Hey Christine, As far as Oxycontin lasting 12 hours, no way no how. Purdue compares taking a 10mg OxyContin as maintaining serum levels similar to taking one percocet every 6 hours. Anyone that's had surgery knows percs don't last 6 hours.

The way the time release mechanism works with Oxy is that it releases about half it's contents at the like 1hour and 15 minutes and the second half at about the 6th hour.

If your pain spikes beyond the ability of the second release to bring it back in check it will certainly have the appearance it doesn't last 12 hours. This doesn't mean taking additional meds during the twelve hours of that first oxy won't have a combined effect with what remains in your system. I would feel overlap after 8 hours from meds but on it's own the last 4 hours are miserable without BT meds or more frequent dosing.

Maintaining specific blood levels for 12 hours doesn't necessarily equate to how long the analgesic action will last. Letting pain spike and trying to bring it back down after it''s out of control has no medical benefit. The design is definitely flawed and you have to wonder about the raw data they created to sell this to the FDA as a 12 hour med.

For example, Methadone has a 30 hour half life, Giving you the impression you will get prolonged relief, however when dosed for acute pain the recomended interval is Q4, it's given every 4 hours.

If serum levels are the end all answer to how long a medication provides anelgesia then even the most acute pain would benefit from a med that still has half it's serum level at 30 hours. There are suggested guides for effective anelgesic serum levels of methadone that show more frequent dosing is neccesaary to keep acute pain in check that show 4 hour dosing is appropriate for acute pain.

As far as I know Purdue has done no such study to coralate serum levels to pain relief.However Purdue has stuck to their guns on this 12 hour dosing. Manufacturer reps have called on or notified every PM doc and pharmacist that OXyC should not be prescribed more frequently than Q12. They won't allow it for their patient assictance program. THere are ways around this and ways to convert your BID dosing into TID dosing which would provide smoother more effective serum levels.

I've tried taking larger doses hoping it would last longer, I've seen dozens of docs do the same thing and acheive absolutely no benefit. A higher doses
of OxyC at twice a day dosing does not solve the duration problem.

You are better to adjust yourself to what works as long as you don't go beyond the prescribed daily dose.In the long run your daily dose will be minimized if your doc works with you providing the right size pills he can still order it BID and have you take it TID. 60mgs BID can easily be changed to take two 40's in the am and one in the PM. The doc tells you to take 40 TID but writes the scripts in a way that won't deviate from the manufacturer's recommendation.

I've seen docs think that because Oxy only is available now in an 80mg pills that is the most they can prescribe. 80mgs twice a day. This is just ridiculous but some docs are so afraid to deviate from the manufacturers recommendation their patients suffer.

Purdue tested Oxy Up to 320 mgs per day. There is no ceiling once a patient becomes safely accomadated to the med. Meth is trickier because of the half life but there truly is no ceiling or toxic build up that damages organs. More people die each year from taking too much APAP or OTC NSAIDS like motrin and aleve.

17,00 people each year die from OTC meds just trying to find relief. A few hundred deaths from Oxyc over 3 years is hardly a large number for the #1 prescribed pain med. I'm not sure they can still make that claim but morphine is safer than Tylenol by a long shot.

I consider my pain acute and long lasting, I don't buy the whole chronic pain is that different from acute pain other than the psychological effects CP has.My pain rsponds the same way acute pain rsspnds to opiates. Acute pain is a breeze when you know you will feel better in 3-4 days. You don't have near the issues in dealing with acute pain other than the idea acute requires more frequent dosing.

I feel meth wear off in 4-5 hours and require redosing, but after 4 doses in my system I guess I reach the combined serum level of repeated dosing and have no problem coasting through the night longer than I do in the day. I have BT meds for extra night pain.

My dose has been stable for years and rotating BT meds and hitting a broader range of receptors can't possible do anything but help manage pain.

I know folks that have only been able to climb out of the bed by combining 3 long acting opiates, Meth, Kadian and 4 100ugh Duragesic patches. That's what it takes to manage his pain. I know what he's dealing with and know his wife and have no doubt his goal is to simply live his life and function to the best of his ability thanks to a knowledgeable doc that understands the benefits of combining opiates.

His doc is a CP patient herself which certainly gives her a different perspective. PM docs believe they don't have to have experienced severe pain to treat it but it has to give them a perspective only a CP patient has. Mgs don't matter. ;)

As far as Toppamax, Finding the right med to treat burning nerve pain is just as tough as finding the right opiate. There are plenty of choices. using anti seizure meds for nerve pain is very effective for some people. It is an off label use for anti seizure meds but the way it was described to me it was like the med would remove every other letter out of each word in a sentance. Doing this disrupts the pain signal. I know people that had shingles that swear antiseizure meds saved their life. They do tend to be mind numbing in the beginning or once you reach your limit. Fortunately surgery relieved my burning nerve pain. I have numbness from the waste down but numb is better than on fire.

I understand completely not wanting to even get into the cycle of nerve blocks every 6 months for minimal help. So what, it's not worth getting your nerve branches skewered every 6 months and during each test. Being fused 6 levels they did 12 test blocks at once on me and that was enough lighting my legs up for a lifetime.

I wouldn't do the blocks as long as relief can be obtained through less invasive methods. They have their place but you can't slam every square peg into a round whole. They do cause scarring and I already have enough to bend a large gage needle. serriously. PT for scar management is a must and PT for myofacial release is worth it's wait in gold if you have the right therapist.

My bro had surgery 3 months ago and is stiff as a board and this was just a lami/iscectomy. No fusion so PT couldn't possibly hurt him , and the doc doesn't believe in PT. He thinks it can all be done at home, and this is the chief of Neurosurgery at Duke. The scar management alone is worth it.

Every doc has their own ideas, and that's all they are. No more valid than someone that has the ability to research their own problem and be proactive in their care.He should have his PCP order the PT since his surgeon is so ignorant about the benefits. I guess he thinks he's the cure all. Don't let a doc do this to you and condemn you to pain for the rest of your life.

Take care, Shore



[This message has been edited by Shoreline (edited 10-31-2003).]