Please help with suggestions for a different pain med - Pain Management Message Board

milwood353 · 01-22-2008, 09:18 AM

Hello,

I have been on Norco, Zanaflex, Lyrica and Cymbalta for lumbar discs pain over the last year and so far we canâ€™t find the right meds to work and I need some help with what to suggest to the PM doc. Norco still gives relief but it is short lived; a couple of hours after taking it and Iâ€™m back to a 6 on the scale. I take the Zanaflex and Norco before I try and sleep at night and I can get 3-4 hrs of solid sleep. The Lyrica (spl) gave no relief at all so I stopped taking it after 30days. Some of you may have read my post regarding the Cymbalta but for those that havenâ€™t I will say I had a reaction that caused the PM doc to have me stop taking it. I have had several ESI and in the midst of my second round of PT because I am trying to do everything I can to avoid a 3 level fusion.

I am just tried of the relentless aching and I donâ€™t know what to ask the doc for or even how to ask for something different with out sounding like a junky or a burden. I was told yesterday to call the PM doc office this morning because he wanted to make sure I was over the adverse effects of the Cymbalta and the PA asked if I was still uncomfortable and I told her that the current pain med was not working as well as it once did and she went to ask the doc about a different type to prescribe and she came back with "use ice or heat when it is hurting bad". I told her that I donâ€™t want to be a burden but I do do the ice or heat just about everyday (everyday that I have PT, 3-4 days a week) but while Iâ€™m at work I donâ€™t have that luxury. Look at me it appears that Woody is having a pity party, sorry guys.

Any ideas on a better, longer lasting pain med would really be helpful.

Woody,

Executor · 01-22-2008, 12:36 PM

Sounds like you've built up a litter tolerance which in normal, and need a more long acting med. I'd go back to the Doc and tell him/her that it just isn't working and you need something better. I'm also betting the ups and downs are bothering you too....Another issue with short acting meds. I know NOTHING about your situation, but on the surface, it sounds like you may need a patch, or Oxy. If all else fails, go to another Doc. As you probably know or have read, there is WIDE opinion bases on how to treat pain....Plainly put, some Docs are just more aggressive than others. Good luck in whatever you do.

milwood353 · 01-22-2008, 12:52 PM

Thanks Professor,

I do have a couple of questions a) what is â€œlitter tolerance b) are you referring to the â€œups and downsâ€ as in attitude swings of the highs and lows? The doc told me that the Cymbalta would help with the highs and lows as well as the pain. If I decide to go to another doc is it expected to take with you your medical records from the pain mgnt doc I am currently seeing or are they not likely to give that info to me? I know there are 3 sets of full MRIs and a set of xray plus, discogram data and CT scans, in al the folder is about 4 inch 5 thick of papers and DVDs.

RetiredDirector · 01-22-2008, 01:27 PM

Woody, if I can jump in here, I think what Professor was saying was you're building a little tolerance to the medication you've been taking. The up and downs are most likely referring to your pain cycles going up and down. This means when you're medicated you are doing up, but when it starts to wear off, you're down.

I would think your next medication if your doctor wants to stay with short acting meds, would be Oxycodone (like Percoset), but you could go to a long acting med if your doctor tends to be aggressive in his treatment. It doesn't sound like he is when he says ice and heat, so the next step would probably be Oxy.

There are several LA drugs out there like Oxycontin, several Morphine, and Duregesic (Fentanyl) patches. My guess would be you doc would probably not want to go with one of those though. Good luck and keep us updated what happens when you see your doctor.

Executor · 01-22-2008, 07:38 PM

Very sorry for the typo....I meant to say "built up a little tolerance" not "litter."

What I mean by the "ups & downs" is the effect of medication in your system. When you first start taking narcotics for pain, most 4 hr meds (like Loratab or percs) will control moderate pain for at least 4 hours, if not more. Not unusual for them to last even 6-8 hours.

However, over time, you build up tolerance and the meds that once lasted 4-6 hours, may only last a couple of hours (2-3 max). Eventually, they won't work well at all. The "ups are the meds entering your system...The "downs" are the meds leaving. The short acting meds are in and out. So, you have "ups and downs" depending on when you took the meds last.

More long lasting meds, like the patch or oxycontin, are long acting in nature. The patch lasts 48-72 hours (the literature says change every 72, but some patients report that it doesn't last that long and need to change every 48). The Oxycontin is every 12 hours...but again, some report the same, and must take more frequently. Tolerance is to blame, as well as one's own individual metabolism. The faster your natural metabolism, the faster you'll burn through the long acting med (in your system).

The point being is that these type of meds stay in your system long and help "level you out" and therefore, decreases the ups and downs. Then, if have breakthough pain, or flareups, another med (usually stronger in nature) can be given for it on a periodic basis. So, your regime would be a long acting med for stability, then another drug (whatever your doc thinks is best) for "breakthrough pain" or flareups.

As far as going to another Dr comment....I was referring to it as a last ditch thing. If your pain is as unbearable as you describe and is going to be a long term type thing, I'd think seriously about getting a new Doc. I'm being crass when I say "are you to ice regularly from here on out on for a good part of your life"?? There has to be a better way. To me, there isn't much worse than uncontrolled pain.

Almost all the long term PM patients I know are eventually put on some type of long acting meds and then the breakthrough pain is addressed on a more individual basis.

Best of luck to you! I feel your pain....Literally.

Good luck!