case may be.
What's it going to take to satisfy you and how long wil you be satisfied given the fact you will get used to and tolerant to whatever you are given for BT if you take the max dose every day. There are people that are given extremely potent BT meds like aqtiq and still end up in the ER wanting the BT pain treated with aditional meds. Isn't that what the doc prescribed BT meds for, so you don't have to go to the ER or increase your dose everytime the weather changes or your activity causes aditional pain? Talk to your doc and be honest about your BT med use and be clear your both on the same page as far as goals of treatment.
Good luck Dave
katlin09
12-11-2008, 02:13 PM
Dave,
Said it very well and pretty much covered all of the bases. 4 months ago I was on fentanyl and oxycontin for long term and oxycodone for BT, which is a heck of alot of pain meds. I'm now down to a high dose of oxycontin for long acting and highest mg percocets for BT, which I try not to use during the day unless I just have to, otherwise they just aren't going to work, and I'm going to have to go back up to the stronger stuff, which I don't want to do. So you kind of have to chose your battles and decide where you want to be, my pain is never less than a 4, but that's what I've decided with my PM that I can tolerate on a daily basis. Plus I have to take alot of psych. meds and these two meds don't always play nice together. So working full time and raising a son, I have to be functional and "with it" at all times.
Kat
Said it very well and pretty much covered all of the bases. 4 months ago I was on fentanyl and oxycontin for long term and oxycodone for BT, which is a heck of alot of pain meds. I'm now down to a high dose of oxycontin for long acting and highest mg percocets for BT, which I try not to use during the day unless I just have to, otherwise they just aren't going to work, and I'm going to have to go back up to the stronger stuff, which I don't want to do. So you kind of have to chose your battles and decide where you want to be, my pain is never less than a 4, but that's what I've decided with my PM that I can tolerate on a daily basis. Plus I have to take alot of psych. meds and these two meds don't always play nice together. So working full time and raising a son, I have to be functional and "with it" at all times.
Kat
Ana80
12-11-2008, 06:25 PM
hi -
you have to do what works for you. I didn't read anything about you going to the ER requesting addition medication. I want to live as pain-free as possible, and so long as my definition falls within the confines of my Dr's set of rules that we have set up, I'm fine. I use b/w 4-6 units of Actiq/day.
I am prescribed 6 ... is this a lot? To some, it is. For me, I live better. If I don't take it, my pain gets so bad, I honestly cannot function. I am in my first year of law school, too; staying home is
NOt an option.
The bottom line I'll reiterate: one must do what (in conjunction w/one's Dr, of course) allows the least amount of suffering coupled with greastest soundness of health and mind. Ultimately, these three go hand in hand.
you have to do what works for you. I didn't read anything about you going to the ER requesting addition medication. I want to live as pain-free as possible, and so long as my definition falls within the confines of my Dr's set of rules that we have set up, I'm fine. I use b/w 4-6 units of Actiq/day.
I am prescribed 6 ... is this a lot? To some, it is. For me, I live better. If I don't take it, my pain gets so bad, I honestly cannot function. I am in my first year of law school, too; staying home is
NOt an option.
The bottom line I'll reiterate: one must do what (in conjunction w/one's Dr, of course) allows the least amount of suffering coupled with greastest soundness of health and mind. Ultimately, these three go hand in hand.
katlin09
12-12-2008, 01:16 AM
The only problem with that opinion is that if your taking your max of a very strong pain med, what happens when it stops controlling the pain and you have no where farther up to go to get more relief? That is something that needs to be considered...
Kat
Kat
Mumbles401
12-12-2008, 08:52 AM
I have had the same problem before, I had tried the fentanyl patch for a month trial and it gave me bad headaches. Go into your next dr appointment and express your concerns, dont make any demands but tell the dr how your body is getting used to the meds and they are not working as well as they used to. As long as you are not a problem patient, running out early, abusing your meds, I see know reason why he dr. wouldnt put you on a trial of something else.
FYI- your dr. may stop your BT meds while you try a new med so be prepared. The patch may work for you, or Avinza (spelled wrong???) it is a once a day LA med with morphine in it
good luck
FYI- your dr. may stop your BT meds while you try a new med so be prepared. The patch may work for you, or Avinza (spelled wrong???) it is a once a day LA med with morphine in it
good luck
lifeaftr40
12-12-2008, 02:19 PM
I was originally on the Fentynal patch with percocets for BT up to 4 a day. I needed all 4 and really then some to make it through the day. Last appointment I brought it up that I needed all daily allowances fro BT and still wasn't good. Change made to MS Contin and with same dosage of percocet for breakthrough pain. The MSContin=== 2 x a day.
I have had to use the percs for breakthrough SOME DAYS but not all four allowed pills. So finally a medication has been discovered that WORKS for me to keep my daily intake of meds to a mimmum. Some days I do need my BT meds and somedays I don't...Now I know that IF I have an active day or another minor injury I have extra meds to fall back on
I have had to use the percs for breakthrough SOME DAYS but not all four allowed pills. So finally a medication has been discovered that WORKS for me to keep my daily intake of meds to a mimmum. Some days I do need my BT meds and somedays I don't...Now I know that IF I have an active day or another minor injury I have extra meds to fall back on
skip89
12-15-2008, 10:55 PM
I went to my PM doc this week and told him how I was using everything each day on most days. That is 80 mgs of oxycontin and 30 mgs of hydrocodone in 24 hrs. Next mo. we are going to look at changing something. I told him I feel like I need some break throughs for the break throughs. Laughing..... On this routine for a good while, so might I be looking at wd's? The oxy is gaining on me even though I am not doing more than prescribed.:(