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Old 08-12-2004, 05:30 AM   #1
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travitch HB User
Question Am I crazy???

Hello everyone. I just wanted to ask a question about my pain medication. The doctor has me on 1 to 2 capsules of Mepergan Fortis (50 mg Demerol and 25 mg Phenergan) every eight hours as needed for pain. I Have been taking these for about three weeks. Initially these kicked my butt and worked well on the pain. Now, I can take two of them and they don't seem to help the pain at all. I know that you can build a tolerance to these types of medications. And, I think I have. I am wondering if switching pain killers would allow to take a regularly prescribed dose to alleviate the pain. In other words I would not have a tolerance to that narcotic even though I have built one to Mepergan.

I had thought to post this in the Pain Management section but as I am not seeing a doctor in that area I felt I should only post in an area that I am currently seeking treatment or have had treatment. If anyone feels it would be better to post the question there please let me know and I will do so.

 
Old 08-12-2004, 06:29 AM   #2
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Re: Am I crazy???

Hi Travitch, welcome!!! Unfortunately, we all tend to build a tolerance for the meds we're on, and so require an increase!! Do you think your dr will give you one, when it's only been 3wks??
If you try another med, it will help with the pain, as long as it's a stronger med then what you're taking! Drs tend to increase your dosage, before changing the med altogether though!
Being that you haven't been on this med that long, is it possible that you've just pushed yourself too far lately, and therefore it doesn't seem as affective as it was?? I know myself, no matter what med I'm on....if I'm active, even a little, the pain level increases, and it feels like I never even took any meds!! The only way the meds work good LOL, is if I'm not doing anything, and that includes simply walking LOL!!
Isn't the CP life just grand?? LOL!! I'd definitely let your dr know the problems you're having, and see what he thinks you should do!! Let us know how you make out ok? Good luck and take care!!

 
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Old 08-12-2004, 12:29 PM   #3
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Re: Am I crazy???

Thanks for the info. You maybe spot on about the over doing it. It is probably some of that and some of my building tolerance. I had hoped it was just a matter of switching to a different medication not necessarily stronger because they have to be chemically different.

 
Old 08-12-2004, 04:10 PM   #4
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Re: Am I crazy???

Hello
Question for you? Are you waiting until you are in bad pain before taking your medication?
Sometimes when you wait until the pain is "out of control" it takes twice as much medication to bring the pain down.
Try not to wait until the pain is "really bad"
just a thought
Good luck
Lisa

 
Old 08-12-2004, 05:33 PM   #5
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Re: Am I crazy???

Nothing wrong with posting on other boards, many of us do this as we sometimes have many illnesses or problems going on at one time.

I don't believe nor have ever experienced tolerance that rapidly. Chances are your body has adjusted, not tolerated the medication. Stop taking it and you will see immediately that it in fact is still working for you.

The goal of PM is to never have you 100% pain free, in fact it won't happen. If it does happen then the likelyhood is that you are on very strong medications and before you know it you are at the end of your rope with no more room to titrate up to a stronger dosage.

Outtolunch is correct, a proper doctor would not necessarily change you to a stronger medication, they might however increase your dosage a bit. I does take a bit of time to tweak pain medications because everyone is completely different in how they react.
When I first started on morphine it too was "kicking my butt" but now some 6 weeks later it doesn't feel as effective as it once was but it in fact is because I know quickly when I have forgotten to take a dose.

in all reality, if you have ongoing chronic pain you really should be seeing a PM doctor for many reasons. Primarily because they have good grasp or actual practice in pain relief as a whole. Many doctors put people on medications that are short acting and only effective for a short duration. CP needs to be treated in a long acting situation with meds for breakthrough if needed. This too may be case for you, you may require occasional break through medications.

The other big reason for seeing a PM is that the laws are very strict when it comes to narcotics. The FDA as well as the medical boards do look at doctors who practice PM but are not real PM physcians and your doctor can run the risk of loosing their liscense if improperly prescribing or over prescribing a given amount of narcotics in a given period of time. It requires very heavy documentation as well and justification which is something standard doctors rarely do.

Also understand that PM as a whole is just not about medications, it is also about adjusting your lifestyle, much to our dislike, in order to reduce pain. Various non evasive and non medicating methods also need to be put in place for a CP such as psychological therapy to learn how to deal effectively and emotionaly with living a life of pain, physical therapy, Pain Management classes or courses, meditation, visualization or focusing are just a few of the more common practices today. Many PM's do require you do some or all of these methods. Some will work, some won't, you take what does work and practice it in addition to your medications.

When working with a PM you will be required to sign a "contract" wherein you may not obtain any kind of narcotics from any other doctor for any reason without the PM knowing about it. They will also not give you a new prescription if you accidently loose your medications. Many will not change meds without seeing you (most scripts can't be called in anyhow) and you may be required to bring back any medications that do not work for you that you are taking to be sure they aren't being sold or abused. A PM also has the right to drug test you.

Yes it's a complicated and sometimes scary process but if you have CP you will do the things necessary to have some sort of quality of life.

As Lisa said, you should be taking your medications before the pain hits. If you are allowed enough every 8 hours, take it every 8 hours. Pain meds are more effective before the pain hits, not afterwards. Try taking them on schedule, see how it goes, you may find it to work out better for you.

I, again, would suggest you see a practicing PM, ask the current prescribing doctor if they don't feel that if your CP is long term that it would be more appropriate to be treated by the proper specialist. It isn't that your doctor isn't compitent by any means but think of it this way, if you need open heart surgery would you go to an orthopeadic surgeon? Probably not. CP is no different.

I wish you lots of luck in getting the relief you need

Barbie

 
Old 08-13-2004, 06:25 AM   #6
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Re: Am I crazy???

Lisa thank you very much for this information. The prescription says "as needed for pain" so I was just following the directions. But what you said here makes sense to me. My mother has suggested that I do bring this up with the doctor and I see him next Thursday.

Barbie thank you very much as well. I do have CP at the moment if a month straight qualifies me. I am hoping that my doctor will forgo the final epidural injection. The first one did not really hurt at all. The anesthiolost told me that he put some narcotic in the shot. Dunno which one. But this shot provided me about 5 to 6 days of relief. In fact after the local all the pain seemed to be gone and I was amazed. I also had uncontrollable ticks for three days following this. I went to get another epidural and this was given by another anesthiologist. This time the local was reduced significantly and no narcotic was added. I received no benefit from this shot. I am hoping that I can discuss a discectomy with the doctor next week. This way I can stop taking any medications after. I don't know if my doctor refers people to PM doctors. I think he does because as I was going to get the MRI a little over a month ago there was also a place for referral to a PM doc. I don't know this is right for me at the moment because I hope to have this problem corrected in the near future.

 
Old 08-13-2004, 08:34 PM   #7
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Re: Am I crazy???

Hi -

I researched that CP was 6 months or longer, but that doesn't diminish the fact that you HURT.

I took Tylenol with Codeine for 2 months in 2001 (my pain has been ongoing since 2000). When I quit cold-turkey, I was HATING LIFE for 5 days (withdrawal for narcotics is shivers and sweats, like the bad flu).

I recommend that if you work with a PM, but still need meds, you might try Ultracet or another non-narcotic painkiller. Doesn't "kick your butt," but it might give you the med option you need while still working with a PM.

Just a thought...hope this helps.
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