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Old 04-20-2011, 07:34 AM   #1
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what med is next??

I have gotta start off by saying everybody on this site is so helpful. So with that said im going to throw this out there and would love peoples advice and personal experience. Iam currently on 175mcg fent per 48hrs, and 30mg roxicodone 2 per 6 hrs as needed for breakthru , maxing at 5 roxi per day. On the day i put a new patch on i feel great. Have so much energy and feel so good i actually enjoy going to the mall with my wonderful girlfriend. But on day 2, i fell horrible. The roxis dont seem to really help at all, and if they do its very minimal. I cant wait for the day i put new patch on. So what do you all suggest i try taking now? My pain mgmt dr is great to work with. I have been taking roxi 30mg since oct and fent since oct 2010. My Dr recently bumped my fent to 175mcg per 48hrs from 150mcg since nov. Since the increase i really cant tell much of a difference.

 
Old 04-21-2011, 09:30 PM   #2
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Re: what med is next??

Freddy,

You might want to read through some of Johnstar's posts. I can't remember the name of the thread but he was talking about the particular way that he wore his patches. If I remember correctly, he said he was on 100 mg but wears two 50's and staggers thier use. He said he gets much better relief that way. Please don't quote me for sure, I'm just giving you a place to start looking.

Also, Johnstar often suggests several other types of medications that act as a booster for the opiates but are non-narcotic themselves.

Good luck in your quest and may you come to a quick solution,

"Joe"
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Old 04-21-2011, 10:09 PM   #3
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Re: what med is next??

Hey Freddy, It's pretty rare that a CP patient feels great. Are we talking no pain at all on day one. I hope your not under the impression thats a reasonable goal for most people in pm. There is a good chance that placement can make a huge difference and perhaps rotating patches using different strength combos will make a big difference, But taking using 60 mgs of oxy on top or even spreading out 5 a day generally means you base dose or long acting med is still not at the right level.

I've been using 30 mg roxis for 11 years for BT. First with healthy doses of orals and then a pump. Even on high dose orals or with a pump, at best my pain level is a 5 and that's considered a success. The only way to make me pain free would be to dope me into law law where i never left the home. Your going to be on a healthy dose of methadone or morphine if you switch but I have managed to keep the oxy effective this long because I don't take it on any kind of schedule and I take the least amount possible so that when I really need it It's effective. I may take a half in the morning and go all day till I take a whole pill and then another whole after that. Some days I use more, some days I use less. I can count the number of time I took 2 at a time and I am allowed but It's a dose that means I'm checking out as far as functioning. There really isn't much more out there other than aqtiq "fentanyl pops" and the way Ive seen people blow their tolerance through the roof with that stuff is amazing. Once your tolerant to that, you have very few choices.

I would hope if your having a great day on day 1 with the patch your not taking 150 mgs of oxy on top to achieve that great feeling. When BT meds just become part of the daily routine rather than for actual pain spikes from weather , injury, etc etc. were they aren't of much help when you actually do have BT pain. Too many people just take them to get the most relief possible with what their given. Those meds are no longer BT meds. If you do have a flair or say fall or injur whatever you pain generator is, then you have to double and tripple up during a flair to feel any effect, which leaves you short and blows your tolerance if your doubling or more. It really comes down to finding a happy medium. Yes we have to learn to live with some pain or be a veg on the couch.

I really don't know your story but I cought the enjoying walking to the mailbox with your gf or wife. I've been where you are and that seems like a huge acomplishment. I spent almosty a year in bed after my last spinal revision unable to walk much farther then the bathroom. But once your pain is managed properly, thats when you have to do your part and push yourself untill you can get out more and not feel homebound and cut off from the world. I was able to get back in shape, loose about 25 lbs and return to work part time after having a pump put in. I never realized how impairing orall meds can be untill the fog lifts because the delivery method changed.

I've been where nothing but managing the pain was my only goal so I do get it but I also recognized once the docs did the best they could, the rest was up to me. I could stay home and avoid anything painful or try to get back out in the world and interact with it. My point is, no matter how bad things seem, they could be worse and they could change tremendously in less than a year.

Talk to your doc, explain exactly whats happening with the meds and get a good understanding of what the goal of PM in your case is, whether he shoots for thirty, forty or 60 percent relief. You and your doc should have the same expectation when it comes to how much relief is enough or untill it hinders more than helps. Take care, Dave

 
Old 04-23-2011, 08:58 AM   #4
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Re: what med is next??

I appreciate all the feedback, As far as day one on a new patch i dont need a breakthrough. Like i said the dose seems real good, im just not getting the duration of 48hrs out of the patch. I live in AZ so its warm and when i feel good I can be pretty active. Ive been told by mylan that the med is released based on body temp, and that since i live in such a warm climate they have heard this complaint very often.In response to staggering, I have been told by some others to stagger my patchs, one day put a new 100mcg on and then the next day put a 75mcg on. Iam one to stay with how the dr wants me to wear and use the patch, per 48 hrs. But its frustrating when i can literally feel that im not getting 48hrs out of them. I would say there effective for about 30 hrs.As my pharmacist says everybody metabolizes medicine differently. Heres how i see my issue, the dose of fent is good its the duration of its effectivness. Get the correct change time then breakthru will not be necessary. I do understand in PM that you cant expect to be pain free all the time, but all i know is how i feel ,and thats day one i do feel great relief, and like i said if they would work on day 2 like they do on day one i would be very happy. So with that said is that unrealistic goal to achieve??

 
Old 04-23-2011, 03:01 PM   #5
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Re: what med is next??

I have never been on the patch before, but Jose's post where he talking about staggering seems to make sense. It sounds like your doctor is really willing to work with you, which is great.

Do you want him to change your medication completely? I'm just asking that because of the post title.

Can you ask your doctor if you can stagger the patch? I would definitely talk to him about it. If it's working that well, then maybe that will be the answer.

I agree with Dave, that the goal of PM is not to be pain-free. It's still really hard for me to accept that with medication and with all of the doctor appointments, etc. (a list of so many things that I do daily, as most of us do, to function) I still have pain! My pain does not go below about a five.

That's with all of the medications and everything else that I do to control it. After years of being in pain, I am still learning to accept it! It's tough.

Since you're in so much pain on those specific days, I think that your doctor should definitely know about it.

Does the roxicodone ever help you on those bad days? You said that on day two of the patch, it only helps you minimally. If your doctor doesn't want you to stagger, then maybe he will change your breakthrough medicine. I think though that with that dose of oxycodone for breakthrough, it may be difficult to find one that works.

 
Old 04-26-2011, 07:52 PM   #6
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Re: what med is next??

Well in reply to some questions from before, yes the roxi helps on day 2 when having increasing pain.Since my original post i have staggered my patches. And so far i would say its helping quit a bit. One day put new 100mcg next day put 75mcg on etc. My pharm even suggested it. I talked with mylan and they said it can make for a much more consistant level of medication in the system. I will keep you all posted, but like i said i think i have improved my issue i was having since I started staggering my patches..

 
Old 04-27-2011, 08:26 PM   #7
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Re: what med is next??

So i saw my pm dr , he very much liked the idea of staggering. Said he has never had a patient do it but has thought about it when duration is a issue. Iam very excited because i can feel a difference on day two already. I do thank you all for your input. Take care

 
Old 04-28-2011, 12:35 AM   #8
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Re: what med is next??

Freddy,

I'm glad I could help. I hope it continues to be a good solution for you so that you may have better days. We all know how important they are to us. It's funny how much differenct just one day of a somewhat normal life can have for us. Simple tasks such as mowing the yard, going to the movies or mall are often taken for granted until you realize that they will all cause you pain.

If you don't stick around on the board, I would like to say good luck in all that you do!!

"Joe"
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Old 04-28-2011, 07:18 AM   #9
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Re: what med is next??

Joe i couldnt agree more with what you were saying about taking things for granted. I used to race atv professionally, "yes thats how i broke my back 3 times", but my point is physically i have been able todo whatever i wanted my entire life. But now im happy to just walk around at the mall with my girl friend or goto movies. Anyways i think you all understand what im trying to say.. Take care..

 
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