It appears you have not yet Signed Up with our community. To Sign Up for free, please click here....



Pain Management Message Board
Post New Thread   Closed Thread
LinkBack Thread Tools
Old 04-17-2008, 12:32 AM   #1
Member
(male)
 
Join Date: Apr 2008
Location: Boston, MA, USA
Posts: 58
mark76 HB User
Questions about tolerance, talking to doctor, etc...

How quickly do you guys think most patients build tolerance to oxycontin? I've been taking it for about 6 months, and I can already tell that it isn't nearly as effective as it was when I started taking it. Is that fairly typical? Once you have a dose increase, how long can you typically expect to be on the same dose? Also, do any of you guys worry about asking your doctor for a dose increase? I'm taking about 30-40 mg of oxycodone per day total (15 mg of oxycontin twice per day with breakthroughs as needed). I think a dose increase would be helpful, but I'm nervous about asking my PM. Before my PM doctor, I used to see my family physician, who really didn't like prescribing me opiates. My PM doctor who I've been seeing for two months after being referred by my GP seems very supportive about treating my pain, which I'm grateful for. Though he never said it out loud, I always felt like my GP thought I was exaggerating my pain level to get medication. As a result, I feel like I'm now terrified of telling my PM how I'm feeling b/c I don't want to go through the same thing again. Has anyone else felt this way?

 
Sponsors Lightbulb
   
Old 04-17-2008, 06:49 AM   #2
Inactive
(male)
 
Join Date: Jan 2008
Posts: 4,017
Executor HB UserExecutor HB UserExecutor HB UserExecutor HB UserExecutor HB UserExecutor HB User
Re: Questions about tolerance, talking to doctor, etc...

Hey Mark....Welcome! What you are experiencing is very typical. Not many PM patients have a good comfort level right of the bat. It takes time to build the relationship with any Doc....Right or wrong, I always felt like I needed to "prove myself." At my PM clinic, I heard stories of dismissed patients, failed drug tests, & etc., so I was kinda leary. Plus, the whole PM thing was new to me. I felt (and still do) very fortunate to have the Doc I have, so I was very cautious...Maybe too cautious in the beginning. Not sure.

I think a lot of it has to do with one's individual Doc....Some have much better bed side manners than others. The ones I always feared were the ones who don't say much and have the poker face on. Even those Docs loosen up over time when they get to know the patient. My Doc is a man of few words, but once you get to know him, he's different....This was part of my issue. The longer you go to the Doc, the thicker your file will get, the more appts you regularly attend (missed appts are bad in PM), & so on. In my case, we are tested randomly about once a year, so the more tests you pass & etc help also. Just my personal opinion, but I think many PM Docs are skeptical of most new patients. They know the world is full of drug seekers and they also know that 98% of the OC on the street comes from diverters, which go to their offices posing as patients. So, naturally, their cautious.

The point being that you'll just have to judge for yourself when the time is right to approach him. If you are getting by, then I'd maybe wait a few more months. However, if you are in pain, then I'd say something. Do you have BT (break through) meds for flare ups? If not, they probably should be added at some point. I'd add BT meds before going up on my long acting (LA) med. The higher the LA med, the higher your tolerance will go because it's in your system 24/7. BT meds increase your tolerance also, but not as much or as fast.

When you do feel the time is right to approach him, I've always felt the best route is to beat around the bush a little bit....Don't come right out and say "I need OC 15mg 2 x day. Tell him your pain has increased and the med doesn't feel like it's working as well, or as long. He may put you on 3x per day before going up in dosage. This is fairly common.

Hope this helps, and good luck.

Ex

 
Sponsors Lightbulb
   
Old 04-17-2008, 08:20 AM   #3
Junior Member
(male)
 
Join Date: Apr 2008
Location: USA
Posts: 11
Kev32 HB User
Re: Questions about tolerance, talking to doctor, etc...

Hi Mark and Welcome! I started on Hydrocodone, moved to Methadone 60 mg/day, and finially was put on Oxycontin 40 mg 2 x a day to start. I stayed at that dose for only a few days due to puking in pain and was moved up to 80 2 x per day. I stayed at that dose for about 1 year and then was moved to 80 mg 3 x per day. The total time I was on Oxycontin was 3 years. My tolerance built up very fast after year 2 of the Oxycontin 80 mg x 3 per day. I was refilling at the 23 day mark during year 3 and finially ran out of a 90 day supply 30 days early. That's when the train wrecked and decided to go on Suboxone for a year.

So I guess I would caution you not to move up in dose unless you absolutely feel you need to do so. Let your body be your guide.

Looking back, I wish my PM doc had worked with me on a taper instead of washing her hands of me. It's never good to take more meds than prescribed and refilling early even if the doc is aware of what is going on. I told my former pain management doc that I was having tolerance issues and she abruptly told me to "just make what I had work". I tried that and failed big time. Just keep the PM doc in the loop on how you are feeling. If they are good, they will not boot you out the door. There are so many drug seekers out there, it makes it very difficult for us with Chronic Pain.

To answer your question, I would just tell the doctor that the meds are not working as well as they used to and your are in pain. If it is affecting your day to day livelyhood, they should increase your dose.

 
Old 04-17-2008, 08:53 AM   #4
Inactive
(male)
 
Join Date: Dec 2006
Location: CA
Posts: 1,569
forginon HB User
Re: Questions about tolerance, talking to doctor, etc...

Your reluctance to ask for an increase is normal, and also a good thing in my opinion. It's always best to give the doc the facts and let him or her decide the treatment.

Here's what I recommend. And it has to do with providing facts and objective information, which the docs prefer. Start keeping a pain diary. List your pain level on a 0-10 scale, with 0=no pain and 10=the worst pain imaginable. Do this every few hours and include what you were doing at the time and what you did to address the pain. When you have built up a good 2-4 weeks present it to your doc. I told my doc that my desire was to have a steady level of 5, and at the time my average was about 7 to 7.5, with spikes to 8.5. She readily agreed and raised my meds. We did trial and error for awhile and finally got to an average of 5. A few years later I reached a point where I wanted to start exercising again, but the pain was not allowing it. So I proposed an increase in my BT med that I could take before the workout and the doc approved. This has allowed me to get some excellent exercise and I've been dropping about 3 pounds per month for over a year now.

Bottom Line? The docs like to work with objective information. Even though pain scores are subjective, recording them and planning around numbers seems to help the docs. Also, if you can show that your finctioning has omproved, or you believe it could improve with a little increase in meds, that seems to sit well with them also.

One caution - Tolerance isn't always the reason your pain is no longer well covered. In fact, it may not even be the most common reason. Oftentimes one's condition has gotten worse or a disease has progressed. The doc may well want to get a few tests done to see what might be causing the added pain before just increasing meds. And there are other reasons pain may escalate. You may have started a new med that counteracts the pain med, and the doc always needs to know everything else you are taking. Let the doc be the doc, and just try to give good information like "I don't know why, but my pain has begun to get worse. What can we do?" Provide your data and let them bring up med increases and such, especially as a new patient.

steve

 
Old 04-17-2008, 11:09 AM   #5
Inactive
(male)
 
Join Date: Dec 2006
Location: CA
Posts: 1,569
forginon HB User
Re: Questions about tolerance, talking to doctor, etc...

Ex,

You are correct. And I fully agree about the receptor site saturation. Some refer to is as hyperalgesia, although that seems to be a misused term for docs who just want to get their patients off of all opioids.

I did experience that when I was victimized by the first defective patch incident and chose detox to start all over again. My tolerance was so high that there was no dose that could adequately address my pain.

steve

 
Old 04-17-2008, 02:47 PM   #6
Senior Veteran
(male)
 
Join Date: Aug 2007
Location: COLUMBUS, OHIO
Posts: 2,163
brianpain33 HB Userbrianpain33 HB User
Re: Questions about tolerance, talking to doctor, etc...

Quote:
Originally Posted by Kev32 View Post
I was refilling at the 23 day mark during year 3 and finially ran out of a 90 day supply 30 days early. That's when the train wrecked and decided to go on Suboxone for a year.
It's never good to take more meds than prescribed and refilling early even if the doc is aware of what is going on.
Yes this is the #1 reason that PM patients are dropped in a heartbeat. You are lucky that you even got on the Suboxone. Most PM docs would walk you out the door and not even prescribe you anything else. This is also how you become an addict without even realizing it unless it is too late. I am not saying that you are addict but getting early refills and taking more than prescribed can get you into trouble not only with the current PM doc, but can also follow you with every doc you go to if you are labeled and addict. I have some experience because I am a recovering addict and have seen lives shattered and torn apart because a person starts out saying "well it's just 1 more" or "I really need it" and then once your brain actually changes and you do become an addict there is no going back. And then if you ever take an opiod/opiate it will set off your addiction. I just try to warn everyone about this becuase I don't want anyone else ending up on that path. It's not fun at all.

brian

 
Old 04-17-2008, 02:53 PM   #7
Senior Veteran
(male)
 
Join Date: Aug 2007
Location: COLUMBUS, OHIO
Posts: 2,163
brianpain33 HB Userbrianpain33 HB User
Re: Questions about tolerance, talking to doctor, etc...

Quote:
Originally Posted by Executor View Post
Very true. I also am a big believer in that your receptor sites over time get saturated with pain meds, and you become more sensitive to pain overall...I've discussed this concept with both my ENT and PM Doc, who is an anesthesiologist, and they both concur.
Ex
So what do you believe is the best thing to do if we are taking pain meds continually for a long time(years). Do you think going off completely for awhile is the best answer or switching to other meds? It scares me that I have to think about this happening although I am sure it already has but what to I do to plan for it and what do I do once it does happen? I am just trying to be as informed and prepared as possible.

brian

 
Old 04-17-2008, 03:35 PM   #8
Senior Member
(male)
 
Join Date: Jun 2007
Location: Virginia, USA
Posts: 136
JoJo921 HB User
Re: Questions about tolerance, talking to doctor, etc...

Hi Mark & welcome to the boards.................One thing you have to remember that I think is of utmost importance, I didn't worry about my doctor at all because I was in so much pain I just asked him what he could do to help. Most people in pain have nothing to fear unless they are trying to scam the doc for meds. Please dont take this the wrong way I dont mean that you are doing that, however just be mindful of how you ask. When I've needed an increase I've just told my doc that the pain is getting worse & once again my quality of life is going down the toilet and then asked him what he could do to help me. Please dont ask for a specific dosage then he will think you are playing doctor. 6 mos is about right although all of us are different to notice that your oxy is not working as well as it was. Good Luck. JoJo

 
Old 04-17-2008, 04:43 PM   #9
Newbie
(male)
 
Join Date: Apr 2008
Location: NC
Posts: 4
rich1022 HB User
Wink Re: Questions about tolerance, talking to doctor, etc...

Hi Mark,
I would have to agree with the others in telling your doctor about your pain levels/increase versus telling them you need a higher dose. I just got changed in the meds that I am taking because I explained that the meds were not as effective anymore. He took me off 1-2 hydrocodone 5/325 every 6hours and put me on percocet 10/650 3 times a day. I get a better pain relief from these meds and I'm not having to take the medicine quite as much. Just be honest with your doctor and make him understand the pain levels you are dealing with by effective communication. I believe this will get you much further in the world of todays doctors.IMO
Rich

 
Old 04-17-2008, 08:44 PM   #10
Member
(male)
 
Join Date: Apr 2008
Location: Boston, MA, USA
Posts: 58
mark76 HB User
Re: Questions about tolerance, talking to doctor, etc...

Thanks so much for your responses and help!

 
Old 04-17-2008, 09:02 PM   #11
Member
(male)
 
Join Date: Apr 2008
Location: walnut creek,ca,usa
Posts: 73
niap HB User
Thumbs up Re: Questions about tolerance, talking to doctor, etc...

If you really have chronic pain you shoudnt be hesitant on asking your doctor. All that need to be said is that your daily life is suffering because your tolerance is building rapidly. He or she might even try a different la med. When ever I have a problem with anything pertaing to my chronic pain I immeadiatlly e-mail my doctor and I always receive a quick response. Its all about timing and truthfullness. You cant wait to tell your doc. anything because that also throws up a red flag! Good luck with your dilema....

niap:wave

 
Old 04-18-2008, 01:25 AM   #12
Veteran
(male)
 
Join Date: Apr 2003
Location: idahofalls, Id. USA
Posts: 414
grizzk62 HB User
Re: Questions about tolerance, talking to doctor, etc...

Hello,

I just have one thing to add. I don't want you to take this the wrong way But don't confuse a loss of euphoria and a feeling of well being with developeing tolerance. Please don't take this the wrong way. But I think what happens alot with people who are just starting out on the journey of chronic pain is confusing the diminishing of these types of side effect w/tolerance. I know for me that those side effects went away very fast. I haven't felt those sides even after heafty shots and steady IV drips for probably now 20yrs. Just a thought is all.

Matt

 
Old 04-18-2008, 03:08 AM   #13
Member
(male)
 
Join Date: Apr 2008
Location: Boston, MA, USA
Posts: 58
mark76 HB User
Re: Questions about tolerance, talking to doctor, etc...

grizzk62 ... not taken the wrong way at all; I appreciate the insight. I actually don't think that is my situation, but I'm wondering if you and anyone else can elaborate on that point. I actually haven't felt any great sense of well-being since being on these medications. I suspect its because the pain has sort of drowned that out. If you do feel it, does it mean the dose is too high?

 
Old 04-18-2008, 04:56 AM   #14
Veteran
(male)
 
Join Date: Apr 2003
Location: idahofalls, Id. USA
Posts: 414
grizzk62 HB User
Re: Questions about tolerance, talking to doctor, etc...

Hey Mark,

Buy no means at all does it mean your dose is to high. It's just to be expected that those particular good feelings and maybe a good shot of energy will taper off to where all you have is pain relief. The one side effect that doesn't wear off is constipation. So you need to stay on top of it. Just another thing to keep in mind is that you can't expect the meds to bring you down to zero pain on the scale. It may get really close at first. At least thats what to good feeling side effects are tricking you into believing. Now everyone is different on the amount of pain relief they bring. For me a good day is in the 4-5 area on the pain scale. For that reason I'm a firm beliiever in all modalities of pain controll, including other meds along with the oipiates such as, Lyrica, Nuerontin, Celebrex, and so on. Over time you will discover which ones work for you and which ones don't. My PM program includes Mthadone 160-200mg Oxyfast 20mgs, Dilaudid 16mgs, Lyrica 600-900mgs, Celebrex 400mgs, Baclofen 60mgs, Cymbalta 120mgs, Eavil 50mgs, and AdderallXR 30mgs. Also a Tens unit, Lidoderm patchs, Trigger piont inj.s, Message twice dailey along with ice and heat packs thru out the day. I allso use guided imagery and biofeedback. You will have to find what works for you. This is how I feel about other methods. If it gives you any amount of pain relief no matter how minute then it is worth. Just a few other things to think about and investigate. Just don't hesitate to ask questions here. Usually somebody has the answer for you. Hope this helps.


Matt

 
Old 04-18-2008, 09:27 AM   #15
Inactive
(male)
 
Join Date: Dec 2006
Location: CA
Posts: 1,569
forginon HB User
Re: Questions about tolerance, talking to doctor, etc...

Matt has raised SO MANY good points here.

I just have a little more to add, and it has to do with the initial euphoria and with tolerance.

It is expected that in the beginning of opioid therapy the patient will experience the euphoria side effect. It's normal, especially if the dose is aggressive. And it is so easy to equate the euphoria with how well the med is killing the pain. I think this is a natural assumption. We say things like "I felt the med kick-in." For an experienced chronic pain patient the notion that the med has kicked-in is when the pain killing effect begins. For me, I can tell because I start itching, which is another side effect of opioids. If the prescribing instructions call for taking the med regularly it won't take long before the euphoria goes away. We become tolerant to the euphoria. Tolerance doesn't only mean that meds no longer work like before. Initially we become tolerant to some of the side effects like euphoria, sedation, sense of well being. These side effects tend to go away early, well before we experience any tolerance to the actual pain killing effects. And this early tolerance to side effects creates a critical point in therapy for a CP patient, or any patient on opioids. There's two ways for a patient to interpret the loss of euphoria. One way is to understand that this is normal, but not indicative of the med losing its effectiveness. The other way is to assume the med is no longer working because the "rush" is gone, and in turn either take more than prescribed or ask for a dose increase. Of course, the danger is in assuming the med has lost its effectiveness and then taking action to increase the dose. This is sometimes referred to as "chasing the high," in addiction circles. And this is the first step towards addiction.

In reality, the first sign that an opioid is beginning to lose its effectiveness is that the dose seems to stop working earlier than before. What once lasted 6 hours becomes a 4 hour window of pain killing effect. If it's true that the med is beginning to lose its effectiveness then one is experiencing tolerance to the primary effect of the drug which is analgesia. This is expected at some point in therapy. Of course, the hope is that prescribed doses will last a good long time and that dose increases will be few and far between. Ant the best way for the patient to put off tolerance is to follow the prescribing instructions religiously - never take more than prescribed.

It's a very hard life for CP patients. Rarely do we run into a PM doc that will provide adequate treatment for our pain. But when we are prescribed opioids it's so critical to understand the mechanics and process of using opioid pain medication responsibly. For those who are brand new to opioids it's doubly hard, and the way these kind of meds work doesn't help. Enduring unrelenting pain is exhausting, and the relief these kind of meds can bring is wonderful. Unfortunately, the reward mechanism that kicks in with opioids can be confusing because it can feel so good. We just have to know what to do with that good feeling when it's present and when it goes away.

steve

Last edited by forginon; 04-18-2008 at 09:35 AM.

 
Closed Thread

Similar Threads
Thread Thread Starter Board Replies Last Post
AGUS/AGC pap results - questions about ECC & endometrial biopsy angel4747 Cancer: Cervical & Ovarian 38 04-11-2012 12:21 PM
New to morphine meds. have some questions scartissue Pain Management 6 05-04-2010 08:44 AM
Questions for all diabetics who have Gastroparesis Mitch5 Diabetes 18 03-23-2010 08:16 PM
"opiate induced pain syndrome" and pain meds questions.... Melnwest Pain Management 12 09-15-2009 05:47 AM
Pain Med/Tolerance Questions lemonflavor Chronic Pain 6 05-22-2009 07:01 PM




Thread Tools

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is Off
HTML code is Off
Trackbacks are Off
Pingbacks are Off
Refbacks are Off




Sign Up Today!

Ask our community of thousands of members your health questions, and learn from others experiences. Join the conversation!

I want my free account

All times are GMT -7. The time now is 01:55 AM.



Site owned and operated by HealthBoards.comô
Terms of Use © 1998-2014 HealthBoards.comô All rights reserved.
Do not copy or redistribute in any form!