lgriffincsa
07-09-2003, 02:07 AM
To those who are taking Oxycontin for cronic pain. I hope y'all dont mind me asking this question. I would like some details as to how your Dr. started you on Oxycontin. I have DDD, a bulge at L4-L5 and L5-S1. My Ortho. sent me to a PM dr. because he did not think I was a good candidate for surgery at this time. My PM Dr. has me on percocet 7.5/325. He insisted a undergo a Discogram, which I did today, and the results comfirmed a tear at L4/L5, which is what is causing my pain. The percocet do not do an adaquate job at controling my pain, which I have pointed out to my PM Dr. twice before I had the DG. He really has taken a lets wait and see what the DG tells us attitude. I have taken Oxycontin in the past, and it (20mg. 2 times per day) did an excellent job at controlling mh pain. Before the DG, my PM Dr. was insisting on some form of surgery to releive my pain. I am taking my Orho.'s advice to not have surgery at this time. I would like to know what I need to do/say to have my PM prescribe this med. to me? Thanks for the advise.
Sponsor
HikingFan
07-09-2003, 02:31 AM
Hi there
I hate to sound pessimistic, but I think that you will run into trouble asking for this drug by name. It has had so much bad hype in the media, that any doctor will get suspicious if you ask for it, no matter how valid your reason. In my experience I have found that dr's in general do not like you "telling" them what you want, even if it is backed by a valid reason and solid research. And to suggest a jump from a fairly moderate narcotic (you are taking 7.5 percs, right?) to something much stronger will trigger suspicion.
I am not doubting that your pain is legitimate, so please don't take it that way! I just know that many PM docs are going to run the gammet of medications before jumping to something so strong. Maybe try telling them that you need something not only stronger, but something that lasts longer. I was on Norco (which is vicodin, but has less tylenol, 10/325) and I was sick of taking it every 6 hours, so I requested something stronger, and longer lasting, and they gave me oramorph (sustained release morphine). Unfortunately, I am not happy with it, because since it is long lasting, I feel drugged all the time. I am going to ask to step back down to the norco next time I see my doc. At least with the norco, it works instantly when you need it, and wears off in a few hours, whereas with the SRmorphine, it takes 1.5hour to kick in, and then makes me tired for the next 8 hours.
Sorry I can't be more helpful, but I really think you will get into a bind if you ask for oxycontin by name. Especially since your doctor sounds super-conservative.
Best of luck to you!!!!!
:wave:
I hate to sound pessimistic, but I think that you will run into trouble asking for this drug by name. It has had so much bad hype in the media, that any doctor will get suspicious if you ask for it, no matter how valid your reason. In my experience I have found that dr's in general do not like you "telling" them what you want, even if it is backed by a valid reason and solid research. And to suggest a jump from a fairly moderate narcotic (you are taking 7.5 percs, right?) to something much stronger will trigger suspicion.
I am not doubting that your pain is legitimate, so please don't take it that way! I just know that many PM docs are going to run the gammet of medications before jumping to something so strong. Maybe try telling them that you need something not only stronger, but something that lasts longer. I was on Norco (which is vicodin, but has less tylenol, 10/325) and I was sick of taking it every 6 hours, so I requested something stronger, and longer lasting, and they gave me oramorph (sustained release morphine). Unfortunately, I am not happy with it, because since it is long lasting, I feel drugged all the time. I am going to ask to step back down to the norco next time I see my doc. At least with the norco, it works instantly when you need it, and wears off in a few hours, whereas with the SRmorphine, it takes 1.5hour to kick in, and then makes me tired for the next 8 hours.
Sorry I can't be more helpful, but I really think you will get into a bind if you ask for oxycontin by name. Especially since your doctor sounds super-conservative.
Best of luck to you!!!!!
:wave:
lgriffincsa
07-09-2003, 04:04 AM
Hikeingfan,
I want to thankyou for your candor. I had the same estimation of the possible outcome if I were to ask for a med by name. I have asked for something that lasts longer and was stronger, I even voiced my concerns about the amount of APAP that I injest daily. My ortho started me on 5mg percocet. My 1st visit with the PM Dr. I told him it didnt control my pain. He increased me to 7.5mg percocet. After 1 month of taking this, I had another appt. with him, to discuss my DG.He had already given me a refill prescription at my last visit. I told him again that the medicine didnt work very well, nor last very long. I admitted to him that I was taking twice the prescribed dosage, and that I was about to run out. I told him that I had 2 days of meds left on a script that was supposed to last for another week. We talked about my APAP intake, which at present is 2600mg per day. He wasn't concerned with those amounts, and gave me an analogy that even though I had heard of people getting ran over in a grocerystore parking lot, I still was willing to take the risk of going grocery shopping because I needed the food; just like there are risks of liver damage with high levels of APAP, I need the pain releif, so the risk is worth it, in his eyes. To shorten the story, He changed the refill date on my script so that I could have it filled a week in advance. He didnt question me, scold me or anything. I just think it is odd that he is aware of #1 I am taking twice the prescribed dose to get any releif, and #2 he is not concerned about the APAP levels. Like I said earlier, I just had the DG today, and again I will run out of meds 1 week before I am supposed to. I have to call his office in the next day or 2 at the most, to get another refill. I see him again on the 22nd of this month for a followup on my DG. I was hopeing that you or someone else could give me some advice about pointing out the ovious to my Dr. (I need longer lasting, stronger meds)since my efforts have failed. Maybe he will be more open to suggestions now that he has his beloved DG results in hand, whereas in his own words, "All I know right now is that I have a paitent with a backache". I guess I should again stress my concerns over my APAP intake, and stear clear of making any specific requests for meds, even though I know they work as needed for my condition. Thanks for listening.
------------------
1998-Major rear-end colision
1998-mid2000-Chiropractic care
2000-mid2002-Pain level increased drasticly. No insurance, took a combo of every OTC painreleiver imaginable.
2002-MRI/ L3/L4 and L4/L5 annular bulging; DDD L4-5 and L5-S1
2003 February- Orthopeadic Spinal Surgeon said not a candidate for surgery,Percocet 5/325 every 6 hrs.
2003 June-1 month at PM clinic, Percocet 7.5/325 every 4 hrs. PM wants to discogram, fusion or IDET.
I can function/work for 3-4 hrs per day/ 2/3 days per week with current meds. I beleive I could function/work normal hours with stronger, timereleased meds. Surgery is NOT an option at this time.
I want to thankyou for your candor. I had the same estimation of the possible outcome if I were to ask for a med by name. I have asked for something that lasts longer and was stronger, I even voiced my concerns about the amount of APAP that I injest daily. My ortho started me on 5mg percocet. My 1st visit with the PM Dr. I told him it didnt control my pain. He increased me to 7.5mg percocet. After 1 month of taking this, I had another appt. with him, to discuss my DG.He had already given me a refill prescription at my last visit. I told him again that the medicine didnt work very well, nor last very long. I admitted to him that I was taking twice the prescribed dosage, and that I was about to run out. I told him that I had 2 days of meds left on a script that was supposed to last for another week. We talked about my APAP intake, which at present is 2600mg per day. He wasn't concerned with those amounts, and gave me an analogy that even though I had heard of people getting ran over in a grocerystore parking lot, I still was willing to take the risk of going grocery shopping because I needed the food; just like there are risks of liver damage with high levels of APAP, I need the pain releif, so the risk is worth it, in his eyes. To shorten the story, He changed the refill date on my script so that I could have it filled a week in advance. He didnt question me, scold me or anything. I just think it is odd that he is aware of #1 I am taking twice the prescribed dose to get any releif, and #2 he is not concerned about the APAP levels. Like I said earlier, I just had the DG today, and again I will run out of meds 1 week before I am supposed to. I have to call his office in the next day or 2 at the most, to get another refill. I see him again on the 22nd of this month for a followup on my DG. I was hopeing that you or someone else could give me some advice about pointing out the ovious to my Dr. (I need longer lasting, stronger meds)since my efforts have failed. Maybe he will be more open to suggestions now that he has his beloved DG results in hand, whereas in his own words, "All I know right now is that I have a paitent with a backache". I guess I should again stress my concerns over my APAP intake, and stear clear of making any specific requests for meds, even though I know they work as needed for my condition. Thanks for listening.
------------------
1998-Major rear-end colision
1998-mid2000-Chiropractic care
2000-mid2002-Pain level increased drasticly. No insurance, took a combo of every OTC painreleiver imaginable.
2002-MRI/ L3/L4 and L4/L5 annular bulging; DDD L4-5 and L5-S1
2003 February- Orthopeadic Spinal Surgeon said not a candidate for surgery,Percocet 5/325 every 6 hrs.
2003 June-1 month at PM clinic, Percocet 7.5/325 every 4 hrs. PM wants to discogram, fusion or IDET.
I can function/work for 3-4 hrs per day/ 2/3 days per week with current meds. I beleive I could function/work normal hours with stronger, timereleased meds. Surgery is NOT an option at this time.
chriztene
07-09-2003, 06:55 AM
Griffin,
It sounds as though your doctor isnt comfortable with prescribing the longer acting meds and some doctors arent.
You might have to be referred to pain management. The first thing the pm doctor wanted to do was take me off of the percosets and put me on a longer acting med without all the tylenol. I am still allowed the percosets for break thru.
The pm doctor even stated the long acting med manages the pain better and you dont have those ups and downs as you do when taking the instant release. (percosets)
It sounds like you have said all the right things...You might keep stating you really do not like all the tylenol and you have read on the internet about the longer acting meds and 'ask' him what he thinks about trying that route..
Best Wishes,
Chriztene
It sounds as though your doctor isnt comfortable with prescribing the longer acting meds and some doctors arent.
You might have to be referred to pain management. The first thing the pm doctor wanted to do was take me off of the percosets and put me on a longer acting med without all the tylenol. I am still allowed the percosets for break thru.
The pm doctor even stated the long acting med manages the pain better and you dont have those ups and downs as you do when taking the instant release. (percosets)
It sounds like you have said all the right things...You might keep stating you really do not like all the tylenol and you have read on the internet about the longer acting meds and 'ask' him what he thinks about trying that route..
Best Wishes,
Chriztene
TDHZ28
07-09-2003, 12:50 PM
Has it been made apparent or discussed that you will need to stay on long acting meds and no other treatment will work? I ask because that is usually when they will go to the oxy or morphine meds. When they can document that this is all this patient can do at this point. If they think your pain will heal and not be long lasting they don't wanna gt you on meds that they will have to taper you off of. The short acting meds, like percocet are really just for short pain episodes. Ask him "do you think I will always need pain meds, and if so what can we go to that is long acting and not hurt my liver?" If he has other plans to treat you he wont want to get you on a med that will be hard to come off of. In my case, the percocet 10/325 6x day wasnt working, so they said, ok you will be on narcotics for all your life and here are your choices, I chose oxy/w/oxyir. I went from 40mgs twice a day to 80mgs 3x day. I have great relief. I had a hard time each time they increased it, but now I am adjusted and doing better. Good luck and I hope it all works out well, I didnt mean to sound preachy but I've been in this PM mess long enough to know how they work and think. It all depends on your personal pain situation and your Dr.'s treatment beliefs. Take care, THERESA
------------------
pain from cervical radiculopathy, spondy, permanent nerve damage, c5/6 buldging dics, DDD,nerve root lesions, anxiety.depression from chronic pain or vice versa. current meds,oxycontin 2 40's twice a day, oxyir for B/T, xanax, paxil, estratest, synthroid, phenergran.
------------------
pain from cervical radiculopathy, spondy, permanent nerve damage, c5/6 buldging dics, DDD,nerve root lesions, anxiety.depression from chronic pain or vice versa. current meds,oxycontin 2 40's twice a day, oxyir for B/T, xanax, paxil, estratest, synthroid, phenergran.
Shoreline
07-09-2003, 03:31 PM
Hi Griff, I wasn't started on Oxycontin until after 3 back surgeries failed and every non opiate modality had been tried over an 8 year period. No doc is going to keep you on short acting meds indefinitely.
If you have reached the point where nothing else works then docs really need to document that they have tried other methods to relieve your pain. The use and need for these meds must be justified. If there is truly no other option than the meds have a place and you make the trade of dependence for relief
Now you know that you have a bad disc, why not look into artificial disc replacement, fusion possibilities to take the pressure of the bad disc, Prolo therapy, ESI's or other modalities that may offer a cure rather than just masking the pain indefinitely.
Most surgeons know that a disc can heal itself. There are also minimally invasive surgeries like micro discectomies to relieve disc pain.
I do believe the meds have a place when there is no other option. You have already seen you own tolerance grow. Hydro products don't work any longer, 5mg percs don't work, now 7.5 mg percs don't work and the only place to go is up in strength and dosage. You have seen your own toleranc double, in how long?
The standard post op pain regimen for most first time back surgeries is to stay a few days after surgery and come home with at best 2 percs or tylox every 4 hours. You have never had surgery and already your tolerance is beyond what the average ortho or Neuro surgeon is used to prescribing for post op pain.
What happens if they do decide surgery is the right option. Nobody has done you any favors by making you tolerant to what most people that have surgery find very effective for post op pain management. Surgeons or PM docs are not obliged to prescribe doses of meds beyond their comfort level. Surgery on a patient they believe already has dependence issues also makes a surgeon hard to find even when everything points to possible surgical resolution.
Why did your doc say your not a good candidate at this time, when will you be?
One or two bad discs doesn't mean you are condemned to a life of pain. You talking about one surgeons opinion. It sounds like your PM doc wants you to at least try for a cure surgically and pain management will always be there should surgical efforts fail.A second or third surgical opinion may convince him and you that surgery is not an option but I would not let one doc condemn you to a life of pain because he feels your not a good candidate for surgery for whatever reason.
Most folks over 30 have DDD so that diagnosis alone in no way condemns you to a life of pain and opiate dependency.
If surgery is an option, which you should get several surgical opinions. You should do it before your tolerant to say 80 mgs of OxyC 3 times a day. Trust me, you could be there in a year very easily with the wrong doc and not stabilizing your problem area.
I've watched other back pain patients opt not for surgery and just for meds that start at 20mgs of Oxy twice a day and be very happy in the beginning with the pain relief but and at the end of the first year the same guy happy with 20mgs of Oxy twice a day now needs 600 times the original dose a year later, now he's using 600mgs of oxyfast every 4 hours. So he went from 40mgs a day to 2400 mgs a day. This doc has done him no favor.
Short acting meds will raise your tolerance faster than long acting meds and when people tend to relate the warm fuzzy feeling that short acting meds induce to actual anelgesia they run into trouble. You don't need to feel something kick in to get pain relief.
What do you think, should this person have tried a surgical remedy or just keep increasing as the problem worsens although nobody is shooting for a cure?
The whole idea of long acting meds is to stay ahead of the pain and to keep it from spiraling beyond the meds ability to control. LA meds also eliminate that surge that short acting meds have that folks find comforting and then relate that feeling to analgesia.
If you keep on with short acting meds you just become more tolerant, if you go to long acting meds before any surgery is tried you will run into docs that won't touch you until they detox you or they flat out won't prescribe anything additional to what your presently taking post surgically. It's the same as not treating the post op pain at all.
Surgeons don't have the same views on opiates that PM docs do. PM docs are there for when everything else has failed.IMO
If they are quick to condemn you to a life of pain and dependence on them for relief they just make themselves a lifetime customer or at least as long as their license stays in tact.
Simply treating pain with meds when nothing else has been tried is a good way for a doc to loose his license, they do have to document their other efforts to manage your pain before they can justify the use of these meds long term.
I followed another ladies PM journey that had the exact same problems you do. Within a year she went from one or two percs to a pm doc that prescribes 400mgs of oxyC 3 times a day. That's how fast tolerance can grow especially when you pain generator hasn't been stabalized. She's happy with her treatment because she can mask her pain to the point of still being able to function, but that won't last forever unless the problem is stabalized.Then she lost her insurance and do you have any idea how much 1200mgs of Oxyc per day would cost. Around 3k a month. I haven't seen a post from her since the day she lost her insurance. She could have switched to the only cheap med, methadone, but it is kinda scarry that nobaody has seen or heard from her since that lost post. The withdrawal from that level of medication would be monsterous.
The disc continues to go, causing more and more nerve problems creating more and more pain and without trying to stabilize the problem all you can do is keep increasing. If you have surgery and it stabilizes your spine but you still have back pain then it's more likely you could stabilize on a dose of meds that actually work and stick with the same dose for years.
The 3 back surgeries I had disabled me, I'm not a great advocate of surgery but surgery did relieve the neuropathic pain and release the pressure from the nerves and stabilized my spine to the point of being able to stay on the same dose of meds for several years.
If you choose to take one Ortho's advice over your PM suggesting you look into other surgical options I wouldn't count on him being there for the long run as your tolerance continue to grow. The ortho that referred you to PM won't prescribe the meds but says your not a candidate for surgery. Why not look into a cure before committing yourself to a lifetime of dependence?
I'm sure you can eventually find a doc that will treat your pain and if your unlucky you will find one that just keeps increasing your meds rather than looking at the big picture and shooting for a cure.
A PM doc willing to give you whatever you ask for isn't doing you any favors by eliminating the possibility for a cure. I'm just throwing a little different perspective out there. I know pain makes us do crazy things and willing to do anything for relief, But wouldn't a cure be better than a doc that will just give you all the pain meds you need to mask the problem?
I'm not suggesting your a drug seeker or any of the other folks I talked about are. It's just an example of how PM can go when the real problem is never addressed or no attempt to stabilize the problem has been made.
Good luck, Shoreline
If you have reached the point where nothing else works then docs really need to document that they have tried other methods to relieve your pain. The use and need for these meds must be justified. If there is truly no other option than the meds have a place and you make the trade of dependence for relief
Now you know that you have a bad disc, why not look into artificial disc replacement, fusion possibilities to take the pressure of the bad disc, Prolo therapy, ESI's or other modalities that may offer a cure rather than just masking the pain indefinitely.
Most surgeons know that a disc can heal itself. There are also minimally invasive surgeries like micro discectomies to relieve disc pain.
I do believe the meds have a place when there is no other option. You have already seen you own tolerance grow. Hydro products don't work any longer, 5mg percs don't work, now 7.5 mg percs don't work and the only place to go is up in strength and dosage. You have seen your own toleranc double, in how long?
The standard post op pain regimen for most first time back surgeries is to stay a few days after surgery and come home with at best 2 percs or tylox every 4 hours. You have never had surgery and already your tolerance is beyond what the average ortho or Neuro surgeon is used to prescribing for post op pain.
What happens if they do decide surgery is the right option. Nobody has done you any favors by making you tolerant to what most people that have surgery find very effective for post op pain management. Surgeons or PM docs are not obliged to prescribe doses of meds beyond their comfort level. Surgery on a patient they believe already has dependence issues also makes a surgeon hard to find even when everything points to possible surgical resolution.
Why did your doc say your not a good candidate at this time, when will you be?
One or two bad discs doesn't mean you are condemned to a life of pain. You talking about one surgeons opinion. It sounds like your PM doc wants you to at least try for a cure surgically and pain management will always be there should surgical efforts fail.A second or third surgical opinion may convince him and you that surgery is not an option but I would not let one doc condemn you to a life of pain because he feels your not a good candidate for surgery for whatever reason.
Most folks over 30 have DDD so that diagnosis alone in no way condemns you to a life of pain and opiate dependency.
If surgery is an option, which you should get several surgical opinions. You should do it before your tolerant to say 80 mgs of OxyC 3 times a day. Trust me, you could be there in a year very easily with the wrong doc and not stabilizing your problem area.
I've watched other back pain patients opt not for surgery and just for meds that start at 20mgs of Oxy twice a day and be very happy in the beginning with the pain relief but and at the end of the first year the same guy happy with 20mgs of Oxy twice a day now needs 600 times the original dose a year later, now he's using 600mgs of oxyfast every 4 hours. So he went from 40mgs a day to 2400 mgs a day. This doc has done him no favor.
Short acting meds will raise your tolerance faster than long acting meds and when people tend to relate the warm fuzzy feeling that short acting meds induce to actual anelgesia they run into trouble. You don't need to feel something kick in to get pain relief.
What do you think, should this person have tried a surgical remedy or just keep increasing as the problem worsens although nobody is shooting for a cure?
The whole idea of long acting meds is to stay ahead of the pain and to keep it from spiraling beyond the meds ability to control. LA meds also eliminate that surge that short acting meds have that folks find comforting and then relate that feeling to analgesia.
If you keep on with short acting meds you just become more tolerant, if you go to long acting meds before any surgery is tried you will run into docs that won't touch you until they detox you or they flat out won't prescribe anything additional to what your presently taking post surgically. It's the same as not treating the post op pain at all.
Surgeons don't have the same views on opiates that PM docs do. PM docs are there for when everything else has failed.IMO
If they are quick to condemn you to a life of pain and dependence on them for relief they just make themselves a lifetime customer or at least as long as their license stays in tact.
Simply treating pain with meds when nothing else has been tried is a good way for a doc to loose his license, they do have to document their other efforts to manage your pain before they can justify the use of these meds long term.
I followed another ladies PM journey that had the exact same problems you do. Within a year she went from one or two percs to a pm doc that prescribes 400mgs of oxyC 3 times a day. That's how fast tolerance can grow especially when you pain generator hasn't been stabalized. She's happy with her treatment because she can mask her pain to the point of still being able to function, but that won't last forever unless the problem is stabalized.Then she lost her insurance and do you have any idea how much 1200mgs of Oxyc per day would cost. Around 3k a month. I haven't seen a post from her since the day she lost her insurance. She could have switched to the only cheap med, methadone, but it is kinda scarry that nobaody has seen or heard from her since that lost post. The withdrawal from that level of medication would be monsterous.
The disc continues to go, causing more and more nerve problems creating more and more pain and without trying to stabilize the problem all you can do is keep increasing. If you have surgery and it stabilizes your spine but you still have back pain then it's more likely you could stabilize on a dose of meds that actually work and stick with the same dose for years.
The 3 back surgeries I had disabled me, I'm not a great advocate of surgery but surgery did relieve the neuropathic pain and release the pressure from the nerves and stabilized my spine to the point of being able to stay on the same dose of meds for several years.
If you choose to take one Ortho's advice over your PM suggesting you look into other surgical options I wouldn't count on him being there for the long run as your tolerance continue to grow. The ortho that referred you to PM won't prescribe the meds but says your not a candidate for surgery. Why not look into a cure before committing yourself to a lifetime of dependence?
I'm sure you can eventually find a doc that will treat your pain and if your unlucky you will find one that just keeps increasing your meds rather than looking at the big picture and shooting for a cure.
A PM doc willing to give you whatever you ask for isn't doing you any favors by eliminating the possibility for a cure. I'm just throwing a little different perspective out there. I know pain makes us do crazy things and willing to do anything for relief, But wouldn't a cure be better than a doc that will just give you all the pain meds you need to mask the problem?
I'm not suggesting your a drug seeker or any of the other folks I talked about are. It's just an example of how PM can go when the real problem is never addressed or no attempt to stabilize the problem has been made.
Good luck, Shoreline
mokita
07-09-2003, 04:54 PM
HI Griffin!
I just wanted to add my 2cents. As my sig says, I've been thru a bit of the 'go to doc - they try to figure it out - can't - refer you to next doc - more procedures - doesn't work' You get the pic. Anyway... I wasn't at my current pain mgmt doc but the 2nd visit - I explained that I find myself going to sleep in pain, waking up w/ pain, taking prescribed med that should work for 6 hrs... in 3 hrs I am watching the clock for the next dose... nothing but pain on my mind. He said - I am going to prescribe oxycontin...I believe your situation warrants it. He then proceeded to give me normal warnings but, his first concern was to get me comfortabe while we went thru all the hoops to figure out what's causing my pain.
So... for me, it was a matter of telling him exactly how my day went... how short a time the meds lasted. But, he may just be one of the more understanding/less intimidated by DEA docs around?!
You haven't been back yet to see him after DG - obviously, right? I would think he would be more open-minded at this time considering the tear! My doc px'd before my dg.... after, when he saw the tear and leak - he was so very compassionate saying that's about the worse thing bcuz the inside of disc is caustic to nerves. No Wonder I hurt like he%%!
Good luck. Let me know how you make out!
Karen
------------------
9/22/00 24 hour labor, baby posterior, left tailbone killing me
12/00 MRI - PCP said nothing amiss - but, had to begin taking vicodin
2/8/02 - 2nd baby born after long, painful pregnancy, weight gain didn't help
2000-11/02 various PT + pain meds
11/02 Referred to Neuro
3/03 NEW MRI - shows slight bulge L3-L4,slight DDD, neural foramen involved, Superior aspect S1 and L5 Nerve root involvement -Neuro Refers to PM for ESI
3/03 PM Doc orders ESI
3/21,4/1,4/8 - ESI's no help
5/9 - Discogram - shows Tear L4 w/ significant leak onto nerves, DDD
Performing doc oversedated, False Negative (pm doc & I agree)
New Consult w/ Dept Head Cleveland Clinic 7/8 to discuss possible new discogram/IDET candidacy
7/8-Doc ordered Facet Joint nerve block for 7/29 to rule out/identify as pain generator. If not, new discogram.
Also, thinks tailbone thing may be from displacement - wants x-ray (think I've had one - have to track it down!)
I just wanted to add my 2cents. As my sig says, I've been thru a bit of the 'go to doc - they try to figure it out - can't - refer you to next doc - more procedures - doesn't work' You get the pic. Anyway... I wasn't at my current pain mgmt doc but the 2nd visit - I explained that I find myself going to sleep in pain, waking up w/ pain, taking prescribed med that should work for 6 hrs... in 3 hrs I am watching the clock for the next dose... nothing but pain on my mind. He said - I am going to prescribe oxycontin...I believe your situation warrants it. He then proceeded to give me normal warnings but, his first concern was to get me comfortabe while we went thru all the hoops to figure out what's causing my pain.
So... for me, it was a matter of telling him exactly how my day went... how short a time the meds lasted. But, he may just be one of the more understanding/less intimidated by DEA docs around?!
You haven't been back yet to see him after DG - obviously, right? I would think he would be more open-minded at this time considering the tear! My doc px'd before my dg.... after, when he saw the tear and leak - he was so very compassionate saying that's about the worse thing bcuz the inside of disc is caustic to nerves. No Wonder I hurt like he%%!
Good luck. Let me know how you make out!
Karen
------------------
9/22/00 24 hour labor, baby posterior, left tailbone killing me
12/00 MRI - PCP said nothing amiss - but, had to begin taking vicodin
2/8/02 - 2nd baby born after long, painful pregnancy, weight gain didn't help
2000-11/02 various PT + pain meds
11/02 Referred to Neuro
3/03 NEW MRI - shows slight bulge L3-L4,slight DDD, neural foramen involved, Superior aspect S1 and L5 Nerve root involvement -Neuro Refers to PM for ESI
3/03 PM Doc orders ESI
3/21,4/1,4/8 - ESI's no help
5/9 - Discogram - shows Tear L4 w/ significant leak onto nerves, DDD
Performing doc oversedated, False Negative (pm doc & I agree)
New Consult w/ Dept Head Cleveland Clinic 7/8 to discuss possible new discogram/IDET candidacy
7/8-Doc ordered Facet Joint nerve block for 7/29 to rule out/identify as pain generator. If not, new discogram.
Also, thinks tailbone thing may be from displacement - wants x-ray (think I've had one - have to track it down!)
chrpps99
07-09-2003, 10:05 PM
I am truly sorry to hear that you are in so much pain and that your pain meds aren't working for you.. I too was wondering why your Ortho Dr says you aren't a candidate for surgery.. And that then your PM Dr wants to try other alternatives beside long acting meds.. But after reading shorelines post, He definetly makes you look at it from a different perspective.. and if you really think about it. It makes a whole lot of sense.. I have suffered for many years... with back problems. Even had surgery...But about a 1 1/2 ago I started having excruitating pain in my Thoracic area.. I just knew I was going to be in this pain for the rest of my life and I went to PM Dr thinking he was gonna give me pain meds and that was it..Well I was wrong and my PM Dr was very conservative and wanted me to try all different things.. Epidural Injections (3) Pool Therapy.. and then finally he said we will try Trigger Point Injections if they don't help then maybe just maybe we will put you on long term pain meds.. I tell you what I had a two sets of TPI and I thought I was going to die from all the pain they were causing.. I had one more set of injections. and I have not had that Thoracic pain again.. So see sometimes conservative treatment works.. Hope things going well for you keep us posted on your update.
Take Care
Sonya
Take Care
Sonya
Jack Beanstalk
07-10-2003, 12:08 AM
Howdy Igrif,
You got a lot of real good advice to think on.Only thing I,ll add is it may not hurt to keep a log or"Pain Diary",stating stuff,like"at 2:00PM,I took 1 Percocet,got relief for a while,pain went from a 6 down to a 3 for a few huors then rose back up to 6 again."That stuff looks good to docs,they like the specifics.Also,be very careful about taking more meds than you,re supposed to,even if it does hurt.That is all the reason they need to discontinue Opiates.It,s called non-compliance and it will hurt you real bad in the long run.If this doc you see now,documents that you took your meds more than prescribed,it could ruin your Opiate treatment if it needed to be continued.BTW,what part of NC are you from?Jack Beanstalk
You got a lot of real good advice to think on.Only thing I,ll add is it may not hurt to keep a log or"Pain Diary",stating stuff,like"at 2:00PM,I took 1 Percocet,got relief for a while,pain went from a 6 down to a 3 for a few huors then rose back up to 6 again."That stuff looks good to docs,they like the specifics.Also,be very careful about taking more meds than you,re supposed to,even if it does hurt.That is all the reason they need to discontinue Opiates.It,s called non-compliance and it will hurt you real bad in the long run.If this doc you see now,documents that you took your meds more than prescribed,it could ruin your Opiate treatment if it needed to be continued.BTW,what part of NC are you from?Jack Beanstalk
lgriffincsa
07-10-2003, 02:51 AM
Woha! I had no idea that I would have started such an excellent and informative thread. Lets start at the beginning: I live in Eastern NC, close to New Bern. I would like to reiterate That I am currently seeing a PM Dr. The PM Dr. has me on the perc. 7.5/325. The PM Dr. is the one who performed the Discogram, and I have not had a chance to talk with him at lenghth about my options, since I had the DG. I will speak with my PM Dr. on 22JULY about the results of my DG, and my surgical options, if any.I breifly spoke with him today, and he said that there is a confirmend tear in the L4-L5 disc, and that my other disc's were ok. He tested 3 disc's total, and L3-L4 was normal, L4-L5 was positive, and L5-S1 was normal, (even though my MRI shows bulging at L5-S1). Prior to the DG, my PM Dr. told me that a fusion or a IDET would be my options if I got a positive result from the DG. I dont know if this has changed since he has conclusive results, now that I've tested positive during the DG. My Ortho. who sent me to my PM Dr. said I was not a candidate for surgery because of the following. He has only seen the MRI, not the DG results. My Ortho said that untill I could not walk at all, I could not have sex, my marriage was about to end because of my back pain, and I was ready to "blow my brains out" because of the pain, then and only then would he reccomend surgery.
It appears that there are some surgical options to alleviate my pain, I just wont know what they are untill the 22 of July. In any event, at this point I will refuse any type of surgery and opt, if given the choice to treat my pain by "masking" it with medication for the following reasons: I am a self employeed mechanical contractor, as such I have no disability insurance. Meaning, if I dont work, my bills dont get paid. My field is so competitive that if I were to take any longer than 2 weeks off of work, I would lose my customer base to a competetor, thus loseing everything I own. I can still work enough to get by at present, and I could work more if I felt better, ie. better meds. Although my pain does interfere with my personal life, I can somewhat manage at present, and feel I could lead a normal personal life with longer acting meds. I hurt most all of the time, but I am not ready to blow my brains out, as my Ortho suggested. Again, better meds, less pain. I have read too many horror stories about failed surgeries and proceedures, and have witnessed the results of 2 failed surgeries 1st hand, via. my father. His fusions left him impotent, and limping. I know people who are on Oxycontin, and have been from 3 to 5 years, depending on the individual. All 3 of these people are on the same does of OxyC that they have been on for at a minimum of 2 years, and still get the same pain releif results, without an increase in their dosage. I do agree however that as long as I am on stuff like Percocet, my tolerance will continue to climb, due to the highs and lows as far as pain releif levels this medicine provides. This is why I beleive that if I were on a long lasting, time-release form of the same medicine, I would not experience the high of no pain, and the low of sudden pain increase.
I would choose a surgery or proceedure that would alleivate my pain, if that operation infact would leave me better off than I am now, and if that operation would allow me to return to work in a maximum of 2 weeks recovery time. I have never even had a vacation that lasted more than 4 days, an extended weekend, for fear of being gone when a customer needed me, and they calling someone else. I built my customer base by being available when others were not, and I am certain that if I were not available, someone else would be. Then they would take my customer. So there you have it. I know that medication is probally not the greatest choice, but from a financial standpoint, at the present time, it is my only choice. My options may become wide open after I see my PM Dr. again on the 22nd.I jsut dont know right now. Until then, I am sticking with my decision, assuming that I am given the choice. My PM Dr. may just send me home and tell me to live with my pain, if I dont agree to a surgery. In that event, I guess its time to find another PM Dr. Thanks for all the great advice. There is really alot to think about and consider. I would love to be in a position where I could have more options, unfortunatly, my career choice dictates my medical options.
------------------
1998-Major rear-end colision
1998-mid2000-Chiropractic care
2000-mid2002-Pain level increased drasticly. No insurance, took a combo of every OTC painreleiver imaginable.
2002-MRI/ L3/L4 and L4/L5 annular bulging; DDD L4-5 and L5-S1
2003 February- Orthopeadic Spinal Surgeon said not a candidate for surgery,Percocet 5/325 every 6 hrs.
2003 June-1 month at PM clinic, Percocet 7.5/325 every 4 hrs.
08JULY2003-Had Discogram, comfirmed pain comming from L4-L5 disc. Awaiting followup exam, and discussion of treatment options.
I can function/work for 3-4 hrs per day/ 2/3 days per week with current meds. I beleive I could function/work normal hours with stronger, timereleased meds. Surgery is NOT an option at this time.
It appears that there are some surgical options to alleviate my pain, I just wont know what they are untill the 22 of July. In any event, at this point I will refuse any type of surgery and opt, if given the choice to treat my pain by "masking" it with medication for the following reasons: I am a self employeed mechanical contractor, as such I have no disability insurance. Meaning, if I dont work, my bills dont get paid. My field is so competitive that if I were to take any longer than 2 weeks off of work, I would lose my customer base to a competetor, thus loseing everything I own. I can still work enough to get by at present, and I could work more if I felt better, ie. better meds. Although my pain does interfere with my personal life, I can somewhat manage at present, and feel I could lead a normal personal life with longer acting meds. I hurt most all of the time, but I am not ready to blow my brains out, as my Ortho suggested. Again, better meds, less pain. I have read too many horror stories about failed surgeries and proceedures, and have witnessed the results of 2 failed surgeries 1st hand, via. my father. His fusions left him impotent, and limping. I know people who are on Oxycontin, and have been from 3 to 5 years, depending on the individual. All 3 of these people are on the same does of OxyC that they have been on for at a minimum of 2 years, and still get the same pain releif results, without an increase in their dosage. I do agree however that as long as I am on stuff like Percocet, my tolerance will continue to climb, due to the highs and lows as far as pain releif levels this medicine provides. This is why I beleive that if I were on a long lasting, time-release form of the same medicine, I would not experience the high of no pain, and the low of sudden pain increase.
I would choose a surgery or proceedure that would alleivate my pain, if that operation infact would leave me better off than I am now, and if that operation would allow me to return to work in a maximum of 2 weeks recovery time. I have never even had a vacation that lasted more than 4 days, an extended weekend, for fear of being gone when a customer needed me, and they calling someone else. I built my customer base by being available when others were not, and I am certain that if I were not available, someone else would be. Then they would take my customer. So there you have it. I know that medication is probally not the greatest choice, but from a financial standpoint, at the present time, it is my only choice. My options may become wide open after I see my PM Dr. again on the 22nd.I jsut dont know right now. Until then, I am sticking with my decision, assuming that I am given the choice. My PM Dr. may just send me home and tell me to live with my pain, if I dont agree to a surgery. In that event, I guess its time to find another PM Dr. Thanks for all the great advice. There is really alot to think about and consider. I would love to be in a position where I could have more options, unfortunatly, my career choice dictates my medical options.
------------------
1998-Major rear-end colision
1998-mid2000-Chiropractic care
2000-mid2002-Pain level increased drasticly. No insurance, took a combo of every OTC painreleiver imaginable.
2002-MRI/ L3/L4 and L4/L5 annular bulging; DDD L4-5 and L5-S1
2003 February- Orthopeadic Spinal Surgeon said not a candidate for surgery,Percocet 5/325 every 6 hrs.
2003 June-1 month at PM clinic, Percocet 7.5/325 every 4 hrs.
08JULY2003-Had Discogram, comfirmed pain comming from L4-L5 disc. Awaiting followup exam, and discussion of treatment options.
I can function/work for 3-4 hrs per day/ 2/3 days per week with current meds. I beleive I could function/work normal hours with stronger, timereleased meds. Surgery is NOT an option at this time.
lgriffincsa
07-10-2003, 08:44 AM
Thanks for the headsup Jackbeanstalk. I had no idea that telling my Dr. the the medicine wasnt working and I had to take more to get releif, would be called non-compliance! http://www.healthboards.com/ubb/redface.gif I thought that only mattered when you were on a strong pain med, and had signed a contract with the Dr. I hope I havent screwwed myself, not after all that I have been thru just to prove to my Dr. that there is something wrong with me, discogram and all. He told me not to take anymore than prescribed, but it just doesnt help. On 2 occasions since, my ortho. has offered to write me a script for percocet, and both times I refused. I told him that my PM dr. was giving me meds, and I didnt want to make him mad by taking someone elses script. Thats got to account for something :eek: . I even told my ortho to document that I turned meds down. I would certainly hope that takeing more of what one Dr. prescribes, and turning down another Dr. script has got to look far better than taking scripts from both Dr.s !? I did get to ask my PM dr. yesterday if there were something else that I could take, with less APAP, and he told me about methadone. I played dumb, and asked him wasnt that for herion addicts? He said yes, but its also used for cronic pain sufferers. I dont want Methadone! I know people that have had horrible allergic reactions to it, and broke out in hives. Made the delerious, and somewhat evil. I read that when it comes time to get off of the meds, Methadone it the hardest to detox from. I wonder if my PM Dr. will give me the choice, when the time comes? Thanks again for listening.
------------------
1998-Major rear-end colision
1998-mid2000-Chiropractic care
2000-mid2002-Pain level increased drasticly. No insurance, took a combo of every OTC painreleiver imaginable.
2002-MRI/ L3/L4 and L4/L5 annular bulging; DDD L4-5 and L5-S1
2003 January- ESI, releif only until anesthetic wore off (12 hrs.)
2003 February- Orthopeadic Spinal Surgeon said not a candidate for surgery,Percocet 5/325 every 6 hrs.
2003 April- ESI, no releif, more pain for 2 weeks.
2003 June-1 month at PM clinic, Percocet 7.5/325 every 4 hrs.
08JULY2003-Had Discogram, comfirmed pain comming from L4-L5 disc. Awaiting followup exam, and discussion of treatment options.
I can function/work for 3-4 hrs per day/ 2/3 days per week with current meds. I beleive I could function/work normal hours with stronger, timereleased meds. Surgery is NOT an option at this time.
[This message has been edited by lgriffincsa (edited 07-10-2003).]
------------------
1998-Major rear-end colision
1998-mid2000-Chiropractic care
2000-mid2002-Pain level increased drasticly. No insurance, took a combo of every OTC painreleiver imaginable.
2002-MRI/ L3/L4 and L4/L5 annular bulging; DDD L4-5 and L5-S1
2003 January- ESI, releif only until anesthetic wore off (12 hrs.)
2003 February- Orthopeadic Spinal Surgeon said not a candidate for surgery,Percocet 5/325 every 6 hrs.
2003 April- ESI, no releif, more pain for 2 weeks.
2003 June-1 month at PM clinic, Percocet 7.5/325 every 4 hrs.
08JULY2003-Had Discogram, comfirmed pain comming from L4-L5 disc. Awaiting followup exam, and discussion of treatment options.
I can function/work for 3-4 hrs per day/ 2/3 days per week with current meds. I beleive I could function/work normal hours with stronger, timereleased meds. Surgery is NOT an option at this time.
[This message has been edited by lgriffincsa (edited 07-10-2003).]
mokita
07-10-2003, 10:45 AM
This post is to Shoreline.
I have a problem w/ a couple of the things you posted.
What doc in their right mind would px a patient 1200 mg of Oxycontin a day? That is nuts. The last I knew - the strongest oxy comes in is 160 mg... so, 1200/120=7.5 - So, this doc is px'in @ least 7 of the Strongest oxy (which are normally reserved for Cancer patients) a day to someone w/ back problems? This is inexcusable, irresponsible behavior on the doctor's part, in my opinion... and I don't think that most pm docs would do this.
Next - you mention ESI's as a "cure" - that is not true. They also 'MASK' the problem until there might be a 'cure' - all the while competent pm docs are trying to find out exactly what w/b best and then "discussing" w/ the Patient what w/b the Best option for That one person... in the end, the decision lying w/ the patient.
As for fusion? That is Final.... can't go back. That shoud be a very last resort.
You have many valid points. I'm just suggesting that the pm patient you 'watched' was a very, extremely rare, rare case.
I, personally, am on pain meds... oxy being one of them. This is what my doc has suggested for the time being while "we" (my doc, his team, and myself) are attempting to ascertain what is actually 'causing' my pain. In the meantime, am I supposed to remain in tears during the day while I try to be a mother to my 2-1/2 yr old and 17 month old girls? Well, that w/b my decision. And I have 'chosen' to try to improve my quality of life w/ opiate therapy. When, or if, my docs suggest surgery? If it is the IDET? I have already said that I am Not a good candidate for it remaining intact as I don't have the kind of help that would enable me to Not pick up over 5# (My youngest weighs 24 #) for over 2months. So, unless they find that my facet joints ARE my Sole problem, and can do a nerve ablation (think that's right) and CURE my pain.... I am probably going to be taking the opiate therapy for the next year, at the least. Who know? Maybe my tear will heal itself.... my doc said that IS possible. In the meantime, I will keep searching for the cause... and look for a cure... all the while taking my meds As Prescribed - and will do what my Contract says - Let them KNOW if I am not getting good pain relief so we can change the meds. In the end... I'm a better mother/wife/friend/daughter/sister and am thankful that I have a Great PM Clinic to help me through this horrific thing called Chronic Pain.
I know this is long.... but, felt I had to say it.
Good luck IGriff!!!! My heart goes out to you and hope that you find the Help you need in your quest to be 'cured'! :)
Karen
------------------
9/22/00 24 hour labor, baby posterior, left tailbone killing me
12/00 MRI - PCP said nothing amiss - but, had to begin taking vicodin
2/8/02 - 2nd baby born after long, painful pregnancy, weight gain didn't help
2000-11/02 various PT + pain meds
11/02 Referred to Neuro
3/03 NEW MRI - shows slight bulge L3-L4,slight DDD, neural foramen involved, Superior aspect S1 and L5 Nerve root involvement -Neuro Refers to PM for ESI
3/03 PM Doc orders ESI
3/21,4/1,4/8 - ESI's no help
5/9 - Discogram - shows Tear L4 w/ significant leak onto nerves, DDD
Performing doc oversedated, False Negative (pm doc & I agree)
New Consult w/ Dept Head Cleveland Clinic 7/8 to discuss possible new discogram/IDET candidacy
7/8-Doc ordered Facet Joint nerve block for 7/29 to rule out/identify as pain generator. If not, new discogram.
Also, thinks tailbone thing may be from displacement - wants x-ray (think I've had one - have to track it down!)
I have a problem w/ a couple of the things you posted.
What doc in their right mind would px a patient 1200 mg of Oxycontin a day? That is nuts. The last I knew - the strongest oxy comes in is 160 mg... so, 1200/120=7.5 - So, this doc is px'in @ least 7 of the Strongest oxy (which are normally reserved for Cancer patients) a day to someone w/ back problems? This is inexcusable, irresponsible behavior on the doctor's part, in my opinion... and I don't think that most pm docs would do this.
Next - you mention ESI's as a "cure" - that is not true. They also 'MASK' the problem until there might be a 'cure' - all the while competent pm docs are trying to find out exactly what w/b best and then "discussing" w/ the Patient what w/b the Best option for That one person... in the end, the decision lying w/ the patient.
As for fusion? That is Final.... can't go back. That shoud be a very last resort.
You have many valid points. I'm just suggesting that the pm patient you 'watched' was a very, extremely rare, rare case.
I, personally, am on pain meds... oxy being one of them. This is what my doc has suggested for the time being while "we" (my doc, his team, and myself) are attempting to ascertain what is actually 'causing' my pain. In the meantime, am I supposed to remain in tears during the day while I try to be a mother to my 2-1/2 yr old and 17 month old girls? Well, that w/b my decision. And I have 'chosen' to try to improve my quality of life w/ opiate therapy. When, or if, my docs suggest surgery? If it is the IDET? I have already said that I am Not a good candidate for it remaining intact as I don't have the kind of help that would enable me to Not pick up over 5# (My youngest weighs 24 #) for over 2months. So, unless they find that my facet joints ARE my Sole problem, and can do a nerve ablation (think that's right) and CURE my pain.... I am probably going to be taking the opiate therapy for the next year, at the least. Who know? Maybe my tear will heal itself.... my doc said that IS possible. In the meantime, I will keep searching for the cause... and look for a cure... all the while taking my meds As Prescribed - and will do what my Contract says - Let them KNOW if I am not getting good pain relief so we can change the meds. In the end... I'm a better mother/wife/friend/daughter/sister and am thankful that I have a Great PM Clinic to help me through this horrific thing called Chronic Pain.
I know this is long.... but, felt I had to say it.
Good luck IGriff!!!! My heart goes out to you and hope that you find the Help you need in your quest to be 'cured'! :)
Karen
------------------
9/22/00 24 hour labor, baby posterior, left tailbone killing me
12/00 MRI - PCP said nothing amiss - but, had to begin taking vicodin
2/8/02 - 2nd baby born after long, painful pregnancy, weight gain didn't help
2000-11/02 various PT + pain meds
11/02 Referred to Neuro
3/03 NEW MRI - shows slight bulge L3-L4,slight DDD, neural foramen involved, Superior aspect S1 and L5 Nerve root involvement -Neuro Refers to PM for ESI
3/03 PM Doc orders ESI
3/21,4/1,4/8 - ESI's no help
5/9 - Discogram - shows Tear L4 w/ significant leak onto nerves, DDD
Performing doc oversedated, False Negative (pm doc & I agree)
New Consult w/ Dept Head Cleveland Clinic 7/8 to discuss possible new discogram/IDET candidacy
7/8-Doc ordered Facet Joint nerve block for 7/29 to rule out/identify as pain generator. If not, new discogram.
Also, thinks tailbone thing may be from displacement - wants x-ray (think I've had one - have to track it down!)
tryuo
07-10-2003, 03:57 PM
I don't think everyone develops a tolorance to oxyc as fast as the people that were mentioned. I myself have been on oxycontin for 7 months now and have only went up from 4 10 mg tablets a day to 3 20 mg tablets a day, so i think from my experience it is more common to slowely increase the dose than to massively increase it. But to the original poster please be careful on your tylenol intake, and do whatever you can to convinve the doc to switch you to a med with less APAP. He is really very ignorant about the dangers of treating chronic pain patients with APAP containing meds. And quick actinmeds like percocet are only intended for acute pain or bt pain, NOT chronic pain, and if he would read the PDR he would know that. It might be time to start looking for a new doctor.
Shoreline
07-10-2003, 04:07 PM
Hey Karen, I don't mind anyone not agreeing with me. But your knowledge and beliefs are very narrow minded and uninformed. The person taking 400mgs of oxyC 3 times a day took 5 80's 3 times a day. This is a high dose but I've seen much higher myself. Do you know how unfair it is for you to say that's an absurd dose and only cancer patients should have that amount.You really don't sound like you know what your talking about.
........................................ ............
What doc in their right mind would px a patient 1200 mg of Oxycontin a day? That is nuts. The last I knew - the strongest oxy comes in is 160 mg... so, 1200/120=7.5 - So, this doc is px'in @ least 7 of the Strongest oxy (which are normally reserved for Cancer patients) a day to someone w/ back problems? This is inexcusable, irresponsible behavior on the doctor's part, in my opinion... and I don't think that most pm docs would do this.
Next - you mention ESI's as a "cure" - that is not true. They also 'MASK' the problem until there might be a 'cure' - all the while competent pm docs are trying to find out exactly what w/b best and then "discussing" w/ the Patient what w/b the Best option for That one person... in the end, the decision lying w/ the patient.
........................................ ............
ESI's may not cure an annular tear but if inflamation is causing irritation of a nerve root the anti inflamatory properties would be considered a cure if they relieve the pain caused by inflamation or relieve pain long enough to allow a disc to heal without operating then it does have curative properties or allows for a cure.
Bye the way, 120x7.5 doesn't equal 1200
80x5x3 does equal 1200
How does the CP patient that is taking 1200mgs of oxyC a day feel when he reads your post? You sound like an ignorant doc that thinks because the highest dose patch is 100ugh that's the most they should ever prescribe.
Do you really think that because OxyC only comes in 80 mg tabs that's the most that someone can take. I've seen plenty of idiot docs discontinue meds because a patient reached 100mgs of Kadian and got no relief and since that's the largest pill the doc thinks that's the most someone can take. I took 600mgs a day for almost a year before switching back to methadone.
I have a friend that used to drive the 4 hours to see DR Hurowitz in Fairfax, he was taking 1800 mgs of MSContin a day, 80 mgs of meth at night and had all the Oxyfast he needed for BT pain. Now he sees my doc and is on the same regemin. You can't say someone can't need that much pain medication until your in their shoes.
By the way, My docs not nuts, He has every PM effort I ever tried documented in my records. He can justify the use of meds by properly documenting other efforts.
Show me one article that suggests there is a ceiling on the amount of opiate a patient should be allowed or can safely use if titrated properly.
Perhaps some BS from the Oxy kills web site but that's written by an angry parent that lost a child due to drug and alcohol abuse.
When I had insurance I was able to switch from my dose of meth to 200mgs of Kadian 3 times a day. But my spine is as stable as it will ever be. I still crunch and squeak with every step but I haven't needed an increase in 3 years, when I lost ins I switched right back to the same dose of meth I had previously been on.
My point is that if the problem isn't stable and continues to worsen and you just mask the pain you have no idea what your doing to your body. Pain imprints into nerve tissue and may become permanent even if surgery is successful at relieving radiculopothy or decompressing a nerve.
You may still be left with a great deal of pain imprinted into your nervous system. It's part of the gateway theory and explains phantom limb pain. Phantom limb pain is just as real as back pain or cancer pain.
If Griff is presently taking 2 7.5 percs every 4 hours he would have to start with 40mgs of OxyC 3 times a day to sustain the same or a little higher serum level that the short acting meds do. A 40 mg oxyC sustains roughly 20 mgs in your system for 6-12 hours. More like 6-8 but some can get by with BID dosing if they have enough BT meds
So now he's at 40 mgs of oxy 2-3 times a day, but this barely cuts it and won't allow him to work the 10 hours a day he wants. The problem continues to worsen and the need for meds just increases. If the problem isn't stable what works today for pain won't necessarily work in 2 months for pain. So what looks like rapid tolerance is simply progression of the problem causing the pain.
If you refuse any modality that takes you out of work is it realistic to keep asking for increases because you have a bad disc but continue to do heavy manual labor.
If you don't believe how high peoples doses can grow just ask Jack beanstalk what his previous dose of Oxy was or Dilaudid before he switched to methadone.
By the way, Purdue threw the DEA a bone when they discontinued distribution of the 160mg OxyC strength 2 ywears ago, less than 3% of their sales where this strength, so docs just prescribe twice as many 80's.You might want to do some more current research if you think the 160's are still available.
I don't know how you can suggest that someone with back pain couldn't need 1200mgs of oxy a day.Do you know what it's like to have 12 screws and 8 rods in your spine and an unstable fusion? How about the folks with NF where tumors grow at the end of nerve endings? There is no ceiling on the dose of opiates a CP patient can take as long as they are tolerant and have titrated slow enough to that dose.
There is absolutely no evidence that cancer pain is any worse than other pain, they just treat it differently if your terminal because addiction and tolerance is inconsequential when your going to die anyway.
Someone taking 1200mgs of oxy a day is at no more risk than someone taking 120mgs of oxy a day. If their tolerance allows it and they require it I would never suggest they didn't need it.You seem to have the psychyc ability to determine what people need, perhaps you can find a job at a block shop and predict doses.
I was suggesting there are many alternatives before you jump on the most powerful meds. I've met a Veterinarian that at one time wore 10 100ugh duragesic patches,now he's using 160mgs of methadone 4 times a day. Meth is anywhere from 5-10 times stronger than morphine. If you use a 1:5 factor that equals to 3000mgs of morphine per day.Who am I to say He doesn't need that much just because I don't.
Another member of a different forum wears 4 100ugh patches changed every 48 hours, Uses 400mgs of Kadian and 160 mgs of meth a day. He only gets relief from using multiple opiates. No he's not dieing, but he has a failed fusion with screws into bone that's sponge like from osteoperrosis. If that's what it takes, that's what it takes.
He actually took part in the chronic pain clinical trials for Duragesic, It was first only approved for cancer pain. Look how many CP folks use the patch now. So this guy that you suggest could never need that much medication made Duragesic available to every patient on this forum from his willingness to participate in the clinical trials for CP patients. Did you know only 6% of the people in the trial were able to go 72 hours before changing the patch?
I have 12 screws and 8 rods in my spine from a 6 level fusion.I crunch and squeek with every step, but after 3 failed surgeries and numerous consults and trying every non opiate method I eventually was put on long acting meeds. Once the dose was titrated to the right level I have sustained that level for 3 years. Because my spine is as stable as it will get.
The hardware is holding things in place, should this set snap like the first set then I can see my needs increasing again untill some amount of stabilty was obtained.
If someone wants to argue that their meds don't cause a high then you can't draw a line and say anything beyond this is absurd unless your dieing. You can be just as accomadated to 1200mgs as 120mgs with no more impairment than anyone else taking opiates.
Just because I've thrown numbers out that you can't imagine doesn't mean it's not true, Jack knows all the folks I'm talking about and knows how accommodated to high doses you can become.
To someone that gets relief from one Lortab they can't imagine someone needing 120mgs of OxyC or 600mgs of morphine a day. Where do you suggest they draw the line for back pain, migraines, neuro fibromatosis,or any pain generator?
What is the most that you think someone should take Karen? There is no correct answer and having cancer doesn't mean you have more pain than someone that's not terminal, that's hogwash. Show me where a single study suggest that cancer is more painful than any other pain generator.
You can't measure pain. It's a unique experience to each person, What you call a 10 may only be a 4 on my scale. Where you may get relief from percocet I need 90 mgs of oxycodone for BT pain.
Does a single level fusion get 40 mgs of oxy and a 2 level 80 and a 3 level 120 and a 4 level 160 and a 5 level 200.
The number of levels doesn't represent an amount of pain. A failed single level fusion can certainly hurt as much as a failed 6 level fusion.
What I'm saying is to simply mask pain because you think you can't afford to take time off or because you don't want to try anything else will have consequences. Either docs not willing to prescribe because other documented efforts haven't been tried.
Or you need surgery but nobody will touch you because they don't want to deal with a tolerant dependent patient. I've been at this PM thing for over a decade and seen things you can't even seem to imagine.
There are people in pain that take doses beyond what you consider reasonable, but what right do you have to say what is reasonable. Don't you think 80 mgs 3 times a day sounds absurd to the opiate naive patient that just came home from a 3 level fusion with just percocet for pain?
How can someone need more medication then someone who just had orthopedic surgery? Let me answer that for you, because of tolerance, because of pain imprinting, because of the gateway theory. Because everyone responds differently to medication and because chronic pain responds differently to opiates than acute pain and different parts of the brain and nervous system are involved in chronic pain. Have you heard of RSD or central pain syndrome?
Griff could put off surgery and keep working with enough meds until his disc disintegrates and once bone is touching bone you spontaneously fuse. Once he's bent over and fused in an awkward position there won't be a surgical alternative. So what favors has the PM doc done by simply relieving his pain and not looking for a possible cure. All he's done is give him a few more months or years before he's disabled by a problem that can no longer be fixed.
IDET may be an answer and it's not as irreversible as say a fusion. Micro discectomies and artificial discs are much less invasive then fusion.
I have seen people that were unable to work and taking large amounts of meds have ESI's and get tremendous relief and decrease meds or discontinue them altogether. Just because you haven't seen it, read about it,or researched it doesn't make these doses outrageous. It takes what it takes. But if you can't stabilize the pain generator you can't stabilize the dose. That's my point.
Griff will likely at some point go to the surgeon and beg for relief because he won't be able to stabilize on a dose and a doc won't continue to increase meds every month because he wants to continue to do physical labor.
When the pain takes his choice to work away he may already be on a huge dose of meds that would scare the normal surgeon off or they may insist he detox prior to surgery. If he's reached the point of begging to fix it how easy do you think it will be to detox off the meds to have the surgery.
I've seen CP patients get absolutely nothing post op because they arrive with a Duragesic patch on their shoulder. Being opiate dependent will make finding a surgeon harder when the time comes, It also creates a big problem controlling post op pain. The surgeon doesn't know what his tolerance is so he will play it safe and let the patient suffer unless you can arrange for his PM doc to handle the post surgical pain.
I feel bad for Griff, I understand his situation. He will reach a point where he can't take it any longer and if he waits to long the possibly of a positive outcome from surgery just decreases.
I wasn't disabled until my 3rd surgery,After that I did loose my home, I did file bankruptcy. It's not a reflection on character, It's what happens when people are disabled. It sucks and is unfair and I worked for years with no pain meds and failed back surgeries and broken hardware. Life isn't fair.
You saying 1200mgs of oxy a day is absurd is no differnt then your dad saying why don't you just take extra strength Tylenol. If 1200mgs is absurd, What's not absurd? 600mgs? 300mgs? 100? or just the dose you happen to be on?
Where did you read that 80 mg OxyC is usually reserved for cancer patients? Is that just something you made up or can you show me where Purdue or anyone says 80's should be reserved for cancer pain? There is a warning that only opiate tolerant patient should use the 80's just like the warnings on 100mg MSContin and 100ugh duragesic patches. But it doesn't mean that's the ceiling dose or should only be used for cancer.
Read the post about ACTIQ, That is the only med I know of that only has FDA approval for cancer pain and we still see CP patients using it. Are they wrong for doing so, because it's the only med that works? A 1200 mic pop is equal to about 1000mgs of morphine and I know one guy that use 6 a day. MGS are just numbers and just because someones dose is higher than yours it doesn't mean they hurt more, it just takes more medication to control their pain for any variety of reasons.
I didn't mean to suggest griff just suffer untill they find a cure but wanted to point out there may be consequences if you put something off that could be fixed just because you can manage the pain or you think you can't afford it. Can you afford to be disabled 2 years from now because you put something off that could have been corrected?
Take care, Shoreline
[This message has been edited by Shoreline (edited 07-10-2003).]
........................................ ............
What doc in their right mind would px a patient 1200 mg of Oxycontin a day? That is nuts. The last I knew - the strongest oxy comes in is 160 mg... so, 1200/120=7.5 - So, this doc is px'in @ least 7 of the Strongest oxy (which are normally reserved for Cancer patients) a day to someone w/ back problems? This is inexcusable, irresponsible behavior on the doctor's part, in my opinion... and I don't think that most pm docs would do this.
Next - you mention ESI's as a "cure" - that is not true. They also 'MASK' the problem until there might be a 'cure' - all the while competent pm docs are trying to find out exactly what w/b best and then "discussing" w/ the Patient what w/b the Best option for That one person... in the end, the decision lying w/ the patient.
........................................ ............
ESI's may not cure an annular tear but if inflamation is causing irritation of a nerve root the anti inflamatory properties would be considered a cure if they relieve the pain caused by inflamation or relieve pain long enough to allow a disc to heal without operating then it does have curative properties or allows for a cure.
Bye the way, 120x7.5 doesn't equal 1200
80x5x3 does equal 1200
How does the CP patient that is taking 1200mgs of oxyC a day feel when he reads your post? You sound like an ignorant doc that thinks because the highest dose patch is 100ugh that's the most they should ever prescribe.
Do you really think that because OxyC only comes in 80 mg tabs that's the most that someone can take. I've seen plenty of idiot docs discontinue meds because a patient reached 100mgs of Kadian and got no relief and since that's the largest pill the doc thinks that's the most someone can take. I took 600mgs a day for almost a year before switching back to methadone.
I have a friend that used to drive the 4 hours to see DR Hurowitz in Fairfax, he was taking 1800 mgs of MSContin a day, 80 mgs of meth at night and had all the Oxyfast he needed for BT pain. Now he sees my doc and is on the same regemin. You can't say someone can't need that much pain medication until your in their shoes.
By the way, My docs not nuts, He has every PM effort I ever tried documented in my records. He can justify the use of meds by properly documenting other efforts.
Show me one article that suggests there is a ceiling on the amount of opiate a patient should be allowed or can safely use if titrated properly.
Perhaps some BS from the Oxy kills web site but that's written by an angry parent that lost a child due to drug and alcohol abuse.
When I had insurance I was able to switch from my dose of meth to 200mgs of Kadian 3 times a day. But my spine is as stable as it will ever be. I still crunch and squeak with every step but I haven't needed an increase in 3 years, when I lost ins I switched right back to the same dose of meth I had previously been on.
My point is that if the problem isn't stable and continues to worsen and you just mask the pain you have no idea what your doing to your body. Pain imprints into nerve tissue and may become permanent even if surgery is successful at relieving radiculopothy or decompressing a nerve.
You may still be left with a great deal of pain imprinted into your nervous system. It's part of the gateway theory and explains phantom limb pain. Phantom limb pain is just as real as back pain or cancer pain.
If Griff is presently taking 2 7.5 percs every 4 hours he would have to start with 40mgs of OxyC 3 times a day to sustain the same or a little higher serum level that the short acting meds do. A 40 mg oxyC sustains roughly 20 mgs in your system for 6-12 hours. More like 6-8 but some can get by with BID dosing if they have enough BT meds
So now he's at 40 mgs of oxy 2-3 times a day, but this barely cuts it and won't allow him to work the 10 hours a day he wants. The problem continues to worsen and the need for meds just increases. If the problem isn't stable what works today for pain won't necessarily work in 2 months for pain. So what looks like rapid tolerance is simply progression of the problem causing the pain.
If you refuse any modality that takes you out of work is it realistic to keep asking for increases because you have a bad disc but continue to do heavy manual labor.
If you don't believe how high peoples doses can grow just ask Jack beanstalk what his previous dose of Oxy was or Dilaudid before he switched to methadone.
By the way, Purdue threw the DEA a bone when they discontinued distribution of the 160mg OxyC strength 2 ywears ago, less than 3% of their sales where this strength, so docs just prescribe twice as many 80's.You might want to do some more current research if you think the 160's are still available.
I don't know how you can suggest that someone with back pain couldn't need 1200mgs of oxy a day.Do you know what it's like to have 12 screws and 8 rods in your spine and an unstable fusion? How about the folks with NF where tumors grow at the end of nerve endings? There is no ceiling on the dose of opiates a CP patient can take as long as they are tolerant and have titrated slow enough to that dose.
There is absolutely no evidence that cancer pain is any worse than other pain, they just treat it differently if your terminal because addiction and tolerance is inconsequential when your going to die anyway.
Someone taking 1200mgs of oxy a day is at no more risk than someone taking 120mgs of oxy a day. If their tolerance allows it and they require it I would never suggest they didn't need it.You seem to have the psychyc ability to determine what people need, perhaps you can find a job at a block shop and predict doses.
I was suggesting there are many alternatives before you jump on the most powerful meds. I've met a Veterinarian that at one time wore 10 100ugh duragesic patches,now he's using 160mgs of methadone 4 times a day. Meth is anywhere from 5-10 times stronger than morphine. If you use a 1:5 factor that equals to 3000mgs of morphine per day.Who am I to say He doesn't need that much just because I don't.
Another member of a different forum wears 4 100ugh patches changed every 48 hours, Uses 400mgs of Kadian and 160 mgs of meth a day. He only gets relief from using multiple opiates. No he's not dieing, but he has a failed fusion with screws into bone that's sponge like from osteoperrosis. If that's what it takes, that's what it takes.
He actually took part in the chronic pain clinical trials for Duragesic, It was first only approved for cancer pain. Look how many CP folks use the patch now. So this guy that you suggest could never need that much medication made Duragesic available to every patient on this forum from his willingness to participate in the clinical trials for CP patients. Did you know only 6% of the people in the trial were able to go 72 hours before changing the patch?
I have 12 screws and 8 rods in my spine from a 6 level fusion.I crunch and squeek with every step, but after 3 failed surgeries and numerous consults and trying every non opiate method I eventually was put on long acting meeds. Once the dose was titrated to the right level I have sustained that level for 3 years. Because my spine is as stable as it will get.
The hardware is holding things in place, should this set snap like the first set then I can see my needs increasing again untill some amount of stabilty was obtained.
If someone wants to argue that their meds don't cause a high then you can't draw a line and say anything beyond this is absurd unless your dieing. You can be just as accomadated to 1200mgs as 120mgs with no more impairment than anyone else taking opiates.
Just because I've thrown numbers out that you can't imagine doesn't mean it's not true, Jack knows all the folks I'm talking about and knows how accommodated to high doses you can become.
To someone that gets relief from one Lortab they can't imagine someone needing 120mgs of OxyC or 600mgs of morphine a day. Where do you suggest they draw the line for back pain, migraines, neuro fibromatosis,or any pain generator?
What is the most that you think someone should take Karen? There is no correct answer and having cancer doesn't mean you have more pain than someone that's not terminal, that's hogwash. Show me where a single study suggest that cancer is more painful than any other pain generator.
You can't measure pain. It's a unique experience to each person, What you call a 10 may only be a 4 on my scale. Where you may get relief from percocet I need 90 mgs of oxycodone for BT pain.
Does a single level fusion get 40 mgs of oxy and a 2 level 80 and a 3 level 120 and a 4 level 160 and a 5 level 200.
The number of levels doesn't represent an amount of pain. A failed single level fusion can certainly hurt as much as a failed 6 level fusion.
What I'm saying is to simply mask pain because you think you can't afford to take time off or because you don't want to try anything else will have consequences. Either docs not willing to prescribe because other documented efforts haven't been tried.
Or you need surgery but nobody will touch you because they don't want to deal with a tolerant dependent patient. I've been at this PM thing for over a decade and seen things you can't even seem to imagine.
There are people in pain that take doses beyond what you consider reasonable, but what right do you have to say what is reasonable. Don't you think 80 mgs 3 times a day sounds absurd to the opiate naive patient that just came home from a 3 level fusion with just percocet for pain?
How can someone need more medication then someone who just had orthopedic surgery? Let me answer that for you, because of tolerance, because of pain imprinting, because of the gateway theory. Because everyone responds differently to medication and because chronic pain responds differently to opiates than acute pain and different parts of the brain and nervous system are involved in chronic pain. Have you heard of RSD or central pain syndrome?
Griff could put off surgery and keep working with enough meds until his disc disintegrates and once bone is touching bone you spontaneously fuse. Once he's bent over and fused in an awkward position there won't be a surgical alternative. So what favors has the PM doc done by simply relieving his pain and not looking for a possible cure. All he's done is give him a few more months or years before he's disabled by a problem that can no longer be fixed.
IDET may be an answer and it's not as irreversible as say a fusion. Micro discectomies and artificial discs are much less invasive then fusion.
I have seen people that were unable to work and taking large amounts of meds have ESI's and get tremendous relief and decrease meds or discontinue them altogether. Just because you haven't seen it, read about it,or researched it doesn't make these doses outrageous. It takes what it takes. But if you can't stabilize the pain generator you can't stabilize the dose. That's my point.
Griff will likely at some point go to the surgeon and beg for relief because he won't be able to stabilize on a dose and a doc won't continue to increase meds every month because he wants to continue to do physical labor.
When the pain takes his choice to work away he may already be on a huge dose of meds that would scare the normal surgeon off or they may insist he detox prior to surgery. If he's reached the point of begging to fix it how easy do you think it will be to detox off the meds to have the surgery.
I've seen CP patients get absolutely nothing post op because they arrive with a Duragesic patch on their shoulder. Being opiate dependent will make finding a surgeon harder when the time comes, It also creates a big problem controlling post op pain. The surgeon doesn't know what his tolerance is so he will play it safe and let the patient suffer unless you can arrange for his PM doc to handle the post surgical pain.
I feel bad for Griff, I understand his situation. He will reach a point where he can't take it any longer and if he waits to long the possibly of a positive outcome from surgery just decreases.
I wasn't disabled until my 3rd surgery,After that I did loose my home, I did file bankruptcy. It's not a reflection on character, It's what happens when people are disabled. It sucks and is unfair and I worked for years with no pain meds and failed back surgeries and broken hardware. Life isn't fair.
You saying 1200mgs of oxy a day is absurd is no differnt then your dad saying why don't you just take extra strength Tylenol. If 1200mgs is absurd, What's not absurd? 600mgs? 300mgs? 100? or just the dose you happen to be on?
Where did you read that 80 mg OxyC is usually reserved for cancer patients? Is that just something you made up or can you show me where Purdue or anyone says 80's should be reserved for cancer pain? There is a warning that only opiate tolerant patient should use the 80's just like the warnings on 100mg MSContin and 100ugh duragesic patches. But it doesn't mean that's the ceiling dose or should only be used for cancer.
Read the post about ACTIQ, That is the only med I know of that only has FDA approval for cancer pain and we still see CP patients using it. Are they wrong for doing so, because it's the only med that works? A 1200 mic pop is equal to about 1000mgs of morphine and I know one guy that use 6 a day. MGS are just numbers and just because someones dose is higher than yours it doesn't mean they hurt more, it just takes more medication to control their pain for any variety of reasons.
I didn't mean to suggest griff just suffer untill they find a cure but wanted to point out there may be consequences if you put something off that could be fixed just because you can manage the pain or you think you can't afford it. Can you afford to be disabled 2 years from now because you put something off that could have been corrected?
Take care, Shoreline
[This message has been edited by Shoreline (edited 07-10-2003).]
mokita
07-10-2003, 05:25 PM
Excuse me, Shoreline. I didn't mean to cause a flame here. I have watched Griff's posts on Back Problems and I felt that you were being a tad insensitive to what she might be going through.
Yes, I guess I must be ignorant. You are much more well-informed when it comes to meds/titrating. I have just finally, after 2-1/2 yrs of constant pain, found a good pm doc. I was concerned about your post to griff suggesting that she try surgeries rather than risk being on meds that might require her to continue to titrate. I firmly believe that is her choice. I am doing my best to educate myself about my options. I come here to learn more. Not to be verbally abused.
Sorry, Griff... I don't need this. I'll catch you on the Back Problems board.
Thanks Shoreline...I am shaking and in tears. You're a swell guy.....
------------------
9/22/00 24 hour labor, baby posterior, left tailbone killing me
12/00 MRI - PCP said nothing amiss - but, had to begin taking vicodin
2/8/02 - 2nd baby born after long, painful pregnancy, weight gain didn't help
2000-11/02 various PT + pain meds
11/02 Referred to Neuro
3/03 NEW MRI - shows slight bulge L3-L4,slight DDD, neural foramen involved, Superior aspect S1 and L5 Nerve root involvement -Neuro Refers to PM for ESI
3/03 PM Doc orders ESI
3/21,4/1,4/8 - ESI's no help
5/9 - Discogram - shows Tear L4 w/ significant leak onto nerves, DDD
Performing doc oversedated, False Negative (pm doc & I agree)
New Consult w/ Dept Head Cleveland Clinic 7/8 to discuss possible new discogram/IDET candidacy
7/8-Doc ordered Facet Joint nerve block for 7/29 to rule out/identify as pain generator. If not, new discogram.
Also, thinks tailbone thing may be from displacement - wants x-ray (think I've had one - have to track it down!)
Yes, I guess I must be ignorant. You are much more well-informed when it comes to meds/titrating. I have just finally, after 2-1/2 yrs of constant pain, found a good pm doc. I was concerned about your post to griff suggesting that she try surgeries rather than risk being on meds that might require her to continue to titrate. I firmly believe that is her choice. I am doing my best to educate myself about my options. I come here to learn more. Not to be verbally abused.
Sorry, Griff... I don't need this. I'll catch you on the Back Problems board.
Thanks Shoreline...I am shaking and in tears. You're a swell guy.....
------------------
9/22/00 24 hour labor, baby posterior, left tailbone killing me
12/00 MRI - PCP said nothing amiss - but, had to begin taking vicodin
2/8/02 - 2nd baby born after long, painful pregnancy, weight gain didn't help
2000-11/02 various PT + pain meds
11/02 Referred to Neuro
3/03 NEW MRI - shows slight bulge L3-L4,slight DDD, neural foramen involved, Superior aspect S1 and L5 Nerve root involvement -Neuro Refers to PM for ESI
3/03 PM Doc orders ESI
3/21,4/1,4/8 - ESI's no help
5/9 - Discogram - shows Tear L4 w/ significant leak onto nerves, DDD
Performing doc oversedated, False Negative (pm doc & I agree)
New Consult w/ Dept Head Cleveland Clinic 7/8 to discuss possible new discogram/IDET candidacy
7/8-Doc ordered Facet Joint nerve block for 7/29 to rule out/identify as pain generator. If not, new discogram.
Also, thinks tailbone thing may be from displacement - wants x-ray (think I've had one - have to track it down!)
tryuo
07-10-2003, 06:02 PM
Shoreline, people come to these boards for answers not to receive patronizing and condescending replies. Find a way to answer peoples questions without hurting their feelings, or don't post here anymore.
lgriffincsa
07-10-2003, 06:30 PM
Mokita,
I want to thankyou for your support, and advice. I have read alot of your posts and you seem to be a very helpful and compassionate person. One more thing, I am a he, not a she, LOL.
Originally posted by mokita:
Excuse me, Shoreline. I didn't mean to cause a flame here. I have watched Griff's posts on Back Problems and I felt that you were being a tad insensitive to what she might be going through.
Yes, I guess I must be ignorant. You are much more well-informed when it comes to meds/titrating. I have just finally, after 2-1/2 yrs of constant pain, found a good pm doc. I was concerned about your post to griff suggesting that she try surgeries rather than risk being on meds that might require her to continue to titrate. I firmly believe that is her choice. I am doing my best to educate myself about my options. I come here to learn more. Not to be verbally abused.
Sorry, Griff... I don't need this. I'll catch you on the Back Problems board.
Thanks Shoreline...I am shaking and in tears. You're a swell guy.....
------------------
1998-Major rear-end colision
1998-mid2000-Chiropractic care
2000-mid2002-Pain level increased drasticly. No insurance, took a combo of every OTC painreleiver imaginable.
2002-MRI/ L3/L4 and L4/L5 annular bulging; DDD L4-5 and L5-S1
2003 February- Orthopeadic Spinal Surgeon said not a candidate for surgery,Percocet 5/325 every 6 hrs.
2003 June-1 month at PM clinic, Percocet 7.5/325 every 4 hrs.
08JULY2003-Had Discogram, comfirmed pain comming from L4-L5 disc. Awaiting followup exam, and discussion of treatment options.
I can function/work for 3-4 hrs per day/ 2/3 days per week with current meds. I beleive I could function/work normal hours with stronger, timereleased meds. Surgery is NOT an option at this time.
I want to thankyou for your support, and advice. I have read alot of your posts and you seem to be a very helpful and compassionate person. One more thing, I am a he, not a she, LOL.
Originally posted by mokita:
Excuse me, Shoreline. I didn't mean to cause a flame here. I have watched Griff's posts on Back Problems and I felt that you were being a tad insensitive to what she might be going through.
Yes, I guess I must be ignorant. You are much more well-informed when it comes to meds/titrating. I have just finally, after 2-1/2 yrs of constant pain, found a good pm doc. I was concerned about your post to griff suggesting that she try surgeries rather than risk being on meds that might require her to continue to titrate. I firmly believe that is her choice. I am doing my best to educate myself about my options. I come here to learn more. Not to be verbally abused.
Sorry, Griff... I don't need this. I'll catch you on the Back Problems board.
Thanks Shoreline...I am shaking and in tears. You're a swell guy.....
------------------
1998-Major rear-end colision
1998-mid2000-Chiropractic care
2000-mid2002-Pain level increased drasticly. No insurance, took a combo of every OTC painreleiver imaginable.
2002-MRI/ L3/L4 and L4/L5 annular bulging; DDD L4-5 and L5-S1
2003 February- Orthopeadic Spinal Surgeon said not a candidate for surgery,Percocet 5/325 every 6 hrs.
2003 June-1 month at PM clinic, Percocet 7.5/325 every 4 hrs.
08JULY2003-Had Discogram, comfirmed pain comming from L4-L5 disc. Awaiting followup exam, and discussion of treatment options.
I can function/work for 3-4 hrs per day/ 2/3 days per week with current meds. I beleive I could function/work normal hours with stronger, timereleased meds. Surgery is NOT an option at this time.
HikingFan
07-10-2003, 07:01 PM
Geez Shoreline, maybe she shouldn't have told you that a certain dose is absurd, but did that really constitute blowing her out of the water and making her feel like an idiot? Obviously, you realized in reading her post that she wasn't nearly as educated as you about oxy, and all is would've taken is a response explaining to her the fatcs about oxy, without making her feel like a jerk.
There was so much anger in your response that nobody deserves...I think you owe her an apology, and need to find a more constructive way to express your disagreement with someone's comments!!!!! :nono:
[This message has been edited by HikingFan (edited 07-10-2003).]
There was so much anger in your response that nobody deserves...I think you owe her an apology, and need to find a more constructive way to express your disagreement with someone's comments!!!!! :nono:
[This message has been edited by HikingFan (edited 07-10-2003).]
Wes1212
07-10-2003, 09:04 PM
there is some good information here and i am printing some of it to take to my neurosurgeon. i hope he reads it :)
Kierra
07-10-2003, 09:53 PM
Hi Everyone
I too think that was harsh Shoreline ..maybe your in pain, having a bad day or mad at the world, I don't know...but I also think you owe her an apology...I hope that you all feel better soon...remember no-one is perfect nor do we try to be
Take care all
your friend
Kierra :wave:
I too think that was harsh Shoreline ..maybe your in pain, having a bad day or mad at the world, I don't know...but I also think you owe her an apology...I hope that you all feel better soon...remember no-one is perfect nor do we try to be
Take care all
your friend
Kierra :wave:
grizzk62
07-11-2003, 12:25 AM
Shoreline,
Thatsd not cool bro. I know Karen and she is well informed on alot of issues and she was speaking out of concern and nothing else. You need to take a reality check and calm down.
Thatsd not cool bro. I know Karen and she is well informed on alot of issues and she was speaking out of concern and nothing else. You need to take a reality check and calm down.
Jack Beanstalk
07-11-2003, 02:01 AM
WWHHHOOOOAAAAHHHH,,,HEEYYY you,all remember,we is all on the same side!!Karen,you were,I believe, just a bit in awe of the dosages and other stuff you made reference to from Shorelines post.You,like so many,were probably gape-jawed at some of them comments cause,the truth is,many folks don,t really know about the "dark side"of the way some of the Pro-Opiate Dr.,s deal with some of their worse-off patients.We,re talkin bout un-real amounts of Opiates,just the way Shore put it,being given to these folks cause they have suffered mind-bogglin pain and they are to a point where all that can be done for relief is to be Rxed these meds.Some people have developed such high tolerances to them that they take 1200-2400mg each day of Oxy,3,000mg of Morphine,the Vet(Dr."JTroy") takes 160mg of Methadone,4 times a day!Yes,he,s a practicing,very respected animal Dr.It,s just that many people have not heard of these things but they do exist.I agree that Shoreline was harsh and lengthy with his post,but I gaurantee he was just lettin out pent-up frustration from readin too many posts about all these folks who are constantly under-medicated or seen by Doc,s who seem like pain is just a "little,trifling thing"that should just be tolerated by their Patients.I promise,in the end,they will get theirs.I guess,all it boils down to is an example of a few hurting,frustrated folks that mean well,but simply butted heads momentarily.I say that you,re all worthy people,or if not,why are you here where people are always asking for or giving out a lttle help for their Brethren? Jack Beanstalk
bonnie11
07-11-2003, 05:21 AM
I agree with you Jack, that Karen was probably awestruck with the amounts of meds that are being Rx'd. Frankly, I am, too. I've been a chronic pain patient for 8 years now, and just started (the last few months) on oxyC's. I take 2x 20mg, and the doc started me on 2x 10mg. The starting dosage did NOTHING for me, and I mentioned on another pain discussion forum about doubling up, for a few days to see if that would help. (Prior to this, the strongest meds I'd taken were Norco's). Someone said 'Oh, no!! Don't do that!! I've heard that oxy's are 5 X stronger than Norco's!!' Well...I don't know if there's some chemical formula that says that's the case, but it definitely was NOT the case for me. If I took 5 Norco's they'd knock me on my butt (and then some), but 20mg oxyC is just about right, and actually a little low for me.
I don't know much about oxy's but I do know a little about pain imprints, and gateways, and even with that knowledge, and the knowledge that each person reacts differently to diff. meds, 1200mgs of oxy a day sounds like LOTS. But 10 years ago, before I had chronic and acute pain, my attitude about taking any kind of opiates was different than it is today, after living without a single pain-free moment for 8 years, and my conditions steadily declining.
I guess it's all relative, and being new, I'm not one to start anything, but Shoreline, maybe you can channel some of that knowledge and energy in a more helpful, positive manner for people like Karen & me. She really didn't deserve being treated the way you treated her up there. Just MHO.
bb
I don't know much about oxy's but I do know a little about pain imprints, and gateways, and even with that knowledge, and the knowledge that each person reacts differently to diff. meds, 1200mgs of oxy a day sounds like LOTS. But 10 years ago, before I had chronic and acute pain, my attitude about taking any kind of opiates was different than it is today, after living without a single pain-free moment for 8 years, and my conditions steadily declining.
I guess it's all relative, and being new, I'm not one to start anything, but Shoreline, maybe you can channel some of that knowledge and energy in a more helpful, positive manner for people like Karen & me. She really didn't deserve being treated the way you treated her up there. Just MHO.
bb
mokita
07-11-2003, 07:19 AM
Thank you all so much :)
Griff told me to come back over 'cuz there's so much support. I DO appreciate it. But, I also want to apologize for being harsh re: amts of meds. I WAS just defending Griff and what I feel are His (sorry bout that Griff) decisions. I do NOT doubt that Shoreline is well versed in the opiate arena....and I'm sorry that he has to know as much as he does. He has obviously suffered terrible pain. I AM In Awe @ the amounts some people need for any quality of life. I normally don't spout off facts & figures w/out knowing more than I do.... I don't like being wrong, for one thing (bad part of my personality! ;)) and I CERTAINLY Don't want to cause on cp'rs anymore unnecessary pain from my ignorance re: discussing amounts of meds as 'absurd.' For That, please accept my apology.
Again, thank you everyone for your support. I know I was speaking out of Pain and Frustration when I posted what I did... thanks to you who understand that! http://www.healthboards.com/ubb/heart.gif
Gratefully,
Karen
[This message has been edited by mokita (edited 07-11-2003).]
Griff told me to come back over 'cuz there's so much support. I DO appreciate it. But, I also want to apologize for being harsh re: amts of meds. I WAS just defending Griff and what I feel are His (sorry bout that Griff) decisions. I do NOT doubt that Shoreline is well versed in the opiate arena....and I'm sorry that he has to know as much as he does. He has obviously suffered terrible pain. I AM In Awe @ the amounts some people need for any quality of life. I normally don't spout off facts & figures w/out knowing more than I do.... I don't like being wrong, for one thing (bad part of my personality! ;)) and I CERTAINLY Don't want to cause on cp'rs anymore unnecessary pain from my ignorance re: discussing amounts of meds as 'absurd.' For That, please accept my apology.
Again, thank you everyone for your support. I know I was speaking out of Pain and Frustration when I posted what I did... thanks to you who understand that! http://www.healthboards.com/ubb/heart.gif
Gratefully,
Karen
[This message has been edited by mokita (edited 07-11-2003).]
oceanview88
07-11-2003, 02:00 PM
Hey Guys, When someone says a dose is absurd it does bother me, just because the folks posting don't need a certain amount of meds doesn't mean all the folks reading don't take that amount.
I obviously take twice the dose of some of the other folks that post here, does that make my dose absurd or my doc reckless? So I'll defend someone's dose that is twice what I take. I know these people and have personally met a couple in person that are in the 1800mgs a day range. There is virtually no quality of life when you start dipping into that level of pain or the need for that level of meds.
I don't think the only right thing to say on this forum is to ask your doc for more meds if you have a problem. Only about 10% of the folks that go to their doc with back pain, mainly lumbar strains actually end up needing surgery. So what do you do with the other 90% that don't need surgery, stick them all on OxyContin or meth until they feel better?
Pain relief with long term opiate maint. comes with a huge price, dependence, relying on a doc to get you the next script before withdrawal sets in, disability to the point that even with meds their is no possibility of working or returning to a career? Loosing friends and family that think you just take the meds for fun, dealing with people that want you to share your meds,crappy pharmacists and techs, prices we can't afford, people in the house stealing your meds. People breaking in your home to steal your meds. But lets not talk about anything negative about opiates because these things don't really exist or happen?
I'm sorry if you felt I was insensitive to griffs problem but it does seem like the only answer people want to hear is increase or find a new doc. You won't always get the answer you want to hear when you post your problem on a public forum.
The answer you don't want to hear may be the best answer but when you close you mind to all other alternatives besides finding a doc that will give you what you want you are only hurting yourself or hurting the person your defending. How do you know the answer to their problems is more narcotic medication, have they tried anything else? Have you even asked if they tried anything else?
It won't hurt me if griff keeps working until the disc disintegrates and her spine spontaneously fuses. Her own doc is basically telling her to let the pain imprint to the point of you being ready to blow your brains out. Why would anyone except that as an answer?
Find another surgeon, get another opinion, try other therapies and the meds will always be there if everything else fails. But straight from my back hurts to a surgeon that says your fine and on to opiates isn't the way to go. That's just my opinion and the American academy of pain management physicians.
I don't advocate the 90 percent that don't need surgery go to long term treatment with opiates before trying anything else and that's what's happening. Patient A goes to surgeon and the surgeon says I don't think your a good candidate so he refers them off to pain management. If the patient doesn't like PM doc 1 just look for one that will give you what you want. That's expectable advice?
How about try everything you can before you commit to opiate dependence. There was pain management before the invention of OxyContin.
If the only expectable response is to ask your doc for more or switch docs to get more, don't worry, I won't post anymore. seeya
I obviously take twice the dose of some of the other folks that post here, does that make my dose absurd or my doc reckless? So I'll defend someone's dose that is twice what I take. I know these people and have personally met a couple in person that are in the 1800mgs a day range. There is virtually no quality of life when you start dipping into that level of pain or the need for that level of meds.
I don't think the only right thing to say on this forum is to ask your doc for more meds if you have a problem. Only about 10% of the folks that go to their doc with back pain, mainly lumbar strains actually end up needing surgery. So what do you do with the other 90% that don't need surgery, stick them all on OxyContin or meth until they feel better?
Pain relief with long term opiate maint. comes with a huge price, dependence, relying on a doc to get you the next script before withdrawal sets in, disability to the point that even with meds their is no possibility of working or returning to a career? Loosing friends and family that think you just take the meds for fun, dealing with people that want you to share your meds,crappy pharmacists and techs, prices we can't afford, people in the house stealing your meds. People breaking in your home to steal your meds. But lets not talk about anything negative about opiates because these things don't really exist or happen?
I'm sorry if you felt I was insensitive to griffs problem but it does seem like the only answer people want to hear is increase or find a new doc. You won't always get the answer you want to hear when you post your problem on a public forum.
The answer you don't want to hear may be the best answer but when you close you mind to all other alternatives besides finding a doc that will give you what you want you are only hurting yourself or hurting the person your defending. How do you know the answer to their problems is more narcotic medication, have they tried anything else? Have you even asked if they tried anything else?
It won't hurt me if griff keeps working until the disc disintegrates and her spine spontaneously fuses. Her own doc is basically telling her to let the pain imprint to the point of you being ready to blow your brains out. Why would anyone except that as an answer?
Find another surgeon, get another opinion, try other therapies and the meds will always be there if everything else fails. But straight from my back hurts to a surgeon that says your fine and on to opiates isn't the way to go. That's just my opinion and the American academy of pain management physicians.
I don't advocate the 90 percent that don't need surgery go to long term treatment with opiates before trying anything else and that's what's happening. Patient A goes to surgeon and the surgeon says I don't think your a good candidate so he refers them off to pain management. If the patient doesn't like PM doc 1 just look for one that will give you what you want. That's expectable advice?
How about try everything you can before you commit to opiate dependence. There was pain management before the invention of OxyContin.
If the only expectable response is to ask your doc for more or switch docs to get more, don't worry, I won't post anymore. seeya
Kierra
07-11-2003, 04:40 PM
Hi Guy's
Im just postiong to wish eveyone a pain free day
Your Friend
Kierra
Im just postiong to wish eveyone a pain free day
Your Friend
Kierra
lgriffincsa
07-11-2003, 05:39 PM
Oceanview88,
I got the feeling from your last post that you were here under "shoreline". I am not quite sure why your name has changed. I really do appreciate the information which you provided in your previous post's. I get the feeling however, that you may not have read my signature. My situation is not quite as cut and dry as going from Ortho, to PM Dr. After my accident, I saw a Chiro for a year and a half. They did manipulation, TENS, physical therapy, heat, ice, massage therapy, water therapy, the works. Nothing they did helped, or atleast only lasted for an hour or 2 after my visit with them; which I had for 3 days per week, for a year and a half. After spending upwards to $8,000 with them, I decided that it was a waste of time and money, so I quite. I did my own ice, heat, and had my wife massage me, and took every OTC pain releiver you could imagine for years afterwards. I barely got by. I finnaly got health insurance, so I decided to see a specialists in back problems, an Orthopeadic Spinal Surgeon. I had Xrays, and an MRI ordered by them, and they felt that though there was a herniation in 2 of my discs, at my age, it wasnt prudent to operate, due to the risks involved, and the potential for making me worse off than I am before the surgery. I was sent to have a series of ESI's, and none of them helped. As a matter of a fact I got worse. My Ortho told me that I should not have any more, and that they dont always work. I was given percocet 5/325 every 6 hours. This med. never helped from day one to releive my pain. My Ortho, as are may other Dr.'s, are not comfortable prescribing narcotics long term, so he sent me to the PM Dr. so that he could provide me with some pain releif. Yes my dose was increased by the PM Dr., but it never worked either. Point is, I have not built a tolerance to the meds, they never were strong enough to start with. I say this to aleiviate your concerns that I will end up taking high doses of narcotics because I build up a tolerance so quickly. I forgot to mention that I have tried several differnent anti-imflamitory meds, muscle relaxers, the works. "Narcotic" meds are the only thing that provides me with any releif; and that has only been minimal with what has been prescribed to me thus far.
The point I am trying to make is that I have spent a fortune with Dr.'s, and their diffenrent ideas about what to do for me. I am no better off than when I started looking for help. I know my body, I know my limits, and I know what works for me. The shortest route between two points is a straight line. It seems that the majority of folks even though they have had one or more of the many surgical options out there, still end up using meds for their pain. It makes tons more sense to me to save my money, not risk the failures of surgery, loss of all that I own, and risk being worse off than I am now, and just get proper meds to help me. I dont know about you, but from my experience, Oxycontin is not the wonder drug that it is made out to be. Atleast not the doses I have taken. True, it does make my pain go away, but I assure you that if I lift, bend or pull more than I ought too, my body over-rides the medicine, and the pain tells me to stop. I only want the meds so that I can atleast get out of bed, get in my van, go to my job, supervise my employees, and have them do all the physical strenious work that I shouldnt be doing. Right now, I cant even do that.
Thanks for your time.
I got the feeling from your last post that you were here under "shoreline". I am not quite sure why your name has changed. I really do appreciate the information which you provided in your previous post's. I get the feeling however, that you may not have read my signature. My situation is not quite as cut and dry as going from Ortho, to PM Dr. After my accident, I saw a Chiro for a year and a half. They did manipulation, TENS, physical therapy, heat, ice, massage therapy, water therapy, the works. Nothing they did helped, or atleast only lasted for an hour or 2 after my visit with them; which I had for 3 days per week, for a year and a half. After spending upwards to $8,000 with them, I decided that it was a waste of time and money, so I quite. I did my own ice, heat, and had my wife massage me, and took every OTC pain releiver you could imagine for years afterwards. I barely got by. I finnaly got health insurance, so I decided to see a specialists in back problems, an Orthopeadic Spinal Surgeon. I had Xrays, and an MRI ordered by them, and they felt that though there was a herniation in 2 of my discs, at my age, it wasnt prudent to operate, due to the risks involved, and the potential for making me worse off than I am before the surgery. I was sent to have a series of ESI's, and none of them helped. As a matter of a fact I got worse. My Ortho told me that I should not have any more, and that they dont always work. I was given percocet 5/325 every 6 hours. This med. never helped from day one to releive my pain. My Ortho, as are may other Dr.'s, are not comfortable prescribing narcotics long term, so he sent me to the PM Dr. so that he could provide me with some pain releif. Yes my dose was increased by the PM Dr., but it never worked either. Point is, I have not built a tolerance to the meds, they never were strong enough to start with. I say this to aleiviate your concerns that I will end up taking high doses of narcotics because I build up a tolerance so quickly. I forgot to mention that I have tried several differnent anti-imflamitory meds, muscle relaxers, the works. "Narcotic" meds are the only thing that provides me with any releif; and that has only been minimal with what has been prescribed to me thus far.
The point I am trying to make is that I have spent a fortune with Dr.'s, and their diffenrent ideas about what to do for me. I am no better off than when I started looking for help. I know my body, I know my limits, and I know what works for me. The shortest route between two points is a straight line. It seems that the majority of folks even though they have had one or more of the many surgical options out there, still end up using meds for their pain. It makes tons more sense to me to save my money, not risk the failures of surgery, loss of all that I own, and risk being worse off than I am now, and just get proper meds to help me. I dont know about you, but from my experience, Oxycontin is not the wonder drug that it is made out to be. Atleast not the doses I have taken. True, it does make my pain go away, but I assure you that if I lift, bend or pull more than I ought too, my body over-rides the medicine, and the pain tells me to stop. I only want the meds so that I can atleast get out of bed, get in my van, go to my job, supervise my employees, and have them do all the physical strenious work that I shouldnt be doing. Right now, I cant even do that.
Thanks for your time.
harlan
07-11-2003, 06:00 PM
I think that we are all somewhat concerned about the drugs that we take to lead a 'normal' life. It scares me to read about the dosages that some people take as I hope that I never get to those levels. It is important to respect pain medications -- they are strong and can easily add a new range of health problems to our lives.
Respect the power of these medications.
[This message has been edited by harlan (edited 07-11-2003).]
Respect the power of these medications.
[This message has been edited by harlan (edited 07-11-2003).]