Tolerance..what to do? - Pain Management Message Board

sharonn · 10-03-2006, 07:52 PM

I started on oxycodone 5mg 4x a day for neuropathy and fusion/herniated disk pain.I am now at 80 mgs. a day and it is scaring me. What can I do? Should I try to taper a little each day until I get down to a lower point..will it work better then? When I have extra pain? Thank you so much.

wolfmarket · 10-03-2006, 09:18 PM

Actually, what you need is to have a long acting base med and a short acting med for breakthrough pain.

For example, meds like OxyContin, Fentanyl patch and MS Contin are used 2 to 3 times per day and because of the wway the med is released, it lowers the peaks and valleys that you get with the short acting meds.

For example, I wear a 100 mcg fentanyl patch for my base med and use 30 mg Roxicodone for b/t.

That is the theory anyway. In my case, the patch does nothing so I lean on my b/t meds for the bulk of my pain relief.

But forget about me. You should speak to your Doctor about having a long acting and a short acting med.

donaeis · 10-04-2006, 04:23 AM

Sadly, there is no adequate treatment for tolerance to prevent it from occurring. Adding more narcotics only compounds the problem by delaying the point at which the medications no longer work and your doctor reaches their limit on how much they will prescribe. It does not develop in everyone as some do well with the same dose for years. But if you find you have escalated the dosage from 20 to 80mg in a short time frame, less than six months, there is definitely trouble ahead since you are developing rapid tolerance. In such cases, it is beneficial to use only long acting narcotics at a fixed dose, then supplementing with other meds such as cymbalta, lyrica, topamax, etc to control neuropathy pain. Also, high dose vitamin B12 (available in stores as methylcobolamin) has been shown to help with neuropathy.

Shoreline · 10-04-2006, 09:36 PM

Hi Donna, There are adjunct meds and meds thathave different properties they can use so that your not relying completely on pain meds to manage CP. If you thinkof pain as a circut or loop, different meds will disrupt that circut at different point.

If your pain is neuropathic, anti seizure meds interupt the loop at a different point, NMDA blockers can also interfere with the loop" drugs like Nemanda, Dextromathorphan or useing methadone for it's NMDA blocking ability. People do tend to be able to stabalize for considerably longer with meth than you see with oxycodone.

Antidepressants are also used to treat CP because they block the circut at a different point.

Clonidine can also have an effect on the circut so it just makes more sense to look at pain as achemical circut and try to tie off or disrupt the flow at as many points as possible. Several classes of meds are known to disrup the neurochemical process involved in transmitting, interpreting, responding and actually creating abnormal neuro transmitter flow and neuro chemicals you only see produced by chronic pain patients.

It may sound insensetive to try to relate pain to a chemical/ elecric circut but breaking pain down to what it actually is and does to our neuro chemical system best explains the process.Chronic pain is transmitted and the chemicals involved in the process are very different from the way acute pain is. Throwing as many road blocks, disruptions or scrambling that signal in that circut is a way to prevent rapidly increasing tolerance. Trying and using anything and everything that helps will slow the tolerance that occurs if opiates are the only tool being used.
JMO and the NMDA blocking agents are worth discusing with your doc. You can't prevent tolerance, but you can slow it down.

Good luck Dave

donaeis · 10-05-2006, 05:50 AM

NMDA receptor antagonism in animal studies using potent non-competitive antagonists such as MK901 will bind irreversably to the NMDA receptor and slow but not stop tolerance or opiate induced hyperalgesia due to NMDA receptor activation. In the clinical world, there are only a handful of competitive agents that are weaker, such as dextromethophan, amantadine, ketamine, etc., but none are strong enough to have any clinical effect on slowing tolerance and the development of opiate induced hyperalgesia.
Adjunctive drugs indeed are alternatives to opiates, but do not have any effect on the development of tolerance.
Interestingly, tolerance is not universally developed.