Help w/what is considered high/low dose of pain meds - Pain Management Message Board

bjeanne · 05-19-2006, 05:27 AM

Hello, firends. This is the second time I finished an entire (and very detailed)past and heard a "click" and it disappeared! urrrrgh. . hence, this is the condensed version. If anyone knows the answers to my questions, I'd be happy to let them know my whole story. .

short cut: I have severe myofascial pain from head to toe, localized and very painful pain (for lack of a better word) at the incision site of my complete tendon reconstruction of my right ankle (including permanent sural nerve damage). Lastly, and this is the long part I'll skip. . I had a freak accident and spraigned my neck and lower back. Xrays at ER showed nothing broken. MRI ordered by my fantabulistic PM Doc showed a pretty big tear in one of my discs in my lower back,plus alot of other "stuff" (i.e. severe disc spacing, Scmorles nodes, PARS defect, DDD in my hips and right knee (possibly secondary to an effective gait since my ankle surgery). I also have referred pain shooting down the back of both of my legs. . I use a cane because I can't still 100% weight bear on my right foot.

I'm wondering who can help me (and I realize these conjectures will be based soley on your personal experiences, etc., I'm just trying to find a benchmark with which to approach my Doc one more time (this is the ONLY area he frustrates me in and alot of it is probably my fault. I go into these discussions not fully "arrmed" if you will, with what I now know, from these boards, is going on with chronic pain management. . . what's an average

LOW DOSAGE MEDIUM DOSAGE HIGH DOSAGE TOO HIGH DOSAGE

of Vicodin for someone to take who easily and quickly develops tolerances to ALL meds. I've let him know twice now that the current dosage I'm on is not keeping me even remotely comfortable and he keeps saying lets "try these injections, etc., first before we make any med changes". He feels that since all opis tend to create the toleration problem, then they'll all do that to me.

I know this was rather alot, but I wanted to get a good, true picture out there of my suffering and pain, etc and was hoping for some word tracking to apprach him from a more confident place next month when I see him again.

AGAIN, TONS of thanks and soft hugs to you all. . .

Barb

feelbad · 05-19-2006, 07:23 AM

Hi Barb.the big thing with the short acting meds is that you are very limited in just how much you can actually 'safely" take just because of the tylenol involved.any med that contains tylenol kind of sets its "own" parameters as far as what you can take.if you are having non stop ongoing pain (and from what you just described,many pain processes)realistically,you really should be on some sort of a long acting med like oxycontin or ms contin to give you the best overall relief from the ups and downs of what you are currently going thru.

right now,you can only actually take in about 4000mgs of tylenol per day and when you are taking this on an ongoing basis,the reccomended is actually down to about 3000mgs.so this really limits the actual dosage that would be possible for you to increase to.this is why the long acting contins are really the best way to go.if your PM is actually just treating you(and it appears very reluctantly at best)with short acting meds,for your types of pain processes and is not willing to let you actually even try one of the LA meds,well,I think it may be time to try and find a much more knowledgable PM doc,really.the one you are currently seeing does not appear to really truely understand the best ways of treating your chronic pain.

as far as high and low dasages of the vicodin you are taking,well that would depend on just what type of hydro med youare taking and the amount of actual tylenol in it.if you are taking like lortabs that contain 10mgs of hydro along with 500 mgs of tylenol,you realistically should not be taking any more than about six per day as this would bring the tylenol intake to that 3000mgs and when takingthis every single day,well you really do not want to go over that amount despite the fact that the max dose allowed is around the 4000mgs,just because the daily intalke amount every single day will be much harder on your liver and kidneys than say someone who is on this for a very short term basis,like post op.they would be able to tlerate a bit more than the 3000mgs just becaue it is only a short term dosage.

you just really really DO need to think about the high amount of tylenol you would be taking if you continue with this short acting med.this does take its toll on the liver and kidneys when they are being forced to have to metabolize a high amount of tylenol on a daily basis.like I stated above,if your PM will not let you at least try one of the long acting meds,vs keeping you on your current hydro,well,I really would start looking for a new doc to manage your pain care.

while injections DO help some people in some ways,this should not be something your PM is pushing on you everytime you complain of out of control pain.this requires a re eval of what your current meds are and the actual dosage amounts.any short acting med really shouldn't be something that is being used to try and treat and control chronic pain like yours.they just cannot even really compare to the superior relief you can obtain with the longer acting meds.and those do not contain any tylenol at all.two big pluses.

If I were you,I would just sit down with your current PM and really discuss the possible use of any contin med and see how it goes.this truely is the best way for someone with your type of pain issues to go here.if he refuses or has a big problem in trying this treatment plan,I would very seriously start looking for a much better more caring and most importantly more knowledgable PM doc.i DO wish you luck with this doc,but if all else fails,you DO have options availiable to you.please keep me posted on how this all goes.and keep an eye on the amount of tylenol you are taking in every day,K?good luck,Marcia

bjeanne · 05-19-2006, 08:29 PM

please ignore, don't know how to "delete"

RetiredDirector · 05-19-2006, 10:36 PM

Hey Barb: Although they don't make a Hydrocodone product that doesn't contain Tylenol (apap) they do make both brand (like Lortab) and generic Hydro with 325 mg of apap. This would allow you to take 9 or 10 a day. Taking 10 would put you a little over the 3,000 mark, but you could probably be ok if it's not too long of a period. Also, you can go to a compounding pharmacy and they can make a Hydro product for you with any amounts your doc will write a script for.

The other thing I wanted to mention, unless you doc is really stuck on the Hydrocodone, you can get Oxycodone without the Tylenol. Oxy IR comes in 5, 15, and 30 mg doses. Same medication as Percoset, only without the apap.

bjeanne · 05-20-2006, 08:41 AM

Hi, Director:

Thanks so much for your reply. So, there is a medication called Oxycodone that you can get with no tylenol in it? What's it called? (stupid question?), just Oxycodone? Is it as effective, do you think, without the Tylenol pain relieving factor in it? I do, actually, take Hydrocodone 10/325 (the lowest, I thought, amount of Tylenol in any opiate?), I take 2, 4 times a day, and as I mentioned, I have been on it for over 3 years and I really don't find true pain relief from it anymore. My PM Doc says that all of the opiates will do the same thing to me, eventually. That everyone develops a "tolerance" level and it is not as effective anymore. Then that's the end of the conversation. He doesn't seem to want to offer me anything else? That's why I'm trying to get as many opinions as I can and go to him more "informed", if you will, to try to have him make SOME kind of change!

Any more suggestions you have or ANYONE HAS, for that matter, would be so greatly appreciated.

Thanks again!! Have a blessed day!
Barb