ThreeBadDiscs

Hey everyone,

I haven't posted a lot on here, but have read A LOT! I have had chronic pain for 4 years from 3 bad discs in my lumbar spine. I have tried all conservative therapies, which have ultimately failed. I have had 3 discograms over 4 years, had a selective endoscopic discectomy in summer 2007, IDET in early 2008, and Transdiscal Biacuplasty in Feb. this year. So we have now "operated" on all 3 of my bad discs. Anyway, I was referred to a fabulous PM doc in Dec. 2007 and have been with him since. Here's a short med history: previous to seeing him I was taking about 10-12 Percocet per day. At my first appointment, he put me on Avinza 30mg with Percocet for BT. Over the next month, the dose was increased, finally ending up at 120mg, once per day. Well, then insurance would not pay for Avinza. I was about to have the IDET, and was switched to Duragesic 25mcg. That eventually went up to 50mcg, and after the IDET settled at 75mcg. At that point, my BT med was also switched from Percocet to Roxicodone 15mg (no Tylenol). One of those was not working, so I started out taking 2 at a time for BT. Well, I did pretty well after the IDET and eventually in July started weaning off the Duragesic and was off them within 2 months. I was still taking the Roxicodone, at this point 3 pills (45mg) 2x/day. Early this year I had another discogram right before the Transdiscal. After the discogram I had severely increased pain, and was allowed to add in another dose, so I was taking 9, 15mg pills per day (45mg at a time, 3x/day). This continued up until a couple of weeks ago. My pain since the Transdiscal has not been great, but I had been "toughing it out" hoping that the procedure worked and I would start feeling better. Well, I didn't, and then had a week of AWFUL pain flare-up, and finally asked PM if we could try a LA med again. He agreed, and put me on MS Contin (which I got the Endo generic) 30mg, 2x/day, and is allowing me to play around with dosing, either by doubling up to 60mg, 2x/day or going 30mg, 3x/day.

So, finally, here is my question and comments after 8 days on this dose. The dose seems to be working OK, but not great. I am still taking the same amount of Roxicodone as I was before starting it and am unable to decrease without an increase in pain. This tells me I should increase the MS Contin. But I'm not sure whether to go to 3x/day or to double-up and stay at 2x/day, or something in between (double up to 60mg in the AM, add one 30mg in 8 hours later, then take 30mg 8 hours after that - at bed time, at which time it's been working fine and I've been sleeping fine). So, those are the questions I'd like your ideas on. And also, I'm curious if anyone knows how the drug is released? And is it the same in MS Contin as it is in the generics, or does each generic have its own release mechanism? I know that with Avinza and Oxycontin there is an initial "bolus" released when you first take it; so I'm just curious if this occurs with the MS Contin or not? Just curious. I have read that the peak plasma levels occur at hour 5-6.

Now, the one thing I want to mention is that since starting taking this med, I have been absolutely EXHAUSTED. Like, to the tune of have been using my lunch break as a nap break, and still go home after work and lay down adn sleep for an hour, then go to bed at regular bed time and have no problem sleeping. I assume this will go away, but I would like to hear it from other people. Also, this makes me nervous to increase the dose, as I would assume this side-effect will increase as well. Has anyone noticed that?

Sorry this is long, it's just this is the first time I've used this med, and my doc has given me lots of leeway to try to find the right dosing, so I want to make sure I do it in the most appropriate fashion. Thanks in advance for any suggestions/thoughts/help. Hope everyone is as pain free as they can be, and enjoying Spring time!

Liz