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Old 10-17-2005, 06:48 PM   #1
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Dave, question about my Percocet dosage

I take Percocet for BT pain. The dosage is 5/325 and I can take four daily.

Today has been bad, pain wise. I've already taken my four Percocet but I need one more because my neck is still throbbing in pain.

Can someone help me out? I don't want to self-medicate but I need some relief and I have plenty of Percocet left. I'm out of my MSOxycontin and get my re-fill tomorrow.

Thanks for anyone's help in advance!


Gabe

 
Old 10-18-2005, 04:39 PM   #2
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Re: Dave, question about my Percocet dosage

Hey Gabe, If you hae to use BT meds 4 times a day consistantly than I would say your base med isn't doing it's job. If you have to negotiate giving up some BT meds to get your base med adjusted I would do wouhat it takes. As far as taking an extra BT med, just remeber that you have to make it up somehwhere, which susually means the end of the motnh, asking to fill early isn't an option if you want to maintain a compliant relationship with your doc, but one extra perc isn't going to hurt you. Sorry this is late , I know you have you BT base meds now, but if your not getting relief you have to talk to your doc, It may simply be the change in whether, I've been miserable too, but the bottom line is it has to work out at the end of the motnh, Asking for an early refill isn't a optin and based on yur BT med usage you obviously having to do too much clock watching and the base med isn't doing it's job any longer, Is it Oxy or LA morphine? My sugestion would be to use a different BT med than your base med, diffferent opiates from different classes bind to different receptors and you get a broader range of coverage.
Hope this helps in the future.You may also want to talk to your doc about adding nemanda, It works well for my wife, but I can't afford it so can't give a personal recomendation. It prolongs the duration of her meds and increases their effectivenss due to the NMDA receptor blocking ability of Nemanada. There are also relaxation techniques you can learn to manage BT pain, the more tools you have to deal with pain and BT pain the better off you will be in the long run. It's gong to be a lng winter and you don't want to have to increase opiates intake every time the weather changes
Take care, Dave

 
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Old 10-19-2005, 06:09 AM   #3
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Re: Dave, question about my Percocet dosage

Shore is totally right here,once again.But I just wanted to mention the fact that you stated that you were already out of your long acting med and that really backs up what shore just told you.If you are having to take more of your base med just to try and control your pain,your base med obviously needs to be raised.By the way,if you are out already before your fill date,you were already self medicating.not slamming you ,just pointing out the fact that you really DO need your base med upped,or even possibly switched if your current mix O meds is not working for you.i wish you luck.this such a cruel and nasty game we have to play just to try and have some quality of life.Marcia
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Old 10-19-2005, 12:10 PM   #4
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Re: Dave, question about my Percocet dosage

Thanks Dave and feelbad for your help!

Just to clarify a few things. I'm not taking more of my MSOxycontin (base). What happened was this: My PM doctor doesn't do re-fills on Friday's and my re-fill for MSOxycontin landed on Friday and when I called they told me sorry and that they would re-fill it on Monday.

So I spent that weekend with just my Percocet 5/325 break-through meds. And it sucked just to let you know and that's why I started this thread!

But yes, I am learning at a very early age the crap we all have to put up with due to our pain, re-fills, etc. Someday's when I have more pain I think that I should be on a higher dose of MSOxycontin (LA Meds). I take a total of 40mg/day. One 20mg in the morning and one 20mg in the evening. I have a great PM doctor but I worry that if I need a higher dosage that I'm building a tolerance and is that a bad thing?

Do PM doctor's understand that there's a possibility that a person can start building a highger tolerance to their base med and is it a bad thing?

Thanks.

 
Old 10-19-2005, 05:49 PM   #5
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Re: Dave, question about my Percocet dosage

Dude, Your dose is low, If it's not managing your pain, and the BT meds aren't really for BT but just part of what you take to get throuh the day, then tell the doc. The only snmaller dose is 10 mgs twice a day, the 10
''s didn't prove to be much more efective than the plecebo. Taking Tens is comaparable to taking one percocet every 6 hours withotut a major release that dampens the pain.

Being young means you probably will develop tolerance and be on a higher dose of meds when your 40 than someone who just developed pain at 38 andis 40 now. The longer it's gone on, the more you expect to see tolerance. Especially If you don't develp some other methods, modalities, meds and tools to manage your pain.

It also depends on what your expecting from the meds, If it's complete relief, than most folks would never be happy.

If your talking about an increase because you pain is a 3 that doesn't make sense, if your not getting 50% relief than your shortchanging your self if you don't shoot for at least that.
Take care, Dave

 
Old 10-19-2005, 11:52 PM   #6
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Re: Dave, question about my Percocet dosage

Dave,

I think I might need a higher dosage in my Percocet for BT pain instead of upping my Oxycontin. I'm on 5/325 per pill for Percocet. I think I am on the lowest dosage for Percocet. Are there higher dosages for Percocet?

Or maybe I need my Oxy increased. I didn't know I was on a low dosage of Oxy. Maybe that's the problem. I'll make an appointment with my PM doctor. It takes a month to get into him though since he's popular here in Des Moines.

Like right now my pain is around a 2 on a scale of 1-10 and I just took two Percocet because I started feeling throbbing pain in my neck and then it would go into bad spasms and I would go down with a severe headache and have to take Imitrex but my Percocet calms it down. I try to prevent my pain from getting out of control now.

Like I have said, I'm new to all of this basically. I've been dealing with chronic pain now for a little over a year and have my PM doctor through this whole time.

Dave, should I ask for my PM doctor to up my Oxy from 20mg/pill to like 40mg/pill twice daily and see if that helps? Or should I ask for a stronger dose of Percocet for my BT pain?

If you answer these questions correctly, I will send you a check in the mail for $1.00 for your advice.

Thanks,

Gabe

 
Old 10-20-2005, 06:03 AM   #7
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Re: Dave, question about my Percocet dosage

i am just wondering.my refill day is always on a wednesday,no matter what,if you are on the (now)28 day schedule wouldn't your fill day be the same every fill?or is there any way that you could set things up so you would never end up needed that fill ever again on a friday?That just seems so unbelievably cruel to not fill someones everyday long acting med and making them go over an entire weekend without them.Know what i mean?i really do think you need to talk to your doc regarding this issue and a raise in your dosage(long acting)you can also be taking oxy IR instead of taking those percs,with tylenol every single day.Oxy IR is 'just"oxy no tylenol.believe me,if you are going to have to be taking narcotics for the long term,you really want to try and avoid anything containing tylenol whenever posible,really.since you in our unfortunate group here of suffering with chronic pain,you really need to start looking at your meds and what is in them that could cause you harm at some point down the road.
I really am sorry that you are having to deal with all of this at such a young age,I am now 45 and i never ever expected to have such a screwed up body at this point in my life either.it really does suck.just have that chat with your doc.Marcia
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Old 10-20-2005, 10:53 AM   #8
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Re: Dave, question about my Percocet dosage

Hey Marcia,

I wish I could have my Oxy re-filled like you do with your base med. Unfortunately, it doesn't work that way for me. My PM doctor for some unknown reason doesn't do ANY re-fills for any of his patients on FRIDAYS. Plain and simple. Now, he's not some mean and cruel person. He's a great guy and we have more of a friendship/doctor relationship. I have his cell phone number. He doesn't give that out to his patients. But because I'm a retired cop and he knows my family (my dad is a cop too) he gave me his cell number in case of an emergency. Before I started Lyrica, I would frequent the ER at least twice/month due to extreme nerve pain that started in my shoulder, traveled up my neck into my head. I suffer from migraines too but the pain in my head was 10 times worse than the worse migraine I have ever had. My whole body was effected by this and I would dry-heave the whole time until the ER doctors got an IV in me giving me 30mg of morphine and a lot of nasuea medication. So, my PM doctor knew this and he wanted me to have his cell phone so if an ER doctor didn't know how what was happening to me my PM doctor could tell them what to do, etc....

I just called and made an appointment with my PM doctor and see him November 7th. I will ask him to switch me over to the OxyIR. Maybe that will give me a little more relief. I'll let you know.

I thank God that my family doctor started me on Lyrica when it first came out and really no one knew about it. My family doctor has all my files from my PM doctor and he noticed that I wasn't on anything for nerve pain. He was kind of surprised and said that there was this new pill that treats people with moderate to severe nerve pain. So, I am his only patient to be on Lyrica and I see him in a week to tell him how it has basically stopped my nerve pain and I have not had a migraine for a month nor have I had to go to the ER room!

Take care everyone.

 
Old 10-20-2005, 01:29 PM   #9
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Re: Dave, question about my Percocet dosage

Gabe gabe gabe, what are you doing taking BT meds to lower a 2 or 3, Maybe we have a completely different pain scale but on a 1-10 scale, taking BT meds when your pain rises from no pain to a 2 doesn't quite fit the need for medication. If the only thing exceptable is to be pain free, you will never be satisfied with any dose of opiates as your tolerance grows. Allthough you're not ecperiencing major problems now, it will just require more and more opiate to stay pain free or at that level.

That's really not the goal of pain management, Increasing the strength of BT to get below a 2 just isn't something your doc intended. I know we all wonder when enough pain relief is enough, It would be wonderful if we can be pain free with the right meds, but if your managing to be pain free taking enough meds, it will require more and more at a faster rate than someone that is willing to settle for 50% relief because taking more meds becomes more impairing than the pain itself.

The dose your on isn't particluarly impairing to most people after several months, so you aren't likely to see major negative side effects at that dose. As your dose increases, and it will, what will you do if your pain reaches a 6 or 7.

You will reach a point where side effects become overwhelming and that limits your dose, unless being sedated is an OK way to manage your pain. It's not exactly functional but you wouldn't be complaining. By then you won't be able to reach a 2 on 1-10 pain scale. This could take a couple years or maybe 5, But if nothing less than complete relief is exceptable It will happen quick.

Please have a talk with your doc about your expectations. You said the med relieved all your nerve pain, what do you need an increase for?
Take care, Dave

Last edited by Shoreline; 10-20-2005 at 01:32 PM.

 
Old 10-20-2005, 01:58 PM   #10
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Re: Dave, question about my Percocet dosage

Hey Dave,

I want to clarify about the statement I made about my pain level being a 2. My pain was around a 6 and after I took my Percocet(BT meds) it took my pain down to a 2. Sorry to confuse you.... lol

I know I'll always have pain everyday, but I consider good days when my pain level is between 1-4. Once it gets to a 5 and higher, that's when I need my BT meds.

Hope you understand now.

Take Care.

 
Old 10-21-2005, 05:45 AM   #11
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Re: Dave, question about my Percocet dosage

My main goal is to actually GET down to a five.five for me would be considered tolerable and this is what I also told my PM at my first vist when he asked me just what my expectations were.On a good day,i can maybe get things down to about a 6-7 but i can never ever seem to get to where I feel actually "comfortable".I will never ever be pain free,ever.the types of pain syndromes I aquired along with my spinal cord damage just wont go there.The central pain syndrome is always screaming,it never stops and is not affected at all really by my pain meds.this pain is the most bizarre of my many generators,it actually feels like a very severe second degree burn x5,that just wont heal.even air blowing slightly over the affected areas sends my skin surface screaming into a frenzy.imagine having a second degree sunburn with blisters,that level of pain?now multiply it by around five.i have this along the c 8 dermatome in my L arm and then on up thru both shoulderblades.this is just one of the five seperate pain generators i am dealing with in one particular area.it is like living with the severe pain of a non stop severe sunburn.i have been able to kind of desensitize it a bit to where I can actually wear clothing over it,but the clothing HAS to be extremely soft.just how in the hell is a person supposed to live with this crap,ya know?when things really get nasty and BT meds are not going to work,I have used the lido patches along with various topicals,the best actually something called Doxipin cream.anyone else have to deal with this crap?any good ideas??always open to suggestions from the crowd.marcia
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Old 10-21-2005, 05:46 AM   #12
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Re: Dave, question about my Percocet dosage

If your having pain everyday then percocet being a quick release pain pill is not really benificial to you.Too much tylenol in them to be taking them everyday.Can your doctor give you a sustained release pain killer.They don't have tylenol in them and you only need to take them twice a day.Then you use the percocet when you have breakthrough pain.....Dave

 
Old 10-21-2005, 06:44 AM   #13
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Re: Dave, question about my Percocet dosage

That makes more sense Gabe, If the seizure med has relieved the bulk of your nerve pain and your present meds keep you in the 5-6 range and BT mds drop you to a 2, a 2 is certainly better than a 6 but the goal really isn't to knock all your complaint completely away. I still think if your able to get to a 2 and your using BT meds 4 or more time a day, that's still sounds like your level of pain stays in the 2-6 range which most woulk consider extremely effective pain control.

Proportianal to your dose you BT med is right on target and based on it's efectiveness, The only real adjustments to be made would to trade some of the percs for a higher strength but reduce the quantity. IF you can maintain the same levels with 30mgs twice a day or 20 mgs of oxyC 3 times a day, a 10 mg perc available if you need it twice a day is what most PM docs would use.

I have seen just as many professionals from law enforcement and the med community given a little more consideration when it comes to the doc thinking the abuse potential is lower, but if anything the stats show that folks in those trusted fields are more prone to problems than the average joe across the street.

You were a cop so the doc assumes your going to be a low risk patient, I'm not suggesting your going to sell your pills but the relief your getting now is more than some will ever get taking 10 times the dose of meds you are.

Purdue recomends BTmeds no more than twcie a day. Every doc that actually used opiates I've seen wouldn't prescribe more than twice a day use of BT meds and even then they don't want you using them as part of your daily maint. IF you use the max dose every day and are used to that level of constantrelief, Those same BT meds won't be efective when your pain is a 7 or 8. However if you save the BT meds for pain that can't be managed by any other means, the same dose that drops a 5 to a 2 won't drop an 8 to a 2. I look at BT meds as a way to stay out of the ER and not make emergency apts with my PM doc. IF I have a flair, I've been given BT meds to manage it. But using the same dose every day doesn't really describe a flair, it just becomes part of your maint dose and then you don't have the means to manage any increase in pain.

If your only satisified when you have the max amount of med available in you it makes it harder and harder to maintain that same level of relief.

Basically a 20 mg oxy C maintans the same as taking 10 mgs of oxy every 4-6 hours or 2 5mg percs every 4-6 hours. IF you only feel real relief when you have 20 mgs in your system, 10 from the 20 mg dose of LA oxy and 10 mgs from 2 percs, your doubling your serum level. To obtain that same relief and give you BT meds would require you to take 40 mgs of OXy C at a time, Now your dose is double what it was anf you have a stronger BT med. If you continue to use BT meds as maint meds, then you get used to whatever level of opiates your BT meds add. The 10 mg percs will add 10 mgs to the 20 mgs that a 40mg oxyC maintains. So now you can only obtain low numbers and the same serum level as taking 3 10 mg percs at one time. Now your base level of opiaetes is 3 times what your takng now and what the 20 mg OxyC maintains.

See how fast you can triple your dose. It won't take long before having 30 mgs in your system isn't enough and that would require taking 60 mgs of OxyC 2 times a day, plus whatever the BT meds due t your serum level. Things escalate exponentially as you become tolerant to the side effects, but tolerance to side effects doen't happen as quickly as tolerance to the anelgesic effects. I'v seen folks content with 20 mgs fo oxy and percs for bt when they start to Taking over 300 mgs of oxy a day in just one year. You don't want to go that route and eventually a doc is going to say no more. The bad thing s it's taking that much more to maintain the same level your have now.

So finding an exceptabl level of pain and learning that you simply can't do everything you used to do prior to an inury or reitirment isn't possible. If someone told their doc their meds work well untill they get back on their horse and go for a ride, an increase isn't the answer, giving up horeback riding is a more reasonable way to keep the flairs under control.

I went through PM when opiates were not an option and when they were offered it was only as a last resort. I don't think people need to suffer but you do have to learn to cope and except some degree of pain, if not, It turns into never ending increases that only gibe you the same level of relief yourgetting from the dose your on now. Then you start to see the costs of having to use these meds to function. If your only satisifed with a dose that alows you to remian as active as ever, you will start to see the high cost that that CP patient exchange just to be able to function.

They can always treat side effects but when you look back each year at where you were and your problem hasn't gotten progressively worse, it's hard to justify how your need for meds tripled or quadroupled in just a year. That will keep happening untill you reach a point where your sick of the meds and everyone else is sick of they way the meds effect you, It's not a good place to be, and was completely preventable had you remained satisfied with the same level fo relief your getting now.

If your allowed 4 percs a day and you have to take 2 at a time but that works, stick where your at or cut the number of percs in half and double the strength using the 10's. But still remeber they aren't prescribed to be part of your base dose, they are prescribed to keep you out of the ER during a flair and making emergency calls to your PM when you pain level increases when the weather changes. He's already given you the means to manage an increase in pain. If you want that same level of relief all the time, Increase yorur base med and truly reserve your BT meds for an increase. If doubling your base dose would keep you in the 3-4 range, your should only need to use BT meds when things spin comletely out of control.

WE all have bad days and good days, but your the one that has to decide if the meds are helping you, or hindering you and damaging relationships and sending your tolerance through the roof.

Personally it would be great to see you pain managed well and stable in the 3-4 range even if it means doubling your OxyC dose, but I would excpect to see your BT meds pretty much drop off to truely as needed and a coupe times a week when things wind up. But if you see the same patern regardless of increases, the probem isn't soley normal tolerance building, it becomes chasing an unrealistic expectation or that level or feeling when you take BT meds on top of the base.

It's Similar to an addict trying to duplicate the same feeling the first time they used a drug. THat never happens despite how much they use but they continue to chase that feeling and their use continues to climb without any benefit.

JUst keep your expectations real, be aware of the potential to be taking 4 times the dose you are now in a very short time if your just not satisified with the relief you get unless it's the max dose you able to take. That's not the goal of PM.

I'm Glad to hear your not reaching for BT meds when you hit a 2 though, whew.... be relaistic with the ability of meds to manage your pain and watch yourself as nobody alse realy can. Nobody has control over what you tell your doc other than you.

Wether I aprove or not, you can be just as happy a year from now on the same dose or be wondering how you went from 20 mgs twice a day to 80 mgs 3 times a day in such a short period of time and don't seem to be rating your pain levels any better than they are today. I've seen it happen too many times and the blame tends to fall on the drug, not the patients expectations. Often BT meds are the culprit because they show the patient what more opiates can do but the price you pay becomes too blury untill it's too late, when is enough enough?

Hopefull they are offering more than medication to learn to deal with the pain you may have for the next 30 years, because at some point increasing won' be an option unless you don't mind having to cath your baldder 6 times a day and your family is packing up and leaving because they are tired of watching you sleep all the time. Those are everyday problems for many CP patients that could have been prevented if the expectations of relief were discussed with the doc and BNT meds were reserved for real BT pain..

Good luck, Dave

Last edited by Shoreline; 10-21-2005 at 07:28 AM.

 
Old 10-24-2005, 10:37 AM   #14
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Re: Dave, question about my Percocet dosage

Gabe, It might be worth considering asking your doc to raise the OxyC dose to a TID (3X a day) instead of the two a day your taking. I've been on the 20mg TID for 2 yrs and its a low dose , but two per day just doesn't work. The meds wear off in less than 8 hrs.

From what I've learned with the OxyC is that all it can do is relieve a very minimal amount of pain at any dose. If I were taking 60 or 600mgs a day, my body is going to adjust to it and the pain will just make its way through. I've never been given the benefit of BT meds, and even though I would like them, my pain has never been controlled well enough to have BT pain.

I am usually at a 5 on the scale 95% of the time, and its basically what I'm told to just deal with. That sucks , but if you really think about it, the more you can just deal with it the better off you are.

My doc dosen't give out BT meds, and I'm not saying they are wrong but in my case (nerve pain) I would be taking them on a daily basis no matter what my base dose was at.

Some people will just never get substantial relief from opiates, at any level , and I believe I'm in that group. I am currently looking for alternatives because I'm not a fan of these meds , but can function without them.

Oh, BTW... If your doc doesn't already do this, have him write DAW on your OxyContin script. You don't want the generics, trust me. And if your on the generics, the brand will probably be more effective for you.

Last edited by Amsterdam; 10-24-2005 at 10:39 AM.

 
Old 10-24-2005, 12:20 PM   #15
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Re: Dave, question about my Percocet dosage

I used to be bad too for taking my bt meds when I really didn't need to. I don't any longer though. I only take them when I absolutely have to. I even manage to go a few days sometimes without taking any of them so lots of times at the end of the month when its time to renew I still have some left. That always makes my doctor happy!! I've only had 1 dose increase in 3 or 4 years. If I have times where my meds just aren't cutting it I always phone or go see my doctor for permission to take extra. I never take extra on my own. I've built up a really good relationship with my doctor now and don't want anything to mess it up. She knows she can trust me with my meds. I hope you find a dose that will keep you comfortable. Good luck.
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