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Old 07-13-2011, 12:35 PM   #1
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Need advice on upcoming med change

Hello everyone,

It's been awhile since I have posted and I hope all is well. I am once again in need of some advice. My fusion has finally been classified as a failure. I had reactive endplate changes but no real bridging of bone at L2-L3. I have now been plunged into the world of pain management. Fourtunately for me, my neuro has not thown me away like a ragdoll and continues to treat pain for now until I can get a medical retirement. I have also lost my career as a police officer as well.

Due to the loss of my career, I have just lost my health insurance also. I was taking 40mg of Oxycontin 3 times a day with 5mg oxy for bt pain. The brand name Oxycontin will cost $750.00 without insurance and there is no way I can afford that before my wife can get insurance through her employer.

I have an extremely good relationship with my pharmacist and she recomended switching to MS Contin since it would cost about $150.00 and recomended a starting dose of 30mg. I know very little about this drug. I do know that the oxy is 1.5 times stronger than the morphene so I am a little concerned. Do you take this drug twice a day or three times a day. I fully understand the process of titration but I am petrified of being thrown into withdrawl and not to mention the loss of pain coverage. Although, I was not getting the greatest with the new formulation of oxy (thanks Purdue!)

I would love any advice that you all could give and any positive or negative experiances when switching to morphene sulfate from oxy.

Thanks in advance and I look forward to hearing from you all again!

"Joe"
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Old 07-13-2011, 01:48 PM   #2
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Re: Need advice on upcoming med change

Hi,
I did the opposite, switched from Ms Contin to Oxy. I went from morphine 30Mg to Oxy 30MG both 3 x a day. I hope you are getting generic morphine? I have been on all types of brand morphine and the generic worked the same for me, so you may want to consider that. I think the cost is way less than the $150

Why are they trying to lower your dose?

 
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Old 07-13-2011, 02:04 PM   #3
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Re: Need advice on upcoming med change

Bunny,

Thank you for your reply. There is no mention of lowering my dose, the pain definately has not diminished. The pharmacist is a fan of starting lower and working up to the effective dose. That is what has me so scared. I know that the oxycontin is more potent. I am afraid of the morphene not working and throwing me into withdrawl as well as the increase in pain. My neuro writes 30 day prescriptions so that is a long time to wait to go up in dose if it is much needed. I have not contacted the neuro for the change yet as I have a week or so left on my current prescription.

As for the generic, that is the way that I will go. Cost is everything for me right now. I have not had any problems with generics in the past. The generic oxycontin worked the best for me and after the last surgery, I was on the generic 40 mg oxycontin and it worked great. Now since they have stopped making the generic and reformulated the brand name, it is not nearly as effective for me, even taking it three times a day.

Thanks again,
Joe
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Herniated L5-S1 in 2005
Herniated L2-L3 in 2008
Dynamic stabilization L2-L3 in 2008 (failed-spondylolesthis of L2)
PLIF L2-L3 in 2009
PLIF failed to fuse

Last edited by joebob254; 07-13-2011 at 02:05 PM. Reason: added something

 
Old 07-13-2011, 03:07 PM   #4
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Re: Need advice on upcoming med change

IDK it seems that IMO getting a lower dose would be pointless? It's not like you are switching from Norco to morphine, don't know what the benefit would be.

I didn't notice any change. The only thing I would look out for is fatigue. That is why I switched from morphine, the fatigue was terrible for me compared to the Oxy. I was falling asleep for 2 weeks at EVERY opportunity!

Hope it all works out

 
Old 07-13-2011, 03:40 PM   #5
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Re: Need advice on upcoming med change

Hi Joe,
I'm sorry about the medical retirement. My husband is a police officer too, and it's been his life for the last 24 years.
Actually, there are several options for your PM doctor/neurosurgeon to switch you over to, that may work just as well for you, and with the generics available, may not cost you as much as the 150.00 a month. Methadone is one of the cheapest , if not the cheapest opiate pain medication there is...and it works really well for both chronic mechanical pain and neuropathic pain. There used to be quite a stigma about methadone but thankfully, since it is used so often for pain management effectively, the stigma isn't as bad as it used to be.
There are generics of the other opiates, aside from Opana that might work well for you as well. It is worthwhile trying them to see what would work best.
When your doctor converts you from one medication to another, they use a formula/conversion table that allows them to take your current dosage and type of pain medication and covert that amount to the new medication to come up with the right dosage. This should minimize any chance of withdrawal if the conversions are done correctly. You will have to keep in mind that there is a chance of cross tolerance, and there may be a need to adjust the dosage up or down of the new medication.
Talk with your doctor about the other options out there and then decide which medication might be best for you and give it a try. They change medications all the time for patients, so the conversion thing isn't that big of a deal. Good luck Joe,
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Old 07-13-2011, 05:03 PM   #6
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Re: Need advice on upcoming med change

Hey Joe,

I switched from Oxy to MsContin when purdue decided to make thier new tamper proof version. It sucked. I was fine on Oxy for 3 yrs, then they make the product less effective. I moved smoothly over to MSContin with no trouble. No drowsiness or stomach irritation. And it is cheaper, I'm on 120mg/day which is 60 pills/month roughly, and the wal-mart price is $92. Luckily my pharmacy price matches, so I didn't have to switch pharmacies, I've been with my pharmacist for 12 yrs. and he knows as much about as my docs do. My doc started me a little lower at first also, as Morphine works on different pain receptors than oxy and just because they say it's stronger, doesn't mean you won't get an effective dose at lower rates. Over the first 4 months we only had to tweak it once, and all was good. I use percocet 10/325's for BT and the combination works well. I never cared for the Oxycontin/oxycodone combo, because your just getting more of the same drug, why not just up your LA med and skip the BT.

Anyways, there you go, if you have questions just give me a yell.

Kat

 
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Old 07-13-2011, 05:39 PM   #7
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Re: Need advice on upcoming med change

Hi Joe...

I had the exact same problem in that I lost my insurance during my divorce so had to switch from Oxycontin to MSContin...

I use Sam's club pharmacy (by law, you do NOT have to be a member to use their pharmacy)...it's actually cheaper there than at my nearest Walmart...but this varies by state..so it's best to call and check around to all the pharmacies and as mentioned...see if your Pharmacy will match if you like the people there..

I get both a generic prescription for 60 pills of 30mg (one every 12 hours)..and 60 pills of 15mg so I can take anywhere from 75 to 90mg a day...So for both of those it is only $58...

I did lower my total dosage as I was on a higher amount of Oxycontin....but my Dr. always starts low on a new opiate as they effect people differently...and I would rather have a pain level of 5-7 and take less meds when needed to leave room for later on...

(I also have 5mg OxyIR generic for breakthrough when needed...I am prescribed two at a time for 10mg... and it was cheaper for the 5mg than the 10mg total dosage for the day...go figure...but it's a different generic maker...that is only $40 for 240 a month..

Most Dr.s will start lower and tirate up to make sure of any side effects....I had more fatigue and a bit of nausea in the beginning...but that went away in a few weeks...so unless you have any type of dire side effect...please give a med some weeks to get situated...it turns out it was the Percocet causing more of my nausea...the acetaminophen...so that's why I am now on just oxycodone...

Hopefully when you speak with your Dr. that you can have it set up to call him in a week or two if you need to raise the dosage for pain relief...so maybe he can do a two week dosage of this mg...and then move from there...

Good luck

Last edited by Ilovemycutedog; 07-13-2011 at 05:41 PM.

 
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Old 07-13-2011, 06:16 PM   #8
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Re: Need advice on upcoming med change

hi joe-

i too went from oxycontin to mscontin after purdue reformulated there medicine into garbage. mscontin is working better, also take msir and oxycodone ir-i switch back n forth on the 2 bt meds and get good relief. i also have medicare now ans xtra help with my rx coverage-but it was no picnic getting approved. good luck
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Old 07-13-2011, 08:44 PM   #9
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Re: Need advice on upcoming med change

There are conversion formulats to figure out what X mg of Oxy equals in MS Contin. I had been taking Opana ER but when the copay card ran out I went to 30 mg of MS Contin for $10/mo (under my insurance).

Sometimes name brands will work for you if you ask the doctor for copay deduction cards. They result in much lower cost. The Opana ER card I had limited my out of pocket cost to $35 for 12 prescriptions.

Have they done a solid fusion from L3-S1 to stabilize the whole area? I couldn't tell if you still have isolated fusions or they've fused it all together. I am L3-S1 and I feel quite stable (though there is still some pain). My Orthopedic Spine Surgeon said the best way, for me, was to take out the L4-S1 hardware and do a L3-S1 fusion. So glad he did.
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Old 07-14-2011, 08:49 PM   #10
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Re: Need advice on upcoming med change

Thank you all for your usefull information. I was a little worried about the switch to morphene due to my experiance with it in the hospital after my first surgery. It just flat didn't work, neither did fentanyl for that matter (IV Dilaudid worked finally). I have found that I have a pretty high metabolism when it comes to these meds not to mention opiate tolerant like all of us. On that note, I have read many of you post about opiate rotation every six months to a year and am interested to hear thoughts about that too.

I have left a message with the nurse and am awaiting a call back. Would you suggest that I ask to start on the 30mg or 60 mg and bid or tid. I know it seems kinda odd but I have actually been able to request the strengths of meds from my doctor. If it is what he thinks is best, then he just writes it out. If not he usually writes the script for what he thinks is best and provides an explanation. I am extremely fourtunate to have clearly established trust (both ways) with my surgeon.

@ Spine,

It's good to hear from you again. My neuro did not want to consider another surgery at this point. Everything is stable with the hardware for now. While I was a patrol officer, my duty belt weighed approximately 20 to 25 pounds and sat pretty much right over the L2-L3 level. He could not explain why the first surgery resulted in the L2 vertebra dislocating into the spinal canal. It was progressive and through persistance on my part, it was caught early. Then it was fused a short time later and that surgery too failed. He believes now that the failures were caused by the belt itself. He did not want to do another surgery if I was going to return to my occupation because he felt that it was destined to fail too. All of his work was right on though. The screws were properly placed and all hardware is exactly where it should be. Fourtunately for me the L5 herniation was one that responded to traditional treatments and never required surgery. It just continues to degenerate and could not be positively nailed as a severe pain contributer.

Now I am in a catch 22. I have been forced to leave police work and with it went my phenominal insurance. Given the information that the belt was a probable contributer to my problems, I initiated a work comp claim but it was flatly denied without even a visit to the doctor. Thats another story though. Now I sit in the limbo of no insurance until we can get it through my wife's work. Sucks huh?

Thanks again for all of your replies. Please keep em coming as I can use all the help I can get.

Joe

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Herniated L5-S1 in 2005
Herniated L2-L3 in 2008
Dynamic stabilization L2-L3 in 2008 (failed-spondylolesthis of L2)
PLIF L2-L3 in 2009
PLIF failed to fuse

 
Old 07-18-2011, 02:11 PM   #11
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Re: Need advice on upcoming med change

IMHO I would NOT switch to methadone. If I ever considered it I would go to a physician who specializes in methadone.. once again IMHO.

 
Old 07-19-2011, 05:00 PM   #12
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Re: Need advice on upcoming med change

I have a quick question for any of you. Do any of you notice signs of despair, or depression with these meds? I take MS Contin 15mg twice a day, 10 mg Baclofen twice a day, and 4 mg Dilaudid probably twice a day as needed for instant relief.
I am fused from C2-T3 congentially. Last surgery was 10/10 ACDF C2-C4 and hardware added to C2-C5 posterior to raise my head.
I suffer from hyporthyroidism and Im taking T3's and T4's for that. Since starting these drugs in 5/11 ( I think) I find myself crying alot and having such despair, I can handle take it. Thanks for any information.
Saucer

 
Old 07-19-2011, 05:12 PM   #13
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Re: Need advice on upcoming med change

I take MS Contin 30 mg three times per day, Percocet, soma, neurontin, Celebrex and voltaren topical gel. I also take Levoxyl for my hypothyroid. While I have my moments of frustration (sometimes a whole day or night if I can't get comfortable),I don't experience any side effects from the meds such as you mentioned.
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Old 07-19-2011, 05:59 PM   #14
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Re: Need advice on upcoming med change

Quote:
Originally Posted by SpineAZ View Post
I take MS Contin 30 mg three times per day, Percocet, soma, neurontin, Celebrex and voltaren topical gel. I also take Levoxyl for my hypothyroid. While I have my moments of frustration (sometimes a whole day or night if I can't get comfortable),I don't experience any side effects from the meds such as you mentioned.
Hi AZ,
Thanks for responding. I was on Soma but taken off as the doctor thought the baclofen had less side effects. I take levithroid and cytomel for thyroid.
I was on Vicodin from 10/10 to about 4/11 but started having tightness in chest, so then came the MSContin. I'm not sure, maybe need to talk again to doctor about the meds. I did try the fentanal patches but found they caused a horrible burning in my head. Thanks again.
Saucer

 
Old 07-19-2011, 06:54 PM   #15
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Re: Need advice on upcoming med change

Well I have pretty severe BiPolar with severe depression...so it's hard for me to tell if the meds contribute. But I guess I don't worry about it because I know the depression will be there anyways, and I'd rather be depressed and not in pain, as oppossed to depressed and hurting.

Kat

 
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