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Old 06-29-2010, 06:54 PM   #1
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tolerance level increase question

I've been on oxycontin (40 mg), oxycodone (5 mg) and Soma (40 mg) for a couple of years. I have tried to stay at the level of meds that are prescribed now because I do not want to get addicted (physically or psychologically) to any of the meds. However, I'm at the point where, within reason, I would take being somewhat addicted to medication if it would bring me some real relief.

The scripts allow for 3 oxycontin/day (90/month), 3 - 4 oxycodone/day (100/month) and 2 soma/day (60/month). I typically take one of each when I get up in the AM before I leave for work. Sometimes I get some relief and sometimes not.

The doctor offered me fentanyl patches when I started the higher level pain medication regimen, but I chose the oxycontin instead. My primary concern was that I wanted to be able to think clearly while at work. I am an engineer by trade and have to be able to function on as high a level as possible. That said, I could tell the medication became less effective within 6 months. Still, I did not want to move to a higher level.

My father has had severe back problems for years and he was prescribed fentanyl patches. One would have to know my father to appreciate what I'm saying, but I have never known any man who has more self-discipline than he. Still, when I told him of the alternative to the oxycontin, he almost came out of his skin with intensity regarding the use of fentanyl. Apparently, he had a terrible time getting off of the stuff, if he even has. Anyway, that was my biggest concern as far as moving to fentanyl.

All that said, I'm at the point now, at 43 years old, where I'd be willing to take almost anything for some relief. The oxy never gave me complete relief from pain, but it did make it manageable for a time. Now, I have to take much more just to get the same results. So after all of that, my question is, how long does it typically take someone to build up a tolerance to something like oxycontin? Does anyone have any input on fentanyl versus oxy? Any other alternatives? I've tried morphine and methadone as well, but neither one helped.

Hopefully I haven't rambled too long, but I would appreciate any feedback available from those of you who've gone down this path before me.

Many thanks

 
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Old 07-04-2010, 05:49 AM   #2
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Re: tolerance level increase question

hello to you and welcome!, where is the pain located? I have a very high tolerance to narcotic pain meds as well. EVeryone is different, it depends mostly on your metabolism.

If I was you, I would increase the oxycontin dose. WHat other choice you have.

let me know where the pain is located. thanks.

 
Old 07-07-2010, 05:46 AM   #3
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Re: tolerance level increase question

My primary pain location is in my lower back and neck. However, both knees are also in pain. I've had two knee surgeries on my right knee, one surgery on my left soldier and brain surgery from an auto accident.

All that said, I'm now trying a fentanyl patch (50 mcg) but it doesn't seem to be helping so far. It's been just a couple of days but I don't see any change yet. The Dr. said it would take a week or so to even have it start working. I will just have to wait and see.

Thanks

 
Old 07-07-2010, 08:15 AM   #4
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Re: tolerance level increase question

while i am glad you ARE trying something different here for this pain, what NC stated up there about simply increasing you daily intake of OC quite honestly may still be the better choice here considering only what a lower dose you HAD been on(40mgs x 3 a day(over years) still would be considered on that lower side becasue of the 'room" to still go up here?) and still having sooo much room still to go up without anything major occuring too? when something HAS worked for you or was working more often than not, if it ain't broke, why fix it" kinda thing? i LOVE the fact that even at my current, and this HAS been the very same daily intake for me now for over five years now too, that i STILL can function normally without 'feeling drugged up" or just not 'with it" at all with the OC compared to othe5r meds i have been given to use before,even with th4 many surgeries i ahve had that seriously messed with my head?

i started on originally at my PM with an even 60-60-60 and at times (two years later)when i certain times of the day were just much worse(midday and morning too) all we had to do to help with the worst times(hitting that midday WAS soo needed at first) was actually take 20 mgs from my nite dose and add it to my midday and everything got soo much better for me. i did not really 'need' or actually even "miss' that much PM coverage at nite only becasue once my legs are up and elevated and i am no longer wieght bearing, my pain DOES natually go down for me? so switching the 'way" one actually takes per dose every day really also can help since alot of us just DO have much worse times and better times too?

but even really trying with your PM to more 'individuallize? what does get taken when the pain is much worse,vs the not too bad times can help alot too? you do not always have to really go across the board with ANY added changes, only try hitting the "worst times of your day with a bit more added to THAT particular time of days dose really helps too. the only reason i was even at the even 60-60-60 was it simply was alot easier when there at the very beginning to just do things that way? not that every single dose was absolutely 'needed" when it was? but when we NEEDED to really best address the certain times of day, it certainly WAS soo very helpful then to just simply rearrange my neds that way and it simply helped alot for me.

if you could get better coverage by simply even having your PM add maybe 20mgs to all of your doeses during the day or just the ones where your actual pain is the worst during the day, may help ALOT more than you think it could. i was rather suprised at just now much better simply moving the 20 mgs from my nite to midday really helped me, and i still had at least 40 to help with my nite pain too? its just going from OC to fent is kind of a jump there if nothing else has been tried that would still be considered a 'lessor' impactful and stronger med than fent would be. if fent does not actually work out for you,mits just much harder after being on the strongest narcotic out there to realistically even get any real good relief from many other lessor options? at least til your body starts to accomodate "those' again? this is just one of the bigger reasons i have stayed away from fent all these years and ahve tried as much as possible to just stick with the OC and work within that with rearranging doses? i still do have a little room to go up here but not too overly much(thats set by my PMs office protocal). but since OC does not actually even "do" anything "to me' as far as any change in my mentation or other issues, that just IS my bigger reason to want to try and stay on it for as long as i can.

have you actually ever had you neck and back MRIed just to really see what the issues are in there that are actually generating your pain in at least those two areas? finding out what the actual generators really are actually is soo much better for trying to really find the very best and most approriate groups/types of meds to really 'hit it' in all the best ways. trying to ONLY use narcotics in alot of peoples pain processes just really does not always work real well. it takes some very specfic "types' of meds kind of added to the overall other meds to really best hit the 'appropriate" pain receptors or the generators of any given pain issues too?

just what are of your brain was injured and to what extent? what are you left dealing with from THAT? i DO hope they did a recent MRI on your c spine that should always be followed and monitored post MVA for ANY real changes in it since most spinal issues ARE pretty highly progressive in nature? and some will not actually even show themselves immediately but only over time. what was the extent of the shoulder injury too? any c spine findings that actually showed up upon the deeper scans being done? or were you ONLY given the standard CT in that ER after the MVA? did they ever just MRI your full spinal for signs of injury after any MVA occurs? the twisting forces simply involved that can impact the lower in some cases as much, esp with seat belts on(still much better to HAVE them on than without them tho), can create thier own forms of specific types of injuries down there too or T spine, just like the much more susceptable c spine area?

how long ago was that accident? marcia
__________________
3-22-01,herniated C-6-7
11-20-01,placement of hardware for failed fusion
9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.

 
Old 07-07-2010, 08:41 AM   #5
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Re: tolerance level increase question

Wow! Thank you for the extensive response. As for your questions:

I had two MRIs on my back 2 - 3 years ago, but they couldn't find anything other than herniated discs. I have not had an MRI on my neck. However, I may be in for that in the near future.

My head injury occurred ~ 20 years ago and it affected my right frontal lobe. They had to take a piece of my skull out, which they had to keep out, and it's now only covered by my chewing muscles.

My shoulder surgery was over 20 years ago and I have gotten arthritis in the joint I'm sure. The doctor told me I would have to get the reconstruction done again eventually, but I am so tired of doctors and surgeries that I am avoiding it until I just can't stand it any more.

As for my knee, the first reconstructive surgery was done ~ 6 months after the MVA. The second one was done ~ 1.5 years ago to remove scar tissue.

I'm no doctor, obviously, but I can't help but think that some of the pain issues I have are directly related to the auto accidents I've had over the years (including being rear-ended by an 18-wheeler while I was driving a Ford Festiva).

When I went to the neuro-surgeon, he couldn't find anything significant enough to operate on. He then sent me to a neurologist, who couldn't find anything to attribute to the pain. I just get very depressed sometimes, thinking that I'm only 42 years old, and that I've got nothing but discomfort and pain to look forward to for the rest of my life.

Anyway, I digress. Thank you again for your response. I do understand your position about the fentanyl. I am seriously considering not taking anymore of it, as what I've taken hasn't helped, and just going back to the oxys.

One question, do you actually go to a pain management specialist or do you go to a GP?

 
Old 07-08-2010, 04:54 AM   #6
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Re: tolerance level increase question

Quote:
Originally Posted by man in MO View Post
Wow! Thank you for the extensive response. As for your questions:

I'm no doctor, obviously, but I can't help but think that some of the pain issues I have are directly related to the auto accidents I've had over the years (including being rear-ended by an 18-wheeler while I was driving a Ford Festiva).
One question, do you actually go to a pain management specialist or do you go to a GP?
You can get the oxycontin from your primary care physician. My doctor thinks oxycontin is an O.K medication for pain. If I was you I would increase the dosage of it. That's how narcotic pain meds works and every doctor knows that. There is NO other option.

Well, anyway, what I wanted to tell you about your car accidents that I'm really SORY it happened to you If you've being rear-eneded you probably had a WHIPLASH. That's what I had. Since then my neck hurts me all the time, it's chronic neck pain. Whiplash can cause lot's of problems and also the ligaments, tendons, and muscles get damaged plus it's possible you have bulging/herniated disks in your neck and that's why it's IMPORTANT to do and MRI of the neck every couple of years(that's what one doctor told me). I had one done and it showed 2 bulging disks. I also have TMJ, I believe it's cause of the accident also.

I would stick with the OXYCONTIN. try adding to it some magnesium(ask your doctor). magnesium is well known for muscle relaxant. Add to it calcium plus vitamin D. It HELPS THE PAIN. you can also take selenium plus vitamin E.

Do you sleep OK at night?

I'm 39 so I know how you feel. Please ask your doctor and be persistent about doing the MRI for your NECK. ok?

let me know how things are. all the best, god bless you.

 
Old 07-08-2010, 06:27 AM   #7
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Re: tolerance level increase question

once again, NC has ALOT of good points here esp about whiplash type of injuries to the c spine and the neck as a whole too? having 'only' herniated discs IS a very solid finding and they DO generally progress over time as well? just how many actual MVAs have you even had so far, and what actual directions were you 'hit' from? that too matters as far as what your body/neck would actually absorb as energy and how 'it' moved during the initial 'hit too?

having even one MVA can seriously mess up your c spine alot among other things within the spinal too, but having MORE than one just kind of really exascerbates pre existing injuries and can create new ones too kinda thing? when WAS the last MRI done on your c spine and just what particular area the one(s) with 'only' the herniated discs is there?? do YOU actually have any and ALL copies of your OWN MRI or any other types of scan or testing results in YOUR possession so you just actually even have them and can also read thru them yourself too? i have every single document/test result AND all the 18? MRIs(most on c spine but since have had to also have two knee surgeries and a rotator cuff too, well...) i have had done all since 2001 when MY herniated c 6-7 simply started to 'present' itself? you just NEED to know what else was/is actually being impacted when anything really even herniates at all? like how really extensive were/are the herniations themselves as in was this WITH an annular tear or the inner propulsis actually extruded outward too? every little area of involvement with ANY herniated disc IS what will simply help to show how much real pain can just even stem from it. the discs themselves tho NOT actually innervated in the norm sense, just DO actually contain 'pain fibers" within them that when the inner stuff just extrudes into that outter annular ring CAN very much create pain(mostly inflammation since they simply do NOT 'like' each other). it all comes down to how 'bad" the actual herniation just IS and what it also could be impacting as far as ANY of your spinal nerves too kinda thing that would dictate the 'possibles' for generating any pain actually.

i am kind of suprised your NS actually sent you to a neurologist and not a pain managemnt facility?? i was sent to my current PM like only six months poist spinal cord surgery had a glob of vessels decide to form inside my cord that were bleeding and needed to come out, creating some insane sp cord injuries on top of everything else) but the PM has helped me in soo many different ways than my primary could just becasue within the more 'family practice setting" he is in, the overall thing there is simply to send all patients who simply DO require more in depth pain care and the Rxes that go with it, directly to a really great PM facility? they just do not 'like' to have to rx the extensive stronger types of meds on any longterm basis, and it WAS just the very best thing for what I needed too back then, mostly since my brand new RSD was also starting to show itself then as well needing more in depth care, injections and ideas just to even begin to try and manage THAT crappy stuff too?

i personally feel your overall OC intake has been running way too low after this much time and you did need that raise in dosage after so much time passes esp when there simply IS that "room' to still go up without any major promblems developing for you with this if there had not been any before kida thing? do YOU see a PM oir primary for pain management?

just what other meds do they hasve you on for what you have going on?

if they simply have not pretty much rescanned your entire spinal for over a couple years, at this point, they just NEED some brand new pics on that whole area from top to bottom, esp using a good contrasting agent at this point too? it would simply help to better highlight certain findings that can actually be there that just do not always show as well with "plain' MRI without any contrast being used? this also helps to best define the older injuries from newer or progressed injury crap as well? and having a chat with your rxing doc about going BACK to the OC but simply accomodating what easily could be basic tolerace or even an increase in your overall pain too as certain injuries just start to progress and things get more "injured' as they go and can easily start to also 'impinge" other structures, esp within that spinal with sooo many different spinal nerves? so just getting the updated MRI itself could possibly reveal alot more ongoing involvment too. it at least should be checked given the MVAs history.

but you just DO ahve alot of room yet to really increase the overall daily intake of your OC and still be well under what most PM clinics will 'only' limit 'their' set protocals of how much OC they will go to then have the patient try other LA types of meds? this should just be given a 'shot' here before sticking with that fent? or even other LA type of meds that simply fall well between the OC and the fent at all?

and DO start obtaining any and ALL copies of any and all testing/scannig results along with alll records from any docs, specialists who you have seen so far(as far back as you can get here considering the timeframe involved) since ALOT of real solid Dxing info is sometimes placed into those records from YOUR ongoing visits that a actually never even get told to the patient at all in some cases(or getting "told' you have "something dxed but not IN the actual records where that just DOES seriously matter)? i found THAT sick crap out when i was simply trying to obtain SSD benefits and found out of course only AFTER i was turned down the very first go round just how much real solid Dxes and other crucial info was NOT even IN my medical files from certain specialists? it was a real eye opener for me let me tell ya. every since then i get EVERY scrap of paper in my records from every single treating doc like at least once a year? but ANY MRIs or other testing, i obtain immediately just so I KNOW i have actually even been told everything even IN any given report too(this also enables the patient to simply ask questions about a particular finding too?)? but that IS another story all togehter there with what is there and what any given patient will even BE told, esp by the wonderful specialists out there?

i do hope you canrget every area of that spinal redone or scanned for the very 'first" time here since the major traumas your body has actually suffered in certasin ways? its just the way many different actual 'forces" will natually impact our bodys depending upon what impacts our bodies and the real angles of the 'hits" here too?

good luck and please do keep us posted. marcia
__________________
3-22-01,herniated C-6-7
11-20-01,placement of hardware for failed fusion
9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.

 
Old 07-08-2010, 09:05 AM   #8
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Re: tolerance level increase question

As for the MVAs, I have had two serious accidents, neither were my fault; one in 1987 and the other in 1995.

As for the NS sending me to pain management, the protocol they used on me a couple or years ago was:
go to GP - send me for MRI - send me to pain management when his scripts (hydrocodone) wouldn't work - pain management gives me four (4) epidurals in one year, including one directly into my tailbone and puts me on 30 mg/day of oxycodone.

After injections don't work, PM sends me to NS. NS sends me to neurologist. Neurologist does a few tests and sends me back to NS. NS says not enough damage to operate and sends me back to GP with notes saying I should be on higher level pain meds. GP puts me on the 120 mg/day OC, oxycodone and I also take Soma for spasms plus Xanax (usually only take them during times of high stress/pain or when needed for sleep). Also on Crestor for BP. When I went in a couple days ago, BP was 124/82 so the Crestor seems to be working.

Anyway, the GP has been prescribing for me ever since. He now says I need to go back to PM. I called yesterday and the only PM clinic nearby is the one I went to a couple years ago which, I feel, did a very poor job. Still, I may decide to go back and try a different dr. this time, advising him that I do not want anymore epidurals.

I'm pretty frustrated right now because I'm tired of being in pain, I'm tired of paying for tests that don't reveal what needs to be seen, I'm tired of feeling like I'm getting the run-around. If and when I go back to the PM facility, I intend to be more assertive and actually be my own advocate.

Thanks again for your response.

 
Old 07-08-2010, 11:07 PM   #9
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Re: tolerance level increase question

Man in Missouri, there is also clonazepam. My primary care physician prescribe me that one. I'm really careful about that one. You also develop tolerance to it. I take when I'm not able to sleep. I need 4mg which(I believe?)is a high dose. (at night time). I'm trying NOT to take it every day.

Now I realize my doc rx'd me xanax long acting which made me nervous in the past so stopped using it. I find clonazepam much much better, it relax the muscles. You start with a low dose(like I've done...) 0.5mg and go up and when this doesn't work you might need(sound like that)a 2mg-4mg etc. It's a benzo and primary care physician rx those.

You've been to the pain clinic couple of years ago...perhaps they are different now, who know?. but you can still get your pain meds from your primary care physician like I do. My PM told me I IMAGINE the pain in the neck...and that's emotional...I wish it was emotional, though they say emotions can affect the pain, but not this pain I have. He didn't even want to rx me narcotic, saying he hates narcotic. He told me it's rare to be affected like that cause of a whiplash, nonsesnse.

I know how frustrated and tired you are but please do not give up hope.

 
Old 07-08-2010, 11:19 PM   #10
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Re: tolerance level increase question

I didn't read all of your post so bear with me. Did you say the PM or someone did a MRI on you? If so, was it done with a contrast dye? Also, what part or parts of your back did they scan? IMHO, all MRI's should be done with contrast dye, unless the patient is allergic to it. Also, some people are under the false impression that when a doc orders a MRI of the spine, that's it's of the entire spine-not so!! It will either be cervical, thoracic, lumbar or sacral;whichever area you are complaining about. One more thought, if you did get an MRI, ask for the results-all hospital's and doc's are doing this now;charts belong to us anyhow!! Wow, didn't mean to go on like that, but my point is that there could be something more wrong with your back that you don't know about, or they haven't seen yet.....janiee

 
Old 07-09-2010, 06:24 AM   #11
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Re: tolerance level increase question

I had the first MRI ordered by my GP. The second was ordered by the neuro-surgeon. There was no contrast dye used and the MRI was only on my lower back. When I do go back for additional tests, I will request a full MRI and make certain to get all of the results.

Thanks

 
Old 07-09-2010, 07:47 AM   #12
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Re: tolerance level increase question

considering the overall impact just about any MVA actually even has on that neck and c spine level at all with soo many different forces kind of hitting you from very different angels as well, i cannot believe they NEVER actually bothered to simply even 'clear' your c spine for possible damage? AND ending up with an actual brain/head injury on top of it? were they nuts or what? that to me just sounds almost negligent, seriously. too many different things simply CAN be impacted during any MVA that it is kind of a 'given' that EVERY single level of that spinal should just have been MRIed using a good contrasting agent too at some point just even see what 'could' even be there at all? even the lumbar, esp with seatbelts on can create its very own twisting and impact forces that can and does impact that area pretty darn hard. i worked trauma for many many years before my sci kind of took my life away. the standard usual testing that gets done once you hit that ER is 'usually ONLY" a CT mostly, only becasue with any level of MVA, there is simply always that one chance that any patient could have ended up with at least some level of actual embedded metal into their body somewhere wich WOULD burn the area with the magnetism(generates alot of heat IN MRI) they use which simply IS NOT a risk witn using only CT. but at some point AFTER that initial trauma in the ER, a good follow up MRI just really seriously needs to be done to simply KNOW what could be impacted down to that critical nerve root and spinal cord level?

its pretty basic in what even occurs when we suiffer MVA, while the vehicle simply stops, our highly vulnerable bodies and mostly the main structual components like the spinal continue to absorb TONS of real solid energy and the kinetic forces involed too?

one HUGE thing i would actually change here is this bouncing back and forth between the very SAME NS and ologist that sounds more like a sick game of ping pong for you. nothing is getting accomplished for YOU, the actual patient with these two here. finding a NEW NS and honestly just skippin that ologist all together at this point just may be the best thing you could do here at all for you? getting that FULL top to bottom contrasted MRI done, esp if the other partial MRIs are even more than a couple of years old, is what i would do? THEN seek out a good experienced NS to go over all findings as they pertain to you right now with a brand new MRI possibly bringing out MORE of the progressive types of ongoing damage, along with actually finally even seeing certain other findings too either becasue NO contrast was ever used or the freaking area was simply NEVER actually looked into and cleared at all either?

you just really DO need some changes here from what has become the standard 'routine' of runaround you undergo year after year here,and getting that full spinal is simply needed to just KNOW what has been impacted and how severely at ALL levels,esp that much more vulnerable c spine level where alot of different things can simply 'happen" up there at all? if you suffered enough force during that MVA that is created a what just HAD to be a severe concussion enough to even create any brain bleed(my son unfortuently suffered that very same thing, and IN his frontal lobe too) then the probability of any level of real c spine damage is simply THAT much higher.

just exactly 'when' were the previous MRIs actually done(approx how long ago) and on what levels of your spinal? THAT does matter, much more than you may think mostly becasue most actual spinal injuries are simply highly progressive in nature, and once injured become VERY susceptable to certain levels of very real arthritic/inflammatory problems too(which would also be sending out inflammatory signals to the surrounding muscle groups around and right below the c spine levels too). i KNOW mine did with my c spine crap. but i already had DDD going on even before i blew out me c 6-7. are you having ANY and i mean ANY types of going down the arms type symptoms or even into specific fingers? this could be anything from real solid pain,to 'sensations' feelings of anything from electrical crap(zingers) to spasms in the fingers to tingles and numbness or a host of other wierd stuff too?

did they actually determine what, if any real lasting damage/impact the frontal lobe bleed had on you at all?

but DO obtain that full top to bottom contrasted MRI as kind of your very first priority. if that c spine has never actually even been looked at post MVA, you really do not have any real clue as to what may or may not even be going on in there that can in some cases, actually be pretty impactful in certain ways? and make darn certain that it is simply done using a good contrasting agent, for alot of different reasons too. then you can start changing the 'ping pong game" you have been playing here with the ologist and the NS who may NOT even be knowledgable enough to even KNOW what YOUR findings actually mean? trust me, they are NOT in any way shape or form even closely created equal when it comes to ANY actual specialists at all. been down THAT road with all my many different surgeries and surgical consults that had me practically running out of consult rooms at certain times. too scarey really.

you just need a full MRI along with very fresh eyes to even look at what your findings really are and anything that may have actually needed surgical intervention but ONLY becasue YOUR particular NS either was not well trained enough or simply did not 'want to" do a needed surgery on you, chose FOR YOU to simply keep you IN PAIN and suffering when perhaps a better more experienced NS may have thought this WAS a very real more immediate 'need' for surgical intervention long ago? ya just wont know anything til you really DO get other opinions from similar types of specialists as to what was or was not even a solid finding either? it boggles my mind at times at how large how some of the huge gapeing differences there can even be between any given 'opinions/impressions from just the "more or less" experienced/knowledgable specialists out there. and unfortuently "their' overall knowledge and experience IS what will determine YOUR actual treatment alone. that IS very scarey. you just should NOT be forced to live with THIS much pain in certain areas only IF there has been a way, IS a way to help actually even relieve it but some stupid specialist decided not too for you? this is why our ins co's actually even allow for second opinions. and i actually had three seperate non affiliated opinions before i was going to allow ANYONE to actually cut into my spinal cord with a scalpel to try and remove this stupid glob i had been born with in there at the c 8 nerve level? and my third one was the ONLY NS who actually had even treated patients, and it was actually hundreds of patients with what i actually had that was the ONE i chose to help me with this nightmare. so ya never know til ya start comparing with consults and evals and them actually seeing the films too, from different NSs mim. i do hope they can get this MRI done asap so you and your docs actually even just 'know' for certain whats up along the old spinal column and cord levels in there. and ALWAYS obtain all of your very own testing results and all medical records from any doc whoever lays hands on you too. it IS pretty insightful reading that really tells YOU whether or not any given doc just truely 'gets it' or they are off on some other planet than you actually are too? Marcia
__________________
3-22-01,herniated C-6-7
11-20-01,placement of hardware for failed fusion
9-22-03,removal of cavernous hemangioma that was inside spinal cord. Neuro damage to L hand L leg and R leg.

 
Old 03-31-2011, 08:50 AM   #13
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Re: tolerance level increase question

Personally, I found that oxycodone in all forms doesn't work well for me for pain relief and my switch from oxycodone liquid for immediate release at 20mg 4x/day to the fentanyl patch that my pain was better managed and my mind was more clear. I've stayed on the fentanyl so I don't know how it will be coming off of it. I was on it for 30 days in the past for post-surgical pain and had no trouble coming off of it at that time, but I don't think I'd built up any physical dependence by then. My advice is to talk to your doctor and be as thorough as possible as each of us responds differently to different things.

 
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