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Old 07-06-2006, 02:07 PM   #1
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Use of two LA pain meds?

I was wondering if anyone here is using more than one long acting pain med? I just switched from Avinza to oxycontin a few weeks ago. I'm now on 40mg oxycontin 3x/day. I take short acting morphine for breakthrough. I am trying to find the right dose and combination of meds. For some reason, I find that using meds from different 'categories' works better for me than using the same for LA and breakthrough. From what I understand from my PM doc, she says this is because there are different receptors for say, morphine and oxycodone, so it sometimes helps CP patients to use meds from different categories. Has anyone else experienced this?

Also, I would like to decrease my SA usage - I am taking daily and feel that this may mean my LA dose is too low. However, I was wondering about adding a dose of MS Contin rather than increasing my Oxycontin...I feel I may still get the benefits of hitting different receptors, but also get better, steadier relief from LA than I am by supplementing with SA, and hopefully need less SA. I am going to talk to my doc at my next appt, but was wondering if anyone has tried using more than one LA pain med and what their experience was?

Thanks in advance for any feedback!
Maine

 
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Old 07-07-2006, 02:14 PM   #2
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Re: Use of two LA pain meds?

Hey maine, Your doc explained it perfectly, However there really isn't the need to use two expensive LA meds unless your not responding to one and it's way to early to tell. If your taking 3,4 or 600 mgs of morhine a day and not getting to a managble level it's more reasonable, but they don't normally do it unless it's neccesarry.

How about adjunct meds like anti inflamtories, anti seizure for nerve pain, anti depressants to supress substance P, Nemanada to block the NMDA receptor. Trying to interupt the pain signal at different points other than opiate receptors follows that same line of thinking about coving multiple receptors whether it's an opiate receptor or at some other point in the chemical process of pain transmision like the NMDA receptor, the calcium channels that carry GABA or the production of substance P.

Give it time and give each med a fair shot. There aren't that many opiates to rule out where there are dozens of other meds that can be used to interupt the neuro chemical reponses and changes that occur with chronic pain.

Asking for 90 30 mg MSC and 90 40 mg oxyC will certainly raise an eyebrow when it's not neccesarry. It will also draw alot of attn to your doc prescrbing practices at the pharmacy and anyone else wondering why so amany LA meds to one patient. He better be able to back up his decision to prescribe those quantites of meds and in such an unusual manner. Many things sound like they make sense, but untill it's a standard of practice or the last resort, give conventional PM with opiates a chance.
Good luck, Dave

 
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Old 07-07-2006, 03:02 PM   #3
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Re: Use of two LA pain meds?

Hi Dave, thanks for your detailed response. I wish I had a dr who could explain things like you do. I wish I could find more adjunctive meds that really work for me. I've been in chronic pain for about 5 years now. At first I was dx'd with fibromyalgia and we tried many meds - ultram, naproxen, relafen, clinoril, cymbalta, neurontin, gabatril, flexeril, skelaxin, zanaflex. Unfortunately, I seem to be sensitive to the side effects, especially nausea. The muscle relaxants worked well for the pain but made my liver enzymes go up after less than a month so I had to stop taking them. One that works for me is Lyrica, which I still take when the pain gets bad, but it has caused me to gain weight. I tried Topomax but it left me feeling depressed and didn't address the pain all that well. I guess I am getting a bit frustrated Do you happen to know of any others that you've heard work well?

This is my second trial with oxycontin. The first time I became tolerant quickly - was at 80mg tid plus 3+ breakthroughs a day. I switched to Ms Contin, then to Avinza where I ended up at 120mg twice a day. I've gone back to Oxycontin in the hopes of taking a lower dose (after hearing over and over again from my endocrinologist how my dose of Avinza was very high and I need to lower it since it is adversely affectly my endocrine system)
I don't know what to do. I guess I was trying to decrease my overall opioid pain med use. I am so fed up - I am getting a lot of pressure from my drs (except my PM doc) to lower my pain meds. Only my PM doc seems to understand that I always take as little as possible, and then it's to manage the pain, not eliminate it. Sorry, don't mean to whine here. Thanks again for listening,
Maine

Last edited by mainecoon66; 07-07-2006 at 05:21 PM.

 
Old 07-07-2006, 06:41 PM   #4
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Re: Use of two LA pain meds?

Hey Maine, Somethng worth asking about is Nemanda, It's an alzheimers drug and my wifes insurance wouldn't cover untill she urned 40, but it's a stronger NMDA receptor blocker than methadone. Blocking this receptor is what's believed to be the unique quality that makes methadone a good med on nerve pain. Drugs that block this receptor increase your tolerance to pain and can decrease rapid tolerance to opiates along with increasing the effectiveness of opiates. My wife has dropped her dose by 2/3 since adding nemanda. Other people use forms of dextromathorphan, It's one of the properties of Ketamine which is used more freely outside the US. They often induce ketamine comas to break the cycle of chronic migraines. It basicaly resets your brain chemsistry under this type of anesthesia..

Conversly, drugs that do bind to the NMDA receptor cause hyper sensetivity to pain and tolerance to opiates. IF your problems are cervicle, Botox is another effective treatment and would probably have good luck with myofacial and other uses like TP injections. Your doc can prescribe Botox B and you pick the bottle of injectable Botox up from the pharmacy for your doc to inject. It's about a 1/33rd the price as Botox A, something like $280 a bottle and isn't much different than the FDA version "Botox A" for cosmetic use and specific types of dystonia and facial/neck muscle parallysis. My wife did this after the first injetion was aproved and so succesful, but then they decided not to cover it any longer. Simply bring the bottle to your apt to allow the doc to do injections if you want to minimze the cost.

The thing is to not stop looking and to take advantage of what does work. The more tools you have the less your relying on a med you slowly grow more and more tolerant too.
I don't know what happened to the post I wrote about your ESI. There was a report called the Burton report that really bashed the use of ESI but even the author still recomended using them to allow time for discs to heal rather than jumping into surgery.Once they cut through those muscles, nothing is ever the same. The odss of having a problem from your first injection would be similar to developing osteo perosis from a single ESI. IF it was your first, you really shouldn't worry, likely they pireced a nerve causing more trauma than providing relief, but the docs aren't going to admit to skewering a nerve when it will get better with time anyway.

Hang in there, Dave

 
Old 07-07-2006, 10:30 PM   #5
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Re: Use of two LA pain meds?

Thanks again Dave - you are so kind to take the trouble to type so much useful info I will definitely check into Nemanda. I think I am going to post a separate question on the difference between nerve pain and other pain. I have been doing some research, and think this may be why my pain doesn't seem to respond as well to some opioids. I also agree on trying other modalities besides narcs...the PM center I go too offers a good suite of non-med tools which I have taken advantage of at different points - PT, meditation, counselling, hydrotherapy. I think that is one of the main sources of my frustration with my current situation..I used to rely a lot on walking and yoga - really felt they reduced my overall pain, as well as improving my mental state. Right now those are both out. I intend to press on and try gentle swimming next.
I've had 3 ESI's in the L4 - S1 area. My last procedure was a diagnostic short acting block, followed by bilateral radio frequency ablation on facets L4 - S1 in May. It was after the RFK that things changed dramatically. A few things worry me - I'm past the point where the esi doc said I should have healed and I am still gettin worse, not better. I have several new symptoms, some of these seem to be odd and correspond to what I've read about Arachnoiditis - feet numbness,swelling and burning, tightness in back of legs, daily headaches (which I seldom got before), sweats/chills, intense burning in my buttocks and back of both legs, itching, my reaction to exercise - now much more painful, bladder problems. These all started directly after my RFK. I also read that people with autoimmune conditions are more susceptible - I have 2. Yet I don't want to worry unnecessarily and haven't read anything about people having arachnoiditis after RFK so I'm trying to reassure myself about that. You mention having a nerve pierced? One thing that did happen in my proc - my doc had a hard time finding the correct positioning for the needle on my right S1...involved a lot of digging around during procedure. So I kept thinking that had something to do with how I felt afterwards. I had no idea they could pierce a nerve? Do you happen to know how long it takes to recover from that if they do? And what that might feel like? That would be a much better answer that what's been rolling around in my head!
Thanks again, and take care,
Maine

 
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