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Old 12-16-2010, 02:45 AM   #1
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Okay, Got Tolerance, Now What?

I'm a Newbie to OxyContin CR but already (less than a month) I feel I have graduated to the next class. Tolerance is on the door. That great pain relief I was seeing, that warm cozy blanket of comfort I felt, that stress-free glow that I enjoyed -oh so briefly. All of that -is disappearing faster than the Glaciers! Today, almost no relief at all, and I suspect tomorrow will be a little less than that. I feel tricked, duped, and sent down a river.

As I said in another post, if this is the game, then I'm not doing it. This is like whack-a-mole on the pain receptors. I need to either make it work at 10mg b.i.d., or I need to head for the exit because there is no way I'm calling my PCP to ask for 20's just a few weeks after starting the damn 10's!

So, what's the answer?


Last edited by Isotope; 12-16-2010 at 01:22 PM. Reason: Typo

 
Old 12-16-2010, 06:22 AM   #2
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Re: Okay, Got Tolerance, Now What?

Good Morning Friends,
Isotope, I understand your concerns and I feel badly that you're going through this difficult time. Just a review of pain management-the goal of pain management is a 50% relief of symptoms. If the meds are helping the pain drop by 50% then you need to be satisfied that it's doing its job. The other side of this coin is that we, chronic pain patients, need to be doing other techniques to help the pain, for example, ice, heat, massage, accupuncture, chiropractic and topical gels or ointments. I don't recall if you're doing any of the other techniques, besides the meds. If you're not, you need to be proactive and try some other ways to reduce your pain.
Please keep us posted on how you're doing, we care.
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Old 12-16-2010, 07:36 AM   #3
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Re: Okay, Got Tolerance, Now What?

Hello Isotop. I have the same problem. I am on Oxycontin 40mg now and trying to take it ONLY WHEN THE PAIN IS SO SEVERE.

I have been on oxycontin 10mg for couple of weeks only and then right away to oxycontin 20mg and then a week later to oxycontin 40mg. It's horrible. I do not know why it is like that. I believe cause my pain is so severe and it is located in my neck. Perhaps you have such a severe pain and that is why you need to increase that oxycontin all the time. You were right it is called high tolerance to narcotic pain medications.

You can take percocet 10/325 in between oxycontin also.

Sounds like you have no family support. I am so sorry you are suffering.

Hang in there. Do not be afraid to tell your doctor. Doctors know what is tolerance.
My doctor almost got heart attack when he heard after a week I needed to increase my oxycontin 20mg to oxycontin 40mg.

You are only on oxycontin 10mg you can tell your doctor that it stopped working.

Last edited by nochange; 12-16-2010 at 07:41 AM.

 
Old 12-16-2010, 12:02 PM   #4
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Re: Okay, Got Tolerance, Now What?

I guess I'm also a bit disappointed in myself. I was managing fairly well with my 30 Norco/Month. I thought I could improve on that with the OxyContin but no.... It was very a short lived celebration.

I wonder if it's the nature of Oxycodone to become tolerant so quickly?

So, I am where I am. I will need to devise plans to make it work at this dosage, or I bail on Oxy completely, or what?. On another Forum I read that switching up the type of Narcotic periodically may help.

So, how about a rotation, much like the Antibiotic rotations that my fellow IBD friends are on? MS-Contin next month, Exalgo the following month, Norco for a month, then maybe back to Oxy for a month -or maybe just forget the Oxy?



Any thoughts on this plan?

Many Thanks,

~

Last edited by Isotope; 12-16-2010 at 01:24 PM. Reason: Typo

 
Old 12-16-2010, 12:57 PM   #5
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Re: Okay, Got Tolerance, Now What?

i have tried everything under the sun to make my severe post traumatic intractable pain less-the only thing that helps is the narcotic pain meds- i take oxycontin 60mg every 8 hrs and up to 3 15mg ir oxycodone a day for bt pain-pegala is so rt-if you can obtain a 50% decrease in your pain it is a huge success, icurrently am at between 6-7 and am grateful for that.
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Old 12-16-2010, 01:50 PM   #6
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Re: Okay, Got Tolerance, Now What?

Quote:
Originally Posted by Isotope View Post
I guess I'm also a bit disappointed in myself. I was managing fairly well with my 30 Norco/Month. I thought I could improve on that with the OxyContin but no.... It was very a short lived celebration.

I wonder if it's the nature of Oxycodone to become tolerant so quickly?

So, I am where I am. I will need to devise plans to make it work at this dosage, or I bail on Oxy completely, or what?. On another Forum I read that switching up the type of Narcotic periodically may help.

So, how about a rotation, much like the Antibiotic rotations that my fellow IBD friends are on? MS-Contin next month, Exalgo the following month, Norco for a month, then maybe back to Oxy for a month -or maybe just forget the Oxy?



Any thoughts on this plan?

Many Thanks,

~
are you really serious about asking to rotate pain meds on a monthly basis? I cannot imagine ANY Dr doing this for a multitude of reasons. Getting a patient stabilized on a medication often takes a while and could never be achieved through rotation of meds on a monthly basis, even with the best narcotic equivalency tables at hand. It's just not that simple.

also, exactly what has disappeared for you since your initial experience with Oxycontin? i would imagine that any euphoric affect may have disappeared, but that is obviously not the purpose of pain management. If that is the " warm cozy blanket of comfort" that cannot be expected long term. As other posters have suggested, the goal is pain management not pain elimination. if you are still receiving other benefits (in your case with IBD, constipation) then wasn't that the goal along with reduced pain? It is unlikely that you would build tolerance to a medication within a month

perhaps your Doctor is different than most prescribing Doctors. mine is extremely understanding and had no hesitation in switching me from oxycontin OP's to MS Contin when I had terrible problems with those new oxys. but I simply cannot imagine asking for certain narcotics by name because I would like to "try" them.

Are you able to go back to the Norco again? if that worked so well, perhaps the time release mechanisms of LA medications are so adversely affected by your IBD issues that you will never gain full benefit from them.

 
Old 12-16-2010, 02:05 PM   #7
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Re: Okay, Got Tolerance, Now What?

Okay-

I think that many people that take Pain Medication probably do look up the name, and they become familiar with that drug, and others too. Especially on a site like this. One gets to know the names and doses and preferences quickly.

Are you saying that I should act dumb with my Doctor (Okay, dumber than I am), so that he can be the one offering up the solutions -or so that I don't seem too familiar with the names?

I don't know, is a monthly rotation crazy? Is 6 months crazy too? That's why I'm asking. I didn't think that Oxy would be going away on me this quickly either.

And, yes, it's a pain issue, not a Euphoria seeking. The 'good' feelings were just a part of the pain relief, not the purpose of my taking the medication.

Last edited by Isotope; 12-17-2010 at 11:35 AM. Reason: More...

 
Old 12-16-2010, 06:06 PM   #8
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Re: Okay, Got Tolerance, Now What?

Okay heres the deal....some of your ideas are starting to get a bit nuts. There is no way that a doctor is going to allow you to change meds on a monthly basis or any kind of rotation. And really who would want to? These aren't advil or tylenol your talking about here...these are heavy duty drugs. The idea with pain management is to make a goal, at which point you want to keep your pain controlled at, say a 4 or a 3 whatever...then get on a med and make a routine with that med. Let your body adjust to it and how it works. If the 10 is not strong enough then perhaps you need to go up to 20mg. I don't quite understand why your so adament about going up on dosage strength but yet your willing to try all these different narcotics and switch them at the drop of a hat. You've only been on Oxy for a month, you've also tried and eliminated Opana in that short amount of time..... Do you even have a break thru med for in between pain? And talking about using Norco for a main long acting med...that makes no sense at all...Norco compared to the Oxy your using now is like an aspirin. You really need to decide on a plan of treatment, and stick with it. If you're not doing alternative therapies along with your meds then you ought to start, i.e. heat, ice, massage, etc.

I know you don't like it when people oppose or talk down to you about your med use and the way you feel about switching meds and docs etc...but honestly your really coming off as irresponsible, confused and just not making much sense. Please take a break, take a breath and slow down before you do something that you'll regret. Remember the name of the game is Pain Management, not Pain Control. The goal is to just get to a point where you can live with a certain level of pain, that's as good as you can expect it to get.

Take Care.

kat

 
Old 12-16-2010, 08:30 PM   #9
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Re: Okay, Got Tolerance, Now What?

Rotation isnt the total answer Iso, most opoids affect more or less the same receptors, changing from Oxycodine to Hydrocodone isnt likely to bring massive increases in releif or decreases in tolorances. Most opoids will substitute for one another quite well.

You werent prescribed oxyxontin to give you warm, fuzzy, stress free confidence, so forget about that, it was prescribed to releive pain - thats the only criterion you can use to measure it - are you losing pain releif as well, or just that happy warm carefree feeling?

10mg twice a day is a pretty low dose, and some dose adjustment in the early days is quite usual, I doubt your doctor would be suprised if you needed an increase after a month or so - its if you needed increase after increase, month after moth that you'd have an issue.

Adding amitriptyline might be especaily good in your case - it blocks pain transmission (blocks fast sodium chanels, same as lidocaine does), it is a potent and long acting antispasmodic, and it is an adjuvant to narcotic analgesics (ie, it increases their effect, without being a narcotic in itself, so it doesnt add to the dependence issue. Starting off at 1/2 of a 25mg tablet at night, and slowly increasing to 50mg at night over a couple of weeks is pretty standard
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Old 12-16-2010, 09:28 PM   #10
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Re: Okay, Got Tolerance, Now What?

While 10 mg bid is a usual starting dose on Oxycontin, I am a little concerned by what you describe as your warm, fuzzy feelings on it.
ALL pain medications are going to loose that warm , fuzzy feeling after a few weeks on it. Those feelings are supposed to disappear. Especially with the long acting pain medications, in fact, I can't recall ever getting that feeling, long acting or short acting medications, although I have read others that have as well.
The idea is to reduce your pain levels by 40%-50% of what you experienced prior to the medications so that you are able to function reasonably in your daily activities.
It sounds like you are taking the pain medications more to help with the diarrhea from IBS, than for pain??? Or am I misunderstanding??
It may be that you do need a small increase , but I wouldn't be so sure that it is tolerance that you are experiencing so soon after being on these meds, but something else???
I highly doubt that any doctor, PM or GP, no matter how good your relationship with him may be, is going to allow you to switch around pain medications on a monthly or bi-monthly basis just because.
I've been in PM now since 1995 when I first had my shoulder reconstructed and developed RSD in it and my entire arm and hand as well, and there were relatively few "restrictions" when it came to how meds were prescribed back then to 2006 when I had my first back surgery, and developed CES, which led to my 2nd surgery in 2007 , and I have never heard of any doctor doing what you are asking about.
I have heard of some doctors who will have a patient stop taking any pain meds for several weeks to months to reduce tolerance, but that method is considered highly controversial and mostly ineffective since within days to weeks in restarting the medications, the former dose is attained and often surpassed.
It might help to reexamine what it is you are expecting out of the whole pain management experience and to talk with your doctors about other modalities that might compliment the pain medication in reducing your pain levels.
Best of luck to you,
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Old 12-17-2010, 12:37 AM   #11
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Re: Okay, Got Tolerance, Now What?

Hey ISO, If you went years before having your pain managed as many have or do, the first month we have relief is a little honeymoon from hell. But the warm fuzzies do deminish and you can't chase that feeling. You can certainly have pain relief without that feeling as long as you don't associate that feeling with pain relief. One of the difference in Oxymorphone is that it doesn't cause that warm fuzzie energized feeling that oxy is known for.

It's the first side efect that deminishes but it doesn't mean that the med isn't working any longer. That feeling deminishes quickly just like nausea or flushing or any other common side effect. Mistaking that feeling for pain relief leads to everlasting increaes and tolerance. I've certainly seen rapid tolerance to oxy but that's why it's important to get the dose right from the get go rather than excepting any relief you can and then having to explain it's not enough a couple months down the road. It's OK if the first couple days leave you drowsier than normal or In Oxys' case, a little peppier than normal. Those feelings go away in a couple weeks regardless of the dose.

The short acting BT meds are just that, only meant for pain that your long acting med doesn't manage, break through pain. If someone takes short acting pain meds on a set schedule, every 4 or 6 hours every day, along with their LA meds at their prescribed dosing schedule. The SA meds are no longer BT meds. They just become part of the daily routine. The long acting med is what should be managing the bulk of your pain and many docs limit the available BT doses of short acting for just that reason. It just makes sense that if someone takes their BT meds 4 times a day every day, they really have nothing to take on those bad days or when they have a flair or even a minior injury like a fall that tweeks an allready bad back. Because the doc has given us something in advance for those types of BT pain, it leaves the patient with nothing in addition to what they are used to taking every other day, when you do have bad days.

I'm not saying oxy can't be used safely as a BT med, Ive used the same dose for almost a decade. I'm given 60 30mg tabs a month and some days I may take a half a pill in the afternoon or to get moving in the morning if the weather drasticlly changed and some days I take a whole pill several times a day. But I never simply take the same dose from one day to the next. I customize it to what I need to get through that flair.

I wouldn't even call needing the initial dose adjusted after the first month tolerance. Anything was an improvement over nothing, just don't mistake the warm fuzzie feeling you may feel the first couple days of a dose change with pain relief. Pain relief is how your functioning months or years later once meds are doing all they can for you without hindering you and your doing all you can to improve your own situation. Strengthening your back, PT, Yoga, whatever helps and doesn't hurt. Once were given a gift like pain relief it's up to us what we do with it. Curling up by the fire or using it to increase you activity level so you don't have to deal with the negative health issues of living too sedentary is your choice.

Again it's another balancing act. you don't want to get into a cycle of you have more relief, so you do more, which causes more pain so you need more pain meds to continue at a level that isn't realistic for your condition. You can't medicate yourself into doing unreasonable things even if they were a major part of your life prior to injury. For example, If your were a marathon runner for a decade prior to a back injury and post injury you can't do your own grocery shopping. Although being able to run may be very important to you, it's not really a quality of life issue or a goal of PM. If the meds allow you to do your own grocery shopping, That may be as good as it gets and we need to be greatful for that.

I don't think you need to give up or act dumb. You just need to be in the hands of a doc that knows what to do when you tell him that the first couple weeks were a huge relief after years of poor pain treatment or none at all, but now things are different. If you have to educate your doc, something is wrong. The next reasonable step would be to adjust your LA med and leave the BT med alone untill you have the base med adjusted to a point where BT pain is truly just BT pain. Yes their are people that are given 4-6 dose of Bt meds a day and take 4-6 doses every day, again, those are no longer BT meds and when they have a flair their in an awkward position.

If you only used the 10 mg OxyC for a month, I wouldn't normally call it tolerance, Your simply not at the right dose yet and all you should have to do is convey how your feeling and functioning to your doc. Let him know the first dose out of the gates isn't working. If it's the warm fuzzy feeling your looking to recapture, your on a very slippery slope because you will never be able to maintain that short lived sensation when a dose is adjusted. I hope that isn't the case. There is also the posibilty that a couple days of combining both the opana and OxyC along with BT meds has now made your present dose inefective. The only way to deal with it is to use adjunct meds or adjunct modalities or simply raise your OxyC dose. Their are meds like nemanda, Clonidine and baclofen that can make the pain meds more effective for various reasons along with antidepressants, and antiseizure meds. There is a different reason for each of those meds helping treat pain. But your doc should know this stuff and you shouldn't have to educate him. He will reach a point where he simply won't continue to prescribe because he's out of his comfort zone.

As much as it may make common sense to hit every receptor possible, thats not a good practice untill nothing else works. I've certainly seen it with patients on high doses of multiple drugs, but these folks were severely disabled. One guy I know uses a combination of 400 mgs of MSContin, 3 100ugh fentanyl patches and Dilaudid for BT. You are a long way from needing to treat your pain that agressively or having the tolerance to survive that dose. He's wheelchair bound most of the time and it took a decade to reach that level of medication. even with that combo, he rarely leaves the wheelchair due to the pain caused by a long failed fusion in a spine with osteo that won't hold a screw. HIs hardware shifts and fractures vertabrea simply from walking.

There are people all along the spectrum of pain and the meds they require, a GP just isn't going to go to certain places he doesn't have the knowledge about. Alot of people advocate finding a GP that doesn't make you jump through the hoops, but that only works on simple cases or where a PM is consuted and creates a plan that a GP follows out. When an increaes is needed, many have to go back to the PM to make the dose adjustment. To me it seems like asking your GP to treat your cancer or step in and manage a bad heart, it's not his specialty and their are plenty of docs out their that do specialize in those fields. They may have more rules, but when you can't function without these meds, ill play by the rules.

I know it's human nature to self diagnose and even consisder your own treatment plans, But that can backfire and your GP may take you somewhere a PM may simply not agree with and once the GP says I can't do it anymore, you have to abide by the PM or jump on every doc in towns wait list and hope he aproves what you and the GP came up with. Just an anecdote about self DXing. I called my pre heart attack symptoms gerds for about 4 months. I felt like I new enough and had stomache problems in the past so it made sense up untill I was in the back of an ambulance at the age of 36 wondering if I would see my family again. I was foolish enough to think there was some magic shot they can give to stop a heart attack in the ER. Heck no, you just ridde it out and if your heart stops they will try to bring you back and if you survive the heart attack you get to do a cardiac cath or have open heart surgery. I kind of wish I had gone to the doc about my gerds before that first heart attack. Why did I have a heart attack? beaue I had been in untreated pain for so long I told docs it was normal for my BP to be 210 /140 and it was from the pain I was in. Nobody ever treated the high BP as many times as it was noted because it was considered reactionary. So don't self DX. Find the best doc in the field you need and let him do his thing. Of course pick his brain and talk about what you may have discused or read, but the ultimate decsion is the docs when it comes to what meds he prescibes.

Back to GP's, I don't know what's wrong with your back, but no GP is qualified to give you a surgical opinion, I don't even think much of the radiology reports. Only a spine surgeon should be discusing whether or not you need or would benefit from surgery. Just like you knew when it was time to get a GI doc involved when your GP could no longer handle things with what he knew to do for normal heart burn, indegestion etc etc.

Anyway, I wouldn't stress about 10 mgs of OxyC not being as effective as it was when you very first started, just be careful not to confuse feeling good with decreased pain.
Take care, Dave

Last edited by Shoreline; 12-17-2010 at 09:14 AM. Reason: grammer, It was very late and I was running on very little sleep.

 
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Old 12-17-2010, 01:01 AM   #12
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Re: Okay, Got Tolerance, Now What?

I'm reading these great posts from you guys, and digesting, and (as katlin09 says) taking a breath. I apologize for sounding like a nut, or using adjectives like "warm" or "fuzzy".

Clearly I don't know the rules yet.
I think I will zip it .....

~

 
Old 12-17-2010, 01:10 AM   #13
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Re: Okay, Got Tolerance, Now What?

I think you need to start thinking in terms of months, not days Iso, and everything will be fine.

When i started blood pressure pills, it took several dose and drug changes to find what controlled the problem, and i dont see any reason to think that pain management should be any different - your doc sensibly started you on the lowest dose of oxycontin, (the start low, go slow aproach) and now you need an adjustment up. Oxycodone isnt any more or less addictive or likely to indice tolorance than any other opoid of similar potency.

If you need somthing to calm your deamons, then a benzodiazepine like Valium, Klonopin or Librium would probably be a lot more suitable than relying on the side effects of your pain killers
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Old 12-17-2010, 02:30 AM   #14
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Re: Okay, Got Tolerance, Now What?

Gonna unzip for a moment on my actual condition and how I got here.

GI pain is my issue. GI Docs have been in my life since the mid-80s. I've had UC and Crohn's, then surgery, total Colectomy and J-Pouch reconstruction in 92'. The reconstructed terminal ileum has been the site of immune attack since 92' -in much the same way my Colon was when I had UC. A high percentage of 'J-Pouchers' are in my boat, they call it Chronic Refractory Pouchitis. It feels like a non-stop urge to go to the bathroom leading to inflammation, bleeding, fever, chills, weight loss, spasms, bloat, gas, electrolyte imbalance, dehydration, and radiating waves of gnawing pain.

Since the mid 80's GI Docs have never given me anything for pain or even suggested it. The treatments are everything from Mesalamine enemas, Hyoscyamine, Cipro, Lomotil and Prednisone to 6-MP, Humira, Remicade, Cyclosporin, and Pouch excision or Permanent Ileostomy.

A fellow Poucher had mentioned on a Forum a couple of years ago that he was helped by 'Tincture Of Opium' and Percocet. A few others piped in to say they also took Narcotic Pain Medicines. The benefits of Narcotics for Chronic Pouchitis are that the GI tract is shut down somewhat, peristalsis is slowed, tone is improved, spasms are reduced, and ultimately Pain is relieved. When I tried Vicodin, then Norco, I found that to be true. The relief was nothing short of amazing.

I'm currently in a long and slow taper from Prednisone after a bout of Pouchitis that put me in the Hospital a couple of times in 2010 with Acute Pancreatitis. If I can't get trickled below 5mgs of Prednisone, which so far, I can't, then I have some not-so-good options to face.

So, I'm anxious, and I'm in pain, and I'm sick of thinking about and worrying about OxyContin, Norco, and all of this crap. I just want it to work, and keep working, like it did at first. I need the GI shutdown and I need the pain relief so that I can start breaking these 5mg Preds in half. I don't want a 6k Remicade infusion cycle or a Cyclosporin Cellular meltdown.

~

 
Old 12-17-2010, 02:41 AM   #15
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Re: Okay, Got Tolerance, Now What?

I know this is a bit off topic for a pain board, but do you take sulphasalazine or somthing similar oraly to help control your condition?
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