I am in a dilema... I have been using vicodin for past 2 years for pain and its been pretty much useless most of that time. And, I have only been prescribe enought to take 1000mg once or twice a day - definitely not enough for the 6-10 24/hour pain I have. I FINALLY was referred to a pain specialist who has suggested Oxcontin time release (2x day) or Morphine time release (1x a day).
I used percocet for a while after my surgery and it did squat also, but I weaned away from it about 2 months later because my surgeon thought my pain levels shouldn't be that high. ha - five months later he wanted to do another surgery.. but that's another story.
So, here I am facing using more pain meds until I can find out whats going on with this chronic unrelenting pain in my neck shoulder arm and scapula... and scared to death of the drugs I need to take to get some of my life back.
Guess my question is where should I start??? Try to manage my pain "on call" and take something 2 or 3 times a day. Or is time-release the way to go??? Is percocet less addicting?
Wouldn't the time-release depend a lot on your metabolism?
I'm scared - can someone help me decide which of these 3 evils I should try ?
Thanks for any feedback... I have a doctor's appointment Monday and need to decide then. Just found this forum and hope to get some feedback before then.
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I wouldn't be worried about what medication is addicting, it's more about what will treat you. If you do go down the route of opiate treatment then you will have a dependency that will require you to taper of the drugs, now unless you have a history of addiction, it's much less likely you will become addicted and abuse these drugs. For example I'm a recovered Alcoholic but I wouldn't dream of abusing my pain meds, because if I did, I would be left without them and in awful unbearable pain. I've been honest and unfront with my doctors about my history and I keep a strict regime on my med use.
There are many other ways to treat pain before turning to opiates, have you tried acupunture, massage, Tens Machine, Meditation, Nsaids if your stomach can handle them are great! I don't look at pain meds as evils, they've helped my get my life back, but I do take the use of them very seriuosly, be careful how you word your conversation with your specialist on Monday, you don't want to freak him out of treating you with the full strength meds that you might need.
Welcome to the boards. Couple things regarding your post. You mentioned three different types of drugs. To start with, do you know the Mg of Hydrocodone (Vicodin) that you were taking. They don't make a 1000 mg. There is 5, 7.5 and 10mg. The other other amount is the amount of Tylenol (APAP) that is in it. If you were on a low dose like 5/500, then there is always 10/500 that may work for you.
Nexy, Percocet and OxyContin are the same primary drug other than the Tylenol. Percocet has Tylenol in it and its primary drug is Oxycodone. OxyContin is just time released Oxycodone without Tylenol.
Both OxyContin and MSContin are time released that should be dosed at least every 12 hours, but better at 8 hours. I'm surprised they would suggest OxyContin twice daily, but MSContin (Morphine), once daily. Since Oxycodone is stronger than Morphine.
Of course you can go the short acting route with Percocet and dose every 4-6 hours. I prefer long acting meds so that there is not the ups and downs of short acting.
I argree with Blaster in that there are many ways to manage pain. One of course is Pain Meds, but sometimes the best relief is different modalities of treatment as he suggested or a combo.
Either way, I hope that you find some pain relief. Take Care
You don't know how much your replies (and before my appointment Monday at ten) mean to me.
You ask many questions. Here are my answers and a couplel more questions...
Yes, I have tried to manage my pain in every way possible for years as I also have a history of chronic migraines. I have been in a biofeedback/meditation study many years ago at a local college, have had massage every couple weeks for about 20 years so I am very much in tune with my body, use Celebrex now 200mg daily but don't think it offers much relief and why should I take something that isn't helping me?, have tried accupuncture 3 times over the years and it doesnt offer the kind of relief I need and at $80 a try I can't afford it, I have a TENS unit that I use on occassion for pain, but that pain pretty much has to be muscular for it to offer much relief - the "buzzing" and "twitching" it offers distracts from the pain rather than prevent it, I have a deep whirlpool tub which helps some of the "side" pain from being in pain 24/7 (like the lower back pain I get from sooo much pain in my shoulder), and I also have other little things I do like gels and numerous ice packs and heating methods. I've tried tons of things to say the least and am not new to pain.
I find your responses to my question of pain meds amazing... I have so much to learn about them. As for vicodin, I didnt know there were so many types. Honestly, I don't think my pain has been addressed adequately because it seems doctors are so afraid to prescribe these type of drugs for their patients.
The vicodin I take says on the bottle 5/500 and I am allowed 1-2 every 4-6 hours for pain. However, only being given 90 a month I have to pick and choose when to take them. So, most of the time I'm at high levels of pain and when I do take them it doesnt do much. Ya think I need a pain specialist by now???? I pray this doctor can help me find a way to bring my almost constant 7-8's to at least a 4-5 once in a while. Living with migraines has pretty much trained me to live a lot of time with some level of pain. I never resorted to pain pills with migraines tho, because I knew I would always get a break after it was over and I have migraine abortives to help break through those attacks.
As for oxycontin vs morphine release... the doctor just mentioned using something once a day (oxycontin) or once (morphine). Now that I realize there is probably vicodin that is much stronger than I'm taking maybe I should start with that? However, I just want to knock this pain out for a while. I have so much pain I couldn't even tell you the source anymore. I'm hoping by reducing my pain the areas most affected will linger and I will better be abel to tell doctors where it "hurts". The only time this happened was when I accidently misdosed and took 2 percs (375 I believe) within one hour. I was like (thought I'd stick one of these in for some humor) the pain has gone except here and there. I could actually point to two places on my shoulder where the pain lingered... Maybe pain meds will be a good diagnostic tool at this point as I have pain all down the right side of my body at times now.
The idea of a time release is appealing, assuming it is strong enough to last 12 hours. But taking something 4-6 hours also has its pros as I can take it prior to an activity like running errands or, should I get some of my life back, going out to a movie or dinner. I guess I just have to pick a direction and try it... I'm leaning towards the every 4-6 hours because if I'm having a good day I might not need it so much. And, if whatever I'm taking is strong enough, it will actually work 4-6 hours lol.
Again, I can't tell you how much your feedback means to me. I didn't realize there were so many variations on drugs - even ones like vicodin...
As a side note - I live in Ohio and have finally been referred to Ohio State for consultation. This doctor gave me a cort injection in my coracoid process and my pain levels dropped like 3 levels almost immediately (from the lidocaine I'm sure). I cried I was so relieved. After the hour and half drive up there I was at level ten and cried with the relief it gave me. It was strange because the pain in my neck and scapula also got better... weird. Too bad it didnt stay with me . This doctor has some new ideas and told me my last 4 EMGs didnt even test the nerves that might be causing some of my problems (llike my winging scapula...) OK - I'm getting wordy now. It would take ten posts twice this long to tell you what I've gone through the past 3 years.
Right now I want to learn all I can about pain meds and what will work best for me.
Should I try a stronger vicodin at first? Go with percocets every 4-6 hours? I'm thinking a stronger percocet than I was using after surgery might work best but I don't think it would be a good idea to tell my doctor what I think I should take... lol I'm so afraid doctors will start thinking I'm seeking pain meds because I'm "addicted".
Any posts prior to my appointment would again be appreciated.
Vicoden isn't much good for chronic pain because you end up dosing every 3 hours.In my opinion you should be on a sustained release like ms contin (morphine),I'm not a big fan of oxycodone as it seems to be abused alot,to mind altering.So you would take the ms contin 2-3 times a day with a small amount of vicoden for break through.Most doctors that I've been to like to get you up on the sustained release so that you don'y need the quick release.Good luck....Dave
Thanks for your reply. I never considered using the time release and perhaps using something else for "break-through" pain. The doc didnt mention that but maybe its something I can ask about.
The time-release would be wonderful if I could have something a little xtra for commitments. Of course, I havent committed to anything for 2 years because of pain... It would just be nice to go to the grocery store and cook dinner one day without being consumed with pain.
Guess I'm just going to have to try various ones to find out. I didnt' realize oxycontine was stronger than morphine. What are the names used for each. I'm afraid Im calling things by the wrong name...
To answer your question about different pain meds and names etc. You should first probably know that there are many "Brand" names that people get confused about. For instance, Lortab, Norco, Vicodon, are all Hydrocodone. You mentioned being on 5/500. This is a low dose of Hydrocodone and 500 mg of Tylenol. They make Hydro up to 10 mg and anywhere from 325 mg of tylenol added to 750 mg of Tylenol
Now Percocet, Percodan, Roxicodone, Oxy IR, OxyContin, Endocet, are all "Oxycodone" as the primary drug. Some of these like Percocet have Tylenol added in, Percodan has Asprin added. Percocet comes in 5, 7.5, and 10 mg. They recently added a 2.5 mg as well. The Tylenol is usually 325 mg. So a 10/325 would be 10 mg of Oxycodone and 325 mg of Tylenol. Roxicodone, Oxy IR are both Oxycodone only without anything else added. Depending on which one, you can get them from 5mg to 30 mg. These are immediate release. And then come OxyContin. There is a society stigma that goes along with this med unfortuantley. OxyContin is just time-released Oxycodone. However, people that abuse this drug break it or crush it releasing all of its contents immediately instead of over 8-12 hours. OxyContin comes in 10 mg -160 mg to be released of the 8-12 hours. You can see the problem if someone abuses this med. This is why a lot of Dr's will not prescribe it. But the primary drug is no different than Percocet.
As far as long acting drugs, you have OxyContin, MsContin (Morphine), Duragesic Patch (Fentanyl), Kadian (Morphine), Avinza (Morphine), Methadone, to name to most common ones. And actually there is a new one called Ultram ER which is Tramadol time-released over a 24 hour period.
Most people with chronic pain prefer and are prescribed Long-Acting meds so that there is a constant stream of pain medicine in their systems without having to go through the ups and downs of short acting meds. Most Dr's that prescribe this will prescribe a medicine for breakthrough pain that is short-acting for immediate relief. For instance, I have many medical problems with my spine and have been through many surgeries, but will live the rest of my life in pain. I am prescribed OxyContin 3x a day and Percocet 10/325 for break through pain. I also take Soma for muscle spasms that occur daily.
Hopefully this clears things up a little. It is good that you have tried other things. I still get injections, and massage and PT to help manage my pain. Keep notes on what has worked and what has not. A good PM will try different modalities of treatment to keep you as comfortable as possible.
If you're taking Vicodin currently, then there are many other meds that can offer relief. It will be up to you and your Dr to decide to go to a higher dose of Vicodin or different med. It all depends on your situation. If it is a chronic pain problem, then a long acting med is usually the best way to go.
The most important thing to remember about pain and pain managment is that it is your body and you need to do what is right for you! You also NEED to communicate with your Dr. He can't help you control the pain if he doesn't know what you are on isn't working well enough.
I have been on every kind of pain med there is out there. Some have worked too well and some barely help me. Part of the equasion is your body's chemical make up and how you react to the meds. If the vicodin has been helping some but isn't taking away the pain, like suggested try a higher dose. If you think Percocet is better for you try that.
Just remember that if one option isn't working you can always try another. A good PM will help you figure this out.
I can't thank you all enough for direction on the next level of pain meds I need to consider. I was at first hesitant of using the time release meds as I was afraid the pain would return too quickly or not go away soon enough. But if the doctor also gives me what is called "breakthrough" meds then I won't be so concerned of how well it works because I know I will have back-up until I find a dose that will work for me.
It also sounds like I have a lot of options right now and, in fact, haven't even yet been given the strongest doses of vicodin that I could have been prescribed. This, I don't understand as I have consistently told my doctors I have pain levels #6-#10 24/7. Don't they believe me? Because I don't go in there begging for pain meds, perhaps they don't think I need them. It's frustrating to find out there are higher levels of vicodin I could have been taking during the course of my pain over this past 3 years. I have probably suffered a lot longer than necessary and what I do know about pain is that once you have suffered with it for a long time your body become more sensitive to it. Maybe if I can lower my pain for a couple months that in itself may start diminishing how quickly my pain levels rise. Wouldn't it be something if I have just had high levels of pain for so long my body hasn't had a good chance to "desensitize" to pain since my surgery in April 2005??
Right now I am just trying to find out what is causing me so much pain. After being bounced from ortho to neuro a few times I am getting frustrated. Because something hasn't "jumped" out at the doctors I am beginning to think they feel I am exaggerating my pain. I am praying this consult at Ohio State will turn something up. This new doctor already has some new ideas on what is causing my pain and it is a little complicated. The doctors I have seen thus far don't want complicated..... that's another story....
To everyone who responded to my posts, again thank you. I will feel a little more educated and relaxed when talking to my doctor about which pain meds to try first. I pray they will work and I can focus my energy on finding out what is causing this pain.
I will let you know how my appointment goes tomorrow.
I had my follow-up with my pain doctor. I left very disappointed. After I reminded her she had suggested either the time-release oxycontin or morphine a couple weeks ago, she completely changed tracks and asked me if I wanted a trigger point injection in my shoulder (trapezius) when my pain is mainly in the front of my shoulder, neck and scapula. My trap is kinda caught in the middle of it all, but it never starts there so I'm having trouble wrapping my mind around a trigger injection there, but I agreed to it and its scheduled for Wednesday...
Then, she suggested dosing as needed and prescribed Vicodin 10/660. I told her I was taking 2 5/500's every 4-6 hours now but had only been prescribed enough in a month to take it a couple times a day. She said she would give me enough pills to dose 3 times a day. Then, when I went to get it filled I found out she wrote it for only ONE tablet every 6-8 hours. So, basically, it is LESS pain meds than I was using for my doses (which barely touched the pain). I can't understand her reasoning for prscribing this, except that I can now take it 3 times a day. How can she go from offering me strong pain meds to basically writing me a script for a lower dose further apart in time??? I wouldn't have left the office had I understood she was giving me less than I'm currently taking. I can't believe it !!! I figured she was prescribing 2 of these each time, not one, as I told her my current dose wasn't working.
I will have a chance to talk to her Wednesday, so I'm hoping she will reevaluate me after a couple weeks on vicodin 3 x a day... In the meantime, I was able to schedule an appointment with my ortho at OSU and will ask him if this trigger point injection will even do me any good if given in my trapezius.
Sigh, I think the pain doc is just another doctor who doesn't want to take the time to "listen". Because I don't have an obvious diagnosis or disease, I think these docs don't understand how high my pain is. I am really discouraged and don't have a clue as to how to impress on her how bad my pain is.... and how long it has been left untreated at these high levels...
Sorry to rant, but I was hoping for some relief. What I did do was take one of the 10/660's right when I filled the script and it had only been one hour since I had taken my 2 5/500's. I am just so tired of being close to tears in pain I just wanted it to be gone for at least a little while. That made it 20mg hydrocodone within an hour. It took an extra hour, but my pain level finally dropped a couple notches. Of course, add to that my hour massage 2 hours later and maybe thats why it has lasted a few hours. I don't have much hope for the 3 x dose. Maybe my new ortho can give me insight tomorrow. I hope my EMG gave me a clue...
Thanks to listening to me the past couple days. I'm still boxed in with this pain and its getting me down more than I want to admit to anyone...
I was fortunate enought to get an appointment with my new ortho the day before my pain doc wanted to do this trigger point injection. My EMG showed some brachial plexus abnormalities which conicide with the pain in front of my shoulder / neck / and arm. So, I'm going forward with ANOTHER surgery.
It will have been a year since my first shoulder surgery and I hate that I have to go through another one because my first surgeon wasn't thorough...
I did ask this surgeon about treating my pain after the surgery. It sounds like he has everything covered for 3 weeks of pain. OMG my last surgeon doled percocet out like it was a sin to take them and once I past 2 weeks post op he didnt even want to prescribe anymore... that's another story. I had MORE PAIN after that surgery and am terrified it will happen that way again. At least this doctor has a direction and not just a "look and see" approach like my last one had..
Pain is still a BIG issue for me right now and I am still going to see my pain doc tomorrow tho my surgeon said NO INJECTIONS prior to surgery on May 5. I am going to see if I can get her to prescribe some percocent for my higher levels of pain that vic can't handle.