My question is this!!!! Why would Oxycontin not work like it should if you are taking it the way you are suppose to???
My reason for asking is my last pain management doctor was asking me when I was telling him That the drug was only working for 4 to 5 hours telling me. He said well you don't have any stomach Ulcers and you are not an Alcoholic, so they should be working. I then said Well I did have stomach problems years ago. Like pre ulcers, he rolled his eyes and basically pushed me out the door. So now that I am seeing a new Pain Management Guy, I want to know what would health problems or things would make this Drug not work like it should??? Now we all know it will never work for 12 hours but come on 8 would be great.
Thanks for any feedback.....My next appointment is on Monday so the sooner the better.
Hello you asked how much I am on... I take 1 40mg every 12 hours for a number of reasons but primary for Interstitial Cystitis, Fibromyalgia, Back Problems, TMJ. As you can see a lot of things.
Why do you ask, would that make a difference in if the meds work or don't work???
HEy ove, Everyoneresponds to fifferent pain meds in differnt way, There is not one pain med at one dose that manages all pain.
The way OxyC is designed, Taking 2 40 mg pills per day. The first release is at .6 hours, A 40 releases half it's contents at the initial release and then your serujm level slowly drops untill the 6th hour and then the the other 20 mgs is released.aperently your pain winds up before that second release and that dose isn't able to bring it back under control. Since you didn't mention BT meds, That may be a place to start. Finfd a doc that will treat your pain and doesn't think BT meds are the road to addiction.
I would think, you either don't respond to OxyCodone well, like some don't respond to morphine or demerol as well. We all have a med that suits our pain needs the most. It sounds more like your pain spirals out of control to the point that by the second release it's not a high enough dose to bring a high level of pain back down. It's that theory that it's easier to keep pain in check than to bring a high level back down once out of control.
The conditions you have are the type that flair up and you have extreme highs and then it may subside and for a few days, the meds are working when your not in a flair. You don't want to adjust your dose so high that it covers your worst pain when it's flaired up. You would be overmedicated on normal or better days. So they shoot for trying to releive 50-0 % of what you would consider your base level of pain. The middle of the road.
OxyContin never managed my pain. It works well for some types of pain but not all. There are basically 3 types of pain. Neuro pain which is very difficult to manage with opiates alone, Somatic pain like back pain where you don't have neuropothy but deep type aching or stabing pain and then there is visceral pain, Visceral pain would be like post surgical pain where you have pain from the incision, stab wounds, gun shots etc.
You have a combiination of different pain generators, IC would likely fall under neuro pain, but it flairs and calmes back down, Fibro is somatic pain, no neuro component like radiculopothy they can say it's from X nerve being compressed but still painful but also some thing can bounce from very high to stayng calm for a while.
TMJ pain is also somatic, It flaires up if you chew steak or talk alot or grind your teeth. It's like havng a broken foot, It may be manageble up until your bear weight on it. In a case like yours where you have multiple generators that bounce from high to low does make it hard to find a level you can live with and the doc is comfortable prescribing an apropriate amount of meds. What mmanages it today, may not touch it tommorow if you ground your teeth all night, but it doesn't mean you should increase you base dose because the TMJ flaired up from dentalk work or teeth grinding.
I don't think they really know what causes fibro to flair up. So it sounds like you have a very wide range when it comes to levels of pain, Hence, what works today may not work tomorrow but you can't increase your base dose with every flair. IT seems BT meds would serve you weel for flair ups.Just like you wouldn't ask or an increase because you ate a bowel of chili and your IC went nuts for a couple days, you can manage it with BT meds and then back down to a steady level of medication.
That's why it's important to have more than just one modality to manage your pain. When the fibro flairs, gentle stretching, water therapy, light massage or Yoga can help. When your jaw flairs up you can also use ice, lidoderm patches, mouth gaurds to prevent clenching and grinding.Yo also have specific meds for IC and foods to avoid.
Nothing confuses a doc more than having more than one problem going on at the same time. When you go to the doc I'm sure they ask what bothers you the most and that's what they shoot for. and hope the meds they prescribe to manage what you say is the worst will also overlap and help in other areas.
The more pain generators you have the harder it's going to be to keep all of them in check. 40 mgs of oxy twice a day is not a large dose. There is basically a different treatment plan for every pain generator which makes it very difficult to put pain out of your mind, when your jaw is aching and your shoulders and neck hurt from fibro, the fibro eases off and your bladder goes nuts. It has to suck to be a full time patent with so many things needing attn. It's overwhelming to many docs but there are docs out there that like the chalenge.
There isn't one med that will treat every generator. pain meds do work, but when your needs can double from one day to the next, the doc isn't going to be comfy giving you that kind of range to manage all aspects of your pain. You sort of have to lump it all together and except a dose that seems to give you the most relief for the most problems with the least side effects.
If you have to double meds from one day to the next, your body can't become acomadated to the side effects and tends to make the patient shoot for managing more pain than is possible. To quell all three problems when all 3 are flair would likely inhibit your ability to function on meds more than improve your abilty to function. PM docs don't normally allow you the meds to knock yourself out on days you need it and then cut the dose in half when you don't, after doing this for a couple months, the lesser dose wouldn't quell the slightest pain because your body is used to taking a large dose.
Not that your taking a large dose now but he's shooting for the middle "50%" reduction of 3 different generators. That's the frustration you see in your doc. What manages your fibro may not touch the IC, or when the IC is exceptable the TMJ skyrockets.
You need to find a doc that can treat patients with more than one modality, and each time you have a flair , if you call, you become somewhat of a nuiscence, You need to learn to mange your flairs either with BT meds or other modalities. Compared to other patients that have one generator that can except 50% reduction and handle the spikes with Break through meds, Short acting meds to give additional relief when your LA meds don't work. You not exactly flying low and under the radar. A call about increased pain means alot more work than just your doc calling you back. The receptonist takes the mesages, puts her slant on it and tells the triage nurse, she interprets it, pulls your chart and it sits on the docs desk untill he can look at what's going on. Very few docs will make a med adjustment over the phone, so the best thing to do is just get in to see the doc that is handling the specific problem.
I didn't see you mention BT meds, The use of them is contreversial, some PM docs don't belive we have the will power to let a bottle of morphine or Dilaudid sit in the cabinet and only be used for the most severe pain.
You may need several specialist in adition to PM. treatment of TMJ can be done by PM docs but they don't have the training that someone who has a background in dentistry or oral surgery does. IC is a rather unique condition and there are docs that specialize in that problem and fibro can be managed by any PM doc. So in reality you may need 3 different docs all prescribing meds, but they can't all prescribe opiates.
You need a more advanced system of pain management with one person overseeing things and watching for drug interactions and directing your care. With so many problems, It's kind of hard to be the ideal PM patient that has found a dose that works, stabalize and doesn't need constant attn. It's not your fault you need constant attn for one of the problems, meaning one week it's the fibro that is the most bothersome, the next may be TMJ and the next may be IC. You have a difficult case and different types of pain respond to different types of drugs and different modalities. Then when you though the human equation in, where different people respond to different drugs in different ways. Docs can become frustrated and think of you as their problem patient that calls weekly with a new complaint or a new flair.
If I could arange an Ideal PM team for you, I would say see Dr brookoof at the university of Tenn. in memphis. He's a PM doc that specializes in IC, the meds prescribed for the pain of IC would likely manage the fibro or both can be treated with different meds, But then you need someone to manage the TMJ, Make the splints, possibly investigate a surgical solution and work with DR Brookooof together as not to have one doc prescribing Methadone or one prescribing OxyC and the other prescribing MSC.
It's frustrating when you are stuck in the middle and nobody seems to be able to do it all. But if you developed cancer and it was causing pain, you would then need an oncologisty as part of your PM team.
You just need to find docs that are willing to work with other docs without the attitude that doc #1 is the expert and has nothing to learn from a doc that treats IC because pain is pain. That's not entirely true. You need a nutritionist to help with IC, You need a dentist or oral surgeon to be working on the TMJ and a PM doc for the fibro.
You didn't ask for 3 painful conditions and there are docs out there that will let an oral surgeon handle the TMJ portion as long as he is kept in the loop as far as what meds he may be prescribng. You don't need an oral surgeon prescribing valium for TMJ and a PM doc prescribing soma or flexerill for fibro. THat would be sloppy medicine and just too many different muscle relaxers, you wouldn't be able to function and when PM hinders function rather than improves, Unless your terminal the negative aspects begin to outweigh the positive and the use of opiates becomes hard to justify.
You may want to look at treating the body as a whole with holistic docs that also use convention meds. What's causing the teeth clenching and TMJ disfunction as well as the neck muscles to tighten. What's the best way to keep the IC in check. Rather than looking for a PM doc that will just give you enough meds to kill the pain at any level, you need more specialized care from docs that tteat these problems on a daily basis. That's why it matters what the pain generator is or are.
Start with the most bothersome, If you don't live in TENN you can still call Brookoffs office and ask for a referral to someone in your area that specializes in IC and PM. Get the dentist on board and likely the fibro can be controlled as a secondary gain from treating the other problems.
Your case is very complicated and many PM docs wouldn't know what to do with you. because simply managing the fibro isn't enough, mangaing the TMJ disfunction isn't going to help the IC and the drugs used to treat IC aren't going to do much for the TMJ.
This is where a patient really needs a multi faceted aproach to pain mangemt with a group of docs that all have different specialties and modalities to offer, Not three docs all prescribing opiates and muscle relaxers. You would be inetvertantly doc shopping evn though you can see this med is for this and this med is for that and the other opiate is for the TMJ.
My PM group has Neuro's, Physiatrists, Psychiatrists, Osteopaths, counselors and you would need to see a doc that specializes in each condition grouped together to ensure some uniformity of care. You can find groups like this at major universities. Or at least find specilaties all under the same univerity hospital . You do have to be aware that a patient that can never be satisfied regardl;ess of med changes and dose increases may not apear to be the best cabndidiate for opiate therapy. Methods like Yoga and Bio feedback or self hypnosis may work great for fibro and do nothng for IC. But if you have the tools and techniques, You can use the apropriate modality for the apropriate symptoms, not try to maskl them all with opiates.
Some docs love the tough caases, so don't be discourgaed. I've sen at least 12 PM docs in the last 11 years and everyone had a different phylosophy and felt their method was the corect way to manage pain. 12 docs, 12 methods???
Good luck and don't give up. It took me 87 years and 3 monster surgeries before a doc prescribed pain meds. I had learned or tried every non oiate method to manage pain you could name and the whole time the group of docs I presently see was in my own back yard. But my GP and surgeons didn't believe in the use or oiates and knew that he did, so they intentionally kept me away from him and never mentioned that this was even an option.
Take care, Dave
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