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Old 12-29-2004, 06:57 PM   #1
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Pain medication - avoiding/reducing tolerance

Hello all,

I've been lurking on these boards for a few days and have found them to be a great resource and very re-assuring. I've been through a lot of pain the past few years. I'm only 33 and feel like I've got a lifetime of back pain to deal with.

My question centers on how I can reduce the extent to which my body builds a tolerance to pain medication. I have 3 bulging and/or herniated disks (the disks between T6, T7, T8, and T9). My family practitioner and physical med doctor both say that surgery in this area of my back, based on how the disks are protruding, is risky given the number of nerve fibers in this area and that they would rather handle it with pain meds at this point. Thankfully, my pain is not 24/7. It usually gets worse during the day and only gets to the 'medication' point usually late in the afternoon. But by evening, sometimes it is unbearable. The nerve pain also causes back muscle spasms, which are painful in and of themselves. I've been through physical therapists, x-rays, MRI's, ESI's and all that, but with little help. Thankfully, I can still swim and bike without greatly aggravating the pain.

My doctor has prescribed percocet 5/325 as needed. At first, I was very worried about taking narcotics, but I'm about 75% past this internalized stigma (I still have concerns, but frankly, nothing else helps!). I felt guilting asking for strong pain meds, but my doctor was actually very supportive after he saw my MRI. When I take pain meds, I usually only take 1 percocet, sometimes with an Advil because I'd rather not have to take a second perc if an advil with the first perc will do it. But there have been times when I've needed 2 or 3 percs (total during the day, not all at once) but this is not the norm.

So.... how fast does a person typically build up a tolerance to percocets? Maybe I'm being silly thinking about this with my relatively low dosage (compared to some of you folks who are in much much worse pain). My doctor said that he had no problems whatsoever prescribing the meds I need -- this made me feel better about asking for them, because I felt guilty asking for them -- but he also said that if it got to the point of taking 5 or 6 percs a day (the tolerance kind of "sneaks" up on you, he said), that he said we should talk about a long-acting med like oxycontin. I'm kinda scared of taking that, especially since my pain is usually only the second half of the day, not 24 hours a day.

I have this idea in my head that if I eventually have to take oxycontin, that I'll be in a fog all day and not be able to do my job. So... this is why I want to make sure that I'm being very careful about not building a tolerance to the percs which I can take as needed and not have to be on them all the time.

I'd realy appreciate any thoughts you have. Maybe I'm being overly concerned. I will say that taking percocet really helps the pain and let's me do "normal" things like cook, household chores, etc. Without it, I'm miserable and avoid life activities which I enjoy but are excruciatingly painful.

-blueswimmer

Last edited by blueswimmer; 12-29-2004 at 06:59 PM.

 
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Old 12-30-2004, 06:08 AM   #2
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Re: Pain medication - avoiding/reducing tolerance

You are so lucky to have found a doctor who WILL prescribe you pain meds!
Just be careful, take them as you are directed, and you should be fine. If you have any pre-disposition to addiction, then I'd discuss that with your doctor.

 
Old 01-05-2005, 12:44 AM   #3
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Re: Pain medication - avoiding/reducing tolerance

Hi: Figured I would throw my two cents in. My back was considered to be in a "chronic state" when I was 21, I am now thirty, in other words everytime I moved I thought I was going to pass out. To make a long story short I was taking percocet every four hours for about two weeks, it was not a pleasent experience getting off. But as I learned over the years you really have to know your pain level well and go with that. Oxycontin is effective but again you really have to time it well. Any drug on the market you can build a tolerance for and you do have to prepare for it but at the same time if you cannot have a somewhat normal life through the difficult times of reccuperation you get depressed and that is more difficult to deal with and tends to prolong the recovery period. Hope this helps.

 
Old 01-05-2005, 02:21 AM   #4
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Re: Pain medication - avoiding/reducing tolerance

I also have two herniated discs, one was better for 5 years after PT, but with this new one, the muscle spasms have started the old one acting up again. I try not to take any pain meds til I can't stand it anymore. Mine is not bad in the morning either, but by evening it is horrible, so I try not to take them til I can't take it anymore.

What do you do about the spasms? I had never had these with my other herniation, but this one is up between my shoulder blades & it causes my shoulders & neck to spasm quite badly. The muscle relaxant they gave me does nothing, in fact, I take my xanax & I think that works better for it.

I had vicodin for pain, but it makes me nauseous, so now I have ultracet, but it makes me totally spacey. There is no way I could leave the house on ultracet!

 
Old 01-05-2005, 11:18 AM   #5
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Re: Pain medication - avoiding/reducing tolerance

Lori,
I want to add my two cents in for whatever it is worth..If you take the pain medicine when it hurts that bad, it isn't going to work as effectively if you take it when you first start feeling the pain. I did what you did, and my pain doctor said I was defeating the purpose, by the time my pain got that high the pain medicine wasn't working well to control the pain..So he told me to take it when I started feeling the pain to get it to work effectively..Does that make sense?..StarAngel..

 
Old 01-05-2005, 11:34 AM   #6
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Re: Pain medication - avoiding/reducing tolerance

I had been on the same pain meds prior to surgery as after. I was on them for months... maybe even over a year. Hydrocodone.. huge dose! I worried about the same thing.. what will I do for pain after the surgery.

Believe it or not, my pain was so different AFTER surgery and the pain meds actually worked BETTER after surgery.

I did have addiction problems for a couple weeks after..and it was quite difficult coming off the painkillers... but things have been wonderful since.

Don't be afraid of your meds. Your doctor knows what you're doing. Just take them as prescribed. I agree with previous posts...don't let the pain get so bad that you defeat the purpose. There's a fine line between trying to suck it up and taking the meds just because you think you have to. Only you know where that point is. But don't let it stress you. The goal is to be out of pain.

 
Old 01-05-2005, 04:20 PM   #7
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Re: Pain medication - avoiding/reducing tolerance

Thanks everyone, for your comments!

It makes things seem better just knowing that others have gone through similar situations. I especially appreciate the comments about not waiting too long to take the pain meds. I often wait until it is so unbearable, but when I do that, I've suffered for hours and then the pain meds don't handle the pain as well (and then the muscle spasms have kicked in, just adding to the disc pain).

Someone had asked about how I deal with the spasms. I have some Flexeril that help somewhat (but man, they wipe me out and make me so tired). A "moldable/formable" ice pack helps. A significant other/partner to "rub out" the knots. I also have a TENS unit, but that has mixed results with spasms -- sometimes it seems to make them worse (its main purpose for me is to relieve the disc pain).

-blueswimmer

 
Old 01-05-2005, 10:21 PM   #8
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Re: Pain medication - avoiding/reducing tolerance

[QUOTE=StarAngel3]Lori,
I want to add my two cents in for whatever it is worth..If you take the pain medicine when it hurts that bad, it isn't going to work as effectively if you take it when you first start feeling the pain. I did what you did, and my pain doctor said I was defeating the purpose, by the time my pain got that high the pain medicine wasn't working well to control the pain..So he told me to take it when I started feeling the pain to get it to work effectively..Does that make sense?..StarAngel..[/QUOTE]

Star, yes it does, guess I'm a glutten for punishment, I don't take anything til I'm good & sore! Stupid I guess, but I try not to take more than I have to & then I end up taking it anyway & I'm sore besides! Good point you make!

 
Old 01-05-2005, 10:23 PM   #9
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Re: Pain medication - avoiding/reducing tolerance

[QUOTE=blueswimmer]Thanks everyone, for your comments!

It makes things seem better just knowing that others have gone through similar situations. I especially appreciate the comments about not waiting too long to take the pain meds. I often wait until it is so unbearable, but when I do that, I've suffered for hours and then the pain meds don't handle the pain as well (and then the muscle spasms have kicked in, just adding to the disc pain).

Someone had asked about how I deal with the spasms. I have some Flexeril that help somewhat (but man, they wipe me out and make me so tired). A "moldable/formable" ice pack helps. A significant other/partner to "rub out" the knots. I also have a TENS unit, but that has mixed results with spasms -- sometimes it seems to make them worse (its main purpose for me is to relieve the disc pain).

That would be me that asked about the spasms. I also have meds for them, but they mostly make me sleepy too. I think that is the purpose, just put us to sleep & we won't notice the spasms! LOL

I have a similar reaction to the ultra sound I get at PT. The day I get it, it seems the spasms are worse that nite & the next day. I wonder why? Am going to ask about it tomorrow. I also use a moldable ice pack or moist heat, whichever works best on a given day!

-blueswimmer[/QUOTE]

 
Old 01-06-2005, 05:04 PM   #10
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Re: Pain medication - avoiding/reducing tolerance

blues,
I recently had a TLIF fusion at l4-l5 but before that also was scared about meds. At first I started with Tylonol 3, then Vicodin, then Percocets. When I was up to 3 at a time every 4 hrs, (and they were STILL not working!) the doctor recomended oxycontin. I was terrified! All I could think of was Rush Limbaugh, etc...I was very scared... but was amazed to learn it was only 1 pill every 12 hrs. Additionally I was MUCH less "Fuzzy" and the pain relief lasted much longer. I also still have percocets for "break through pain" (which I did not need until after surgery). I took the lowest dose pre-op, but it was enough to control my pain and was a great relief to only think about pain relief 2x a day vs the 6 x a day with the percacets. My point is not to PUSH oxycontin on anyone, but toshare ny experience and point out that sometimes the "scary" BIG pain meds are not as scary as they seem -just my humble opinion.

I hope you feel better soon and won't need any further intervention or pain meds!
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Old 01-07-2005, 07:20 AM   #11
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Re: Pain medication - avoiding/reducing tolerance

Well I think pain is very much personal. ONLY you really can gauge your pain and explain how it feels or how long it last or when it peaks! The best thing you can do is be honest with yourself and write it down. By documenting the flow of pain and explaining it well to your doctors then you can surely get the ample medication you need. Do not try to be a superhero when it comes to pain because you will need that inner strength to come off it....trust me!

As far as Rush.....I think each of us that have been on oxycotin can totally sympathize with the man. I understand he got the drugs illegally, and that I do think is wrong, but as for taking them and functioning, I am not suprised. I think I functioned very well on oxycotin and had many people tell me they could not tell I was on any type of narcotic. Some people are not sensitive to the euphorics of certain drugs. To many its like taking aspirin. But when you are surely in chonic acute or neuropathic pain then the drug targets it and remember you are not doing it recreational. With this said, I suggest anyone in pain or going through back surgery to find the nearest pain specialist. Tell your surgeon or family physician to help you find one. They are absolutely wonderful and will guide you through your pain issues. Remember....doctors do not want to be your psychologist people!! And you have to look at this on three levels....YOUR body hurts.....so you have a surgeon and orthopedic to help you with that, but you also have your mind and intellect which is racing with questions and dealing with your social needs or lack of because there is no doubt we feel isolated during this times....and then there is this spiritual you that we all know is very important to keep strong through this. In fact, I feel during my back issues that it was the most humbling experience of my life and one thing for sure is that on my back I have had some of the most up close and personal conversations with God. I suppose what I am trying to tell you is....don't be discouraged! Don't feel you are alone! Because you are not alone! Every day is a challenge but if you support your mind, body and soul during this time then you will be just fine!

I do want to say for you that are weening yourself off narcotics....

Drink alot of water and juices and take vitamins! Make sure you get exercise whatever your doctor feels you are allowed to do at this time....and get outside and get fresh air as much as you can. Use ice and heat if your doctor says you can and make sure you find out how much time is allowed for each session. Get massages! I think getting a weekly massage is the best thing for you...remember your circulation is important and the massage is wonderful! I think taking a yoga class is great for your spine and you can also get a beginners yoga tape and do it right in your home every day! Listen to music and take hot baths or hot showers! Eat good foods! And make sure you smile on days when you feel like frowning. There will be days when everything you do will take much effort but it will get better. And remember....take your medication like your doctor says because not only are our backs in need of concern but we must always protect our livers. I do suggest if you have to be on pain meds for a long length of time to discuss this with your doctor about checking the enzyme levels in your liver. So much of the drugs are hard on our livers and stomachs and intestines. This is where a pain specialist really comes in handy. Just know there is great help out there!

Good luck to you all and God bless you while he heals you!

 
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