Shoreline

Hi Jag, I have no doubt things are hard on you. It's tough to watch someone you love deteriorate and be in pain.

As far as the meds involved. It sounds like the doc has a shotgun method of pain management. Blast him with everything that might possibly work rather than actually supply him with a level of pain meds that actually helps.

The purpose of pain management is to restore function, The list of antiD's, antianxiety meds, antipsychotics and the minimal amount of pain meds doesn't sound like it's doing anything more than keeping him from eating a bullet. A second opinion would be a good thing but likely your husband is afraid of loosing the little relief he is getting.

For a CP patient what appears to be a high dose of pain meds to an opiate naive patient, "someone that has never taken anything stronger than a vicodin or perc," the number of meds does seem to be a bit extreme. TO a CP patient the level of opiates really doesn't seeem extreme. I've seen many taking much higher levels, and be much more functional, so things are relative to the population he represents.

It's not the dose of any one med that looks extreme to me but the sheer number of different meds and different classes of meds.

If you husband has a nerve component to his pain, like burning leg pain, this is the toughest pain to treat. It doesn't respond to opiates the same way a broken arm would or any other injury would. Before the days of long acting opiates all they could offer were antidepressants and meds to sedate the patient.

He should have improved function from PM not impaired. The antiD's can do a number on your libido, some are particularly well known for this effect. I can't imagine staying awake on that concoction although I take 10 times the amount of opiates he takes.

He may need a testosterone boost, it can easily be checked. Once the right amount of opiates were prescribed I was able to discontinue 4 other prescription meds and all the Tylenol and advil I was killing myself with.It took achange of docs and a 50% increase in opiate medication but it was nice to lift the cloud all thaose meds can cause.Prozac, Elevil, seraquel and lexepro in the daytime, add some klonopin and some opiates and you have a zombie in most anyone

As far as level of function, no amount of opiates or medication may return him to his former self and allow him to work again. Being disabled isn't a choice. At least not in my case. When the 3rd revision of my fusion was done I was bed ridden for a year because that fusion failed too. So no amount of opiate meds or other meds will stabilize my spine. I can function and take care of the house, the shopping, our child and at least feel I am contributing something to the homefront aside from an SSD check.

So much of what men do for a living makes up what a man thinks of himself. Tax time can become report card time. What he grossed determines his level of manhood. These are things that counseling alone and eventually together can help deal with.

If he were on opiates alone he wouldn't be as sedated as he must be with this list of other CNS depressants. CP patients become accommodated to the sedative and euphoric side effects or opiates.

You really don't get used to the edffects of all the psych meds, they have an intended purpose and change brain chemistry. 3 different antiD's, an antipsychotic and an anti-anxiety meed at the same time? Then add in a little something for pain and hope you haven't created a zombie?

There is no high from opiates when you are in pain and if pain is the only reason for the meds the likelihood of true addiction is very low.

Understanding that becoming dependent on these meds, meaning you go through withdrawal if discontinued abruptly does not equate to addiction is important for both of you. Addiction involves a whole list of destructive behavior. Ideally the meds should be improving function not inhibiting function. I think that may be the root of the problem. If you saw an increase in ability to function and a spark of personality you wouldn't be concerned by the the number of mgs of an opiate it took to manage his pain.

IMO, It really doesn't matter if your husband takes 80 mgs of OxyContin a day or 600mgs or Morphine a day as long as his function improves he's doing well given the circumstances.


Often the patient feels the spouse deserves better and becomes withdrawn in his own way pushing the spouse away although you may have no intention on bailing out. In his mind, he has no choice where he sees that you do have a choice, you can leave.

OxyContin has a terrible reputation, especially in Kentucky, It must be tough to avoid all the negative press. Many people think morphine is only for people dying of cancer when morphine is by far not the strongest narcotic pain killer. Just the gold standard to which other meds are compared. Oxy is 1.5 times stronger than morphine. Hydrocodone is actually equivalent in strength to morphine mg to mg. Dilaudid is stronger, methadone is stronger and the duragesic patch is measured in micro grams it's so strong.

I do think a fresh perspective may help as long as he knows he won't loose the pain relief he has. He may respond better to morphine or one of the other meds and experience less side effects. His testosterone level may have plummeted due to medication which can be easily checked. I'm not saying antidepressants don't have their place but he's medicated like a psyche patient more than a CP patient.

Don't get stuck on the number of mgs your husband needs of any med. If he requires 100mgs of long acting morphine 3 times a day and can drop 4 of the other sedating meds and his head clears and his function improves then who cares how many mgs of morphine he takes. Apparently this PM doc thinks it's better to limit the opiates and pile on the adjunctive meds. I have been both routes and had to change docs to get to a point where I could DC all the crap and focus on the pain meds, after all pain is the main issue, It's causing the anxiety and depression.

Print this post out and let him read it. I have had 3 lumbar surgeries, the last to replace broken hardware and now I'm fused from L1-S1 and recently broke another screw. But my pain is well managed and I don't need all the psych meds that have the biggest impact on his personality. My wife is happier, I'm happier and I function better. I don't worry about mgs of opiates, I worry about number of different medications since they all react with each other in some way, mostly sedation/somnelence=lack of personality.

The right level of the right pain med will actually clear his mind if he can dump all the other psych med crap unless he had major psych issues prior to the back problems.

Excepting that you have to live with some degree of pain is part of the key and understanding improved function is the goal, not just decreased pain by turning him into a zombie with all the other meds.

IMO He absolutely needs to find someone more aggressive with the pain meds and give up the shotgun approach of blasting him with every med you can think of. All it's doing is impairing him, rather than increasing his level of function. That can be obtained with pain meds alone.
Good luck, Shore



[This message has been edited by Shoreline (edited 10-28-2003).]