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Old 04-16-2008, 06:22 PM   #1
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Question Finding the right medication for my pain.

I have been taking Tramadol S.R. (2 x 200mg) a day now for about 4 1/2 years along with Naproxin, Endep (anti-Depressant) and at times Valium. I have also gone through a year of Steroid injections (6) into my lower back which just about sent me around the bend. But have not been able to stabilise my pain to a manageable degree. So after another visit to an Emergency room at my local hospital, I have Asked my 4th doctor if I could try one of the patches available now. Though they have never been offered to me in the past. Any strong medication has been highly regulated here in Australia and Doctors are very cautious about drug abuse.

It's been a week since I went off the Tramadol and straight onto the 10micro Norspan Patch. I did use codeine and a couple of Endone's to get me through the first day or so, when I didn't know any better.

The last 2 days of the first patch were not good but I stayed away from the Endone as suggested. Yesterday my Doctor changed me up to the 20micrograms Norspan patch.The first day of the new patch has not been much fun but the pharmacist I talked to suggested I didn't use any other strong meds so as to test the patch to see if it will do the job for me.

I have been assured that there will be a suitable patch for me but I will have to be patient while trying to adjust. I was also told that the next step up if this doesn't relieve the pain is Fentnyl / Durogesic. As I am new to this site and only just found out about these patches I don't really understand the effects of swapping between different types of drugs. So the side effects I have been experiencing have been unexpected and a little confusing. So I really have had to put my trust in this Doctor and advice from this community.

I guess there are quite a few others who have and are going through this process. Looking for some relief of the relenting pain. Mine being from a back injury causing 2 degenerating disc's in my lower back.

Please if anyone has some advice for me on trying these different products and how best to move between opiates and Buprenophine and possibly back again. Also what other meds can I safely use to compliment the pain relief that I really feel I need to bridge the transition between the new prescriptions. Is Paracetamol all that I can safely use? And maybe a hot pack.

Thank for any support. Allan.
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25-Nov-2010: ALIF fusion L5-S1. 9 years of Chronic lower back pain. Nearly 18 months of pain across my upper pelvis, through my butt and down my left leg into my foot. Sciatica relieved by surgery.

 
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Old 04-16-2008, 06:53 PM   #2
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Re: Finding the right medication for my pain.

Welcome! This board has a lot of great "regulars" who have a wide array of experiences, so there will probably be no shortage of opinions for you to consider.

Although you provided some good detail about your condition, it's really hard to know what you're going through and what would be appropriate. There is no substitute for your Doc. However, we can speculate and provide "advice", but please take it with a grain of salt.

Sounds like your Docs have been fairly conservative, which in many ways is good. Not knowing what meds are readily available in Australia, you may not have the same options as we have here in the US, so that may be a issue. I will say although the fentanyl patch is a great product and is very appropriate for chronic pain, it may be too big of a jump for you at this point. It clearly states on the package that it's only indicated for "opioid tolerant patients." Are you opioid tolerant? To me, opioid tolerant patients are those who've been on drugs such as oxycodone and have had tolerance issue.

If you research / search posts on this board, you will see that those who have had trouble with the patch, are those patients who were either put on it too soon, or at too high of a strength. Candidly, the fentanyl patch is for those patients that have struggled with other traditional long acting pain meds....It typically works where other meds have failed.

Is Oxycontin available in Australia? How about Lortab or Vicoden? Percocet? If so, I would experiment with them first. They have a much large window of error and work very well when take appropriately. Conversely, Fentanyl is usually something you graduate to, not start with.

Hope this helps.

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Old 04-16-2008, 07:24 PM   #3
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Re: Finding the right medication for my pain.

bruce:
I would be extremely careful with the Norspan (buprenorphine) or here in the US it is called Subutex/Suboxone. Here is what I found out about it:

Because of the narcotic antagonist activity of Buprenorphine HCl, use in the physically dependent individual may result in withdrawal effects. So if you use it while taking another narcotic medication (ie. oxycodone) you will probably go through some withdrawal. I know the other information I learned which said that taking acetaminophen(paracetamol - in Australia) and even w/codeine would be alright. I don't know why you could actually use codeine without some type of withdrawal but maybe codeine is just not strong enough, who knows. I am sure your pharamacist would be able to answer this. Now if you were to go from taking the Norspan patch to an opiod/opiate, I am sure you would have to get most of it out of your system first. The problem is that buprenorphine has a long half-life meaning it takes a long time for it to get out of your body. Hopefully someone with more knowledge and/or experience will be able to help out. Maybe you could also try asking on the addition recovery board since most people in the United States actually take it for opiate addiction. I am not saying you are an addict but that they could maybe provide more experience and/or knowledge.

brian

p.s. welcome to the board

 
Old 04-17-2008, 10:25 AM   #4
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Re: Finding the right medication for my pain.

The buprenorphine (bup) in the Norspan patch is what's referred to as an opioid partial agonist/antagonist. These narcotic pain meds work by attaching to "pain receptors" in our brains, spinal columns and peripheral tissues. Most of the more common narcotic pain meds are called "full agonists" like morphine, demerol, oxycodone, etc. Their potency depends upon how tightly they bind to the pain receptors, how well they saturate the pain receptors and how long they remain bound. A full agonist has no ceiling, meaning there's no upper limit to how much can be used, which is great news to those with intractible cancer pain.

A partial agonist, like bup does have a ceiling, beyond which there are very negative side effects. In addition bup has narcotic receptor antagonist properties as well, meaning when it binds to the receptor is blocks anything else from getting there. And, it binds so strongly to the receptor that anything else there at the time gets kicked out. This is why if one is dependent on a full agonist like morphine, and takes bup, they will go into immediate withdrawal.

What this means to you - you probably should NOT be trying to mix bup and opioid meds like codeine, morphine, etc. They should not work well together and may well cause you to feel the opposite of euphoria, which is dysphoria. My recommendation would be to stick with bup entirely if on Norspan, and use the sublingual bup for breakthrough pain. Then, if you go to the fentanyl duragesic patch, you need to completely avoid anything with bup in it or you'll be very sorry (terrible withdrawals).

steve

 
Old 04-17-2008, 04:40 PM   #5
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Re: Finding the right medication for my pain.

Thanks Steve, I was finding it hard to understand, but it is becoming clearer.

Today is the 3rd day for me on the 20 micro Norspan patch and I have started to feel a little better. I have needed some Paracetamol and a valium to get to sleep last night and have been very careful this morning not to do to much, but in general things are a bit better. The last couple of months have been hellish. I will give this a chance for a couple weeks before considering any other changes in med's.

I just hope to get a bit more freedom from pain to be able to have some sort of life. eg. being able to go out once in a while in the evening. I have been in so much pain by the afternoon I have had to lay down and stay home. So not much of a social life.

Allan.
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25-Nov-2010: ALIF fusion L5-S1. 9 years of Chronic lower back pain. Nearly 18 months of pain across my upper pelvis, through my butt and down my left leg into my foot. Sciatica relieved by surgery.

 
Old 04-18-2008, 03:49 AM   #6
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Re: Finding the right medication for my pain.

Allan,

You sound like me with your limitations you can read my posts under round1. I too have to lye down due to pain in my back. I have DDD also but had a fusion last may, coming up to the year mark and struggling still. I am now on oxycontin 10 mg morning and night, but to be honest I thought there would be a better improvement so i am still searching for this Drug relief for my pain too. I have recently started with a Pain Management Constultant so he has started me on this...... but to be honest I think I need a little visit back to him and say sorry not working as well as I thought. Would love to hear what gives you some relief, know what you mean about a social life..... I have forgotten what one on those is like !
Round1

 
Old 04-18-2008, 06:15 AM   #7
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Re: Finding the right medication for my pain.

Yes it is hard to have a social life when you confidence is low and your in pain going out and having to stand or sit for very long.

Since my divorce about 8 years ago I have had trouble holding on to a relationship. Not just anyone is able to understand or handle my stuff (not a lot of nights out and a lot of time with my feet up, sometimes a little cranky).

I still try to do the jobs that I need to do for myself on a low income. But try not to over do it and pay for it with extra pain, sometimes for months afterwards.

But I suppose the only physical thing that has helped me has been walking and swimming, though it hurts as soon as you get back out of the pool.

As I have said the Tramadol was ok, just, for the last 4-5 years but it is not enough for me now. I am hoping that I can find (or should I say my doctor) a patch that will give me a few more years of some relief. Though it is never really enough to live like it used to be.

If I have any success with the patch I will be very happy for a bit. Maybe I can cut down on the anti-inflammatory a little. They are what concern me the most. My stomach has always been a bit dodgy. And I have only heard bad things about them.

This is good to be able to get some stuff off your chest.

Allan
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25-Nov-2010: ALIF fusion L5-S1. 9 years of Chronic lower back pain. Nearly 18 months of pain across my upper pelvis, through my butt and down my left leg into my foot. Sciatica relieved by surgery.

 
Old 04-23-2008, 06:25 AM   #8
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Question Re: Finding the right medication for my pain.

On my second 20micro Norspan patch this time (after one of 10micro didn't help) and I don't know if it is any better than the Tramadol (Ultram) I took previously (400mg per day SR) apart from not having to take the pills and not missing one by mistake.
I will give it another week and see how it goes. I am not sure if I can have any stronger dose. Someone said that you can use 2 x but wearing 2 patches isn't my idea of pain management.
My Dr said that there was the option of a Fentynal patch, but I was also advised here that it was a big step up. I don't know if that is for me but what else do you do when pain makes life so hard. I can sometimes get through the day ok by keeping occupied, but if I do to much I suffer a lot at night. The pain seems to catch up to me in the evening and I find it difficult to sleep.
Has anyone else been through this process? Are there any other options?
In Australia I suppose it depends on the laws and regulations, what the Pain Doctors can prescribe for Chronic pain sufferers.
I do hope I can manage on the Norspan 20's but if not? I see my DR next week for more choices.
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25-Nov-2010: ALIF fusion L5-S1. 9 years of Chronic lower back pain. Nearly 18 months of pain across my upper pelvis, through my butt and down my left leg into my foot. Sciatica relieved by surgery.

 
Old 04-23-2008, 07:15 AM   #9
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Re: Finding the right medication for my pain.

Sorry to hear that things aren't improving.....If the patch you're on was working, I would think you would have had at least some improvement by now.

I think you have to take a lot of what you read on these boards with a grain of salt....I wouldn't necessarily go in one direction or another just because of what you read here. I use the information as "food for thought" or one of those hmmmmm moments, if that makes sense.

First and foremost, however, listen to your Doc. He/she knows your case best. If he/she says the next option is the fentanyl patch, then you have to trust your Doc. I'm not familiar with what drugs are available in Australia, so access/availability may be an issue. I would go to your next appointment and just be honest with the Doc and tell him/her that your in a lot of pain and even suffering and the current regimen just isn't working. If the fent patch is too big of a jump you'll know and you can change back....As long as the Doc starts you on the lowest patch, you'll be fine. Those who have had trouble either started on too high of a dose, or moved up too fast.

Good luck.

Ex

 
Old 04-23-2008, 05:24 PM   #10
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Re: Finding the right medication for my pain.

Quote:
Originally Posted by allanbruce View Post
the Tramadol (Ultram) I took previously (400mg per day SR) apart from not having to take the pills and not missing one by mistake.
My Dr said that there was the option of a Fentynal patch, but I was also advised here that it was a big step up.
I was in a similar kind of situation when I first started on the patch. I was taking 400mg/day of tramadol, along with around 4000mg/day of acetaminophen(which is not good on the liver at that high of dose), and went on the 25mcg fentanyl patch. It was a bit of an adjustment but I was able to handle the 25mcg patch pretty well. It was when I tried to go up to fast at that point that I ran into problems. Currently I am on the 50mcg patch and NO ULTRAM(tramadol) and only around 1300mg/day total of acetaminophen(included in the Percocet). I think that you would notice a huge difference in the fentanyl patch but I don't know if it would be TOO STRONG. I do know you are going to go through MORE of an adjustment since you are on the Norspan(buprenerophine) but I don't know how that will work switching between that and fentanyl. I am sure your doctor knows what he is doing so make sure you follow his instructions. Keep us posted alight. I've been where you are and I know how much it sucks to be in pain and the meds just barely make a dent, so keep holding on.

brian

 
Old 04-27-2008, 01:11 AM   #11
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Re: Finding the right medication for my pain.

Back to my Dr tomorrow so I'll see what he thinks, stay with it or move on. I really don't think the 20micro Norspan patch is that much different to the 400mg of Tamadol I was taking.
I have had to take the some amount of Naproxin (1000mg a day), Paracetamol (about 4 to 6 x 500mg a day) and 5 or 10 mg Valium at night to sleep, and more if I try to have a sleep in the arvo. Along with a hot bag on my back for 15-20 minutes when laying down or on the lounge to watch TV. And also the Endep for depression and to help me sleep better.
I have also heard that the tramadol has a anti depressant effect so that might be why I have been feeling down and having a hard time coping around other people lately.
I have had a lot of pressure on me from family and associates lately and I am just going to have to walk away from it soon. Maybe just get away for a week somewhere. Maybe go camping at the beach and sit under a shady tree, just to dream how things could be or are for others. Free from pain and depression. Maybe meet someone who cares.
Allan.
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25-Nov-2010: ALIF fusion L5-S1. 9 years of Chronic lower back pain. Nearly 18 months of pain across my upper pelvis, through my butt and down my left leg into my foot. Sciatica relieved by surgery.

 
Old 04-27-2008, 05:48 AM   #12
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Re: Finding the right medication for my pain.

I have taken Celebrex and the one they stopped selling, vyox over a couple years. Anyhow I was on naprason years ago and had no trouble. So with the naproxin slow release I make sure I eat first and have no problems.
I have never been offered Oxycontin and have only ever been given endone once by a doctor for when things got bad (He retired) and once from a doctor at emergency. I think it is hard to find a doctor that is willing to give out any thing to strong as they are watched as well I suppose.
I have only ever been given Tramadol, but this doctor started me on injections at Greenslopes and another with injections He gave himself for a year and they decided that wasn't helping(after I nearly broke down in the Surgery). My Pain specialist shook my hand and said good luck and the muscular-Skeletal doctor I had been seeing said we would be able to find a patch that will work (trying Norspan first then Fentynal next if the Norspan didn't work out). So that is where I am now.
Still no mention of any other choices. None of the doctors have offered me Oxycontin, so I suppose it must be highly regulated. And without insurance the waiting lists are long for any operative treatments.
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25-Nov-2010: ALIF fusion L5-S1. 9 years of Chronic lower back pain. Nearly 18 months of pain across my upper pelvis, through my butt and down my left leg into my foot. Sciatica relieved by surgery.

 
Old 04-27-2008, 06:43 AM   #13
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Re: Finding the right medication for my pain.

I can ask him about Oxycontin but he seems to want to go down the Patch path. He does give me some valium and I have a few endone left from the hospital as I can't take them at present and there is always codeine. Play it by ear and see what he has to say Lunch time. Then an appointment with the Podiatrist for my ingrown toe nails. Lucky I'm on the pain meds they are not much fun.
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25-Nov-2010: ALIF fusion L5-S1. 9 years of Chronic lower back pain. Nearly 18 months of pain across my upper pelvis, through my butt and down my left leg into my foot. Sciatica relieved by surgery.

 
Old 04-27-2008, 06:48 AM   #14
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Re: Finding the right medication for my pain.

As far as operations go the Neuro-surgeon doesn't want to touch me while there is room for the siatic-nerves and I can still walk.
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25-Nov-2010: ALIF fusion L5-S1. 9 years of Chronic lower back pain. Nearly 18 months of pain across my upper pelvis, through my butt and down my left leg into my foot. Sciatica relieved by surgery.

 
Old 04-27-2008, 01:15 PM   #15
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Re: Finding the right medication for my pain.

allan,
be extremely careful with the depression. yes you are correct about the tramadol has anti-depressant qualities because it is effects serotonin and norepinephrine. I had suicidal thoughts when I went off too quickly and I had to go back on it. You may need an anti-d like Cymbalta which also treats nerve pain. Do the doctors over in Australia prescribe non-narcotic meds for nerve pain like Lyrica(pregabalin), Neurontin(gabapentin), Cymbalta(don't know the other name). I know that someone mentioned amitryptiline which is good for nerve pain and also nortryptiline. Those five are really good meds for nerve pain although it is trial and error. I am on the fentanyl patch and it helps ALOT for my nerve pain along with Lyrica, Percocet(oxycodone), and Trileptal. Hope you get some better relief

brian

 
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