Sufficent bt meds are hard to come by in australia.
Is this a national rule / law or something? Or just your Doc?
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I usually take 5mgs IR oxy around 6pm or so in order to cook dinner, sometimes earlier in the afternoon if my pain spikes and I have things to do.
If this is working for you, I'd be hard pressed to change it.
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I take my last dose of oxy at 10pm and that's when I go to bed, it usually wakes a couple of hours before I can get to sleep - considering what you are saying, it would probably be beneficial for me to use bt meds at this time to cover me until the oxy kicks in?
Can you take any other type of sedative? Antihistimine? Have you asked your Doc about a sleeping pill?
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Pain management is very complicated!
Yes it is! And very individualized too.
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My hormone levels are all ok, I have had them tested recently.
Just a quick word of caution here....Many get their hormone levels tested and are told they are ok or "average." The truth of the matter is that most Docs, especially GPs, don't know what average is....They read "average" on the lab report and say "ok, it's average." The lab report will give back a range of numbers based on all test subjects. A person doesn't want to be "average" of everyone, but "average" for your age. A big, big difference.
For example, when men get their T level checked, they often get numbers back around 250 or so...And told it's "average." Well, it is "average" for all test subjects 17-90+. The problem is that a 250 number is that of a 75 yr old man!
I'd ask for your test results and research the numbers yourself.
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The observation you made about cp patients and morning lethargy made sense to me and perhaps is just an unfortunate truth that I'll have to deal with. I am hoping that something like cymbalta might help.
Yes...I have come to accept this as well....I try not to schedule anything early in the AM as a result....I've nevery tried cymbalta. I've always been reluctant to approach my Doc about meds to counteract side effects...I've wondered if he'll say "lets just reduce them." But, that's just me. All depends on your relationship with your Doc.
I have sinus issues, so I take a decongestant in the AM upon waking...It has ephedrine in it, so it's like caffeine, but only better. So, it gets me going a bit. It's also long acting, which is good.
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May I ask how and when you believe bt meds should be used? Pm in australia greatly limits the use of bt meds but is more reasonable with the use of meds such as oxycontin because of its safety profile. There are CPers on the boards here who are given 60+ bt meds a month - I am lucky to be written 30, 20 is considered th monthly maximum and the most that can be written at one time without an authority.
I believe BT meds should be used as needed. I for one use them very liberally....Luckily for me that I have a Doc who will support me. It appears as if our two countries have much different philosophies on BT meds. I couldn't get by without them.
IMO, pain doesn't always cooperate....The body isn't capable of having the pain signals suppressed all day every day. Eventually, they will fight through and that's when you need BT pain meds....Or, you will be "triggered" by something that sets off your pain.
5mg IR isn't very much....What strength OC are you on? If you're on anything higher than 20mg, then I doubt the 5mg does much due to your tolerance.
Limited BT meds is a national initiative - it helps to keep abuse down. I take 20mgs oxy 3 times a day so no, 5mgs for BT is not enough. My gp is fine with rxing more and regularly does but it starts getting very complicated once they're prescribing more than 1 - 2 per day. I'm thinking of asking for an upgrade to 10mgs of IR oxy but am a bit worried that he'll want to try a drop in oxycontin as well. I'm probably worrying about nothing because the more I think about it, the more I realise that it's my BT pain that's making me grumpy. I've taken a lot more notice of it since we've discussed it and I've noticed a cycle during waking hours. My pain hovers around 5 - 6 for the first 5 hours after taking my oxycontin but then, for the next 3 hours, climbs to about an 8/10. An 8 out of 10 for me is where I really can't concentrate or find a comfortable position and I twitch from nerve flashes. I get really really irritated if anyone tries to communicate with me at this time because I can only concentrate on my pain. Does that make sense?
I think that the answer for this is really more BT meds (or a higher dose twice daily of BT meds) at that 5 hour after dosing time. What do you think?
Ok, looking at hormones from your perspective (the most exact way of doing so) means that my levels are quite low still in comparison to where they were before my liver surgery. This could explain some things. I might get some tests on melatonin etc to see if this is why I'm getting tired, but not sleepy.
Before bedtime I use xanax to start the calm down for bed routine, it does help somewhat. Antihistamines are out because the older variety that cause drowsiness are nearly all phenothiazines and this gives me akasthesia - not fun and an emergency the last time I took phenergan.
Oh, I meant to add - the reason that it's the HICs policy to limit BT meds is also because it leads to faster tolerance. You can take 60mgs of LA meds for longer without developing tolerance than you can take 40mgs LA with 20mgs SA meds. Hope that makes sense. It's a sensible way of doing things for those patients with relatively stable chronic pain but it really isn't doing me any favours at the moment!
I'm thinking of asking for an upgrade to 10mgs of IR oxy but am a bit worried that he'll want to try a drop in oxycontin as well. I'm probably worrying about nothing because the more I think about it, the more I realise that it's my BT pain that's making me grumpy.
This sounds very prudent to me. Given your total intake of 60mg per day, 5mg is a drop in the bucket.....And, this is why they probably aren't working. In fact, my Doc (and I agree) has a completely different view of BT meds. BT meds should have some "punch" or relatively strong in comparison to the LA meds...They have to be powerful enough to raise your BPL, from it's current level (from the LA med). If you are taking 20mg of OC and have an established BPL, a small dose of Oxy (even if IR), isn't going to change it much.
PM is definitely a "science" and there are many different views on how to approach things.
Also, sometimes a different active ingredient can work more effectively (vs the same one) for BT pain. In my case, I take oral morphine for LA med, and liquid Oxy for BT pain. The combo works very well. I was once on OC and Oxy for BT and it didn't work nearly as well....Almost as if my body became immune to the Oxy, if that makes sense. Once I already had Oxy in my system (established BPL), a little more Oxy didn't do much for me.
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I've taken a lot more notice of it since we've discussed it and I've noticed a cycle during waking hours. My pain hovers around 5 - 6 for the first 5 hours after taking my oxycontin but then, for the next 3 hours, climbs to about an 8/10. An 8 out of 10 for me is where I really can't concentrate or find a comfortable position and I twitch from nerve flashes. I get really really irritated if anyone tries to communicate with me at this time because I can only concentrate on my pain. Does that make sense?
Yes, it does make sense. Keeping a journal or some type of log may help you make your case with your Doc if you decide to approach him about your BT regimen.
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I think that the answer for this is really more BT meds (or a higher dose twice daily of BT meds) at that 5 hour after dosing time. What do you think?
Yes, I think it is very prudent. Most PM patients have liberal access to BT meds....Several times per day. As I've stated in earlier posts, pain isn't predictable and can't be scheduled. CP people have "good" days and "bad" days. Some of my days, for example, are so bad, that if it weren't for my BT meds, I wouldn't make it. I may have to use them 4-5 x. However, there are days when I don't need any, or just once. I couldn't imagine being "limited" to 1 x day.
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Ok, looking at hormones from your perspective (the most exact way of doing so) means that my levels are quite low still in comparison to where they were before my liver surgery. This could explain some things. I might get some tests on melatonin etc to see if this is why I'm getting tired, but not sleepy.
It may be nothing, but it couldn't hurt to dig a little deeper into your hormones. Many who specialize in HRT, suggest that one should be in the upper third of one's respective age group. At the very least, the 50 percentile.
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Oh, I meant to add - the reason that it's the HICs policy to limit BT meds is also because it leads to faster tolerance. You can take 60mgs of LA meds for longer without developing tolerance than you can take 40mgs LA with 20mgs SA meds. Hope that makes sense. It's a sensible way of doing things for those patients with relatively stable chronic pain but it really isn't doing me any favours at the moment!
I happen to respectively disagree. But, again, that's what makes PM so difficult. There are many different perspectives. I happen to think that tolerance rises faster with LA meds than BT meds. My rationale is this....LA meds establish a "set point" or a new floor of the med in your blood (BPL). Thus, this raises your tolerance. Conversely, if you don't take any LA meds, or a very lose dose....You have either no floor or a small one. If you were to take a fairly big dose of BT med...It's in and out.
To me, pain should be fought as it comes along...Not prevented. With me for example, my pain sometimes gets very, very bad. If I was severely limited in my BT meds, I'd have to be on one heck of a lot of LA med in order to address the "bad" days. However, I have many decent or "good" days....Why take all that med when you don't have to....Reserve it for when you need it, or in the form of BT meds. Yes, you develop tolerance with BT meds, but not as much...At least that's my view point.
This is no easy subject, that's for sure.
Regards,
Ex
The Following User Says Thank You to Executor For This Useful Post: ellenwolfie (07-31-2011)
I have been taking cymbalta for a bit over 2 weeks now. I started on 30mgs and then 60mgs a week later.
It seems to be very effective for helping irritation and frustration during the afternoon when I am in pain. Unfortunately I'm not sure if it's doing anything for my energy during the day - although my thinking seems to be a lot clearer. I am still feel a bit sick but that is decreasing, it is much better if I eat at the same time as taking it in the morning. It does make my insomnia a bit worse I think but it's difficult to tell. If all it does is help me feel less irritated and grumpy when I'm in pain, it's worth it to my relationship!
I just wish I had more energy during the day. Winter is coming though, and that always makes it hard.
