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Old 06-22-2012, 07:33 PM   #1
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Concerned About Meds.

Hello All,

My Hubby has been in alot of pain due to Sinus Issues. He was taking 10mg for his Neck issues for about a year. For 2 months his sinusitis has been getting worse and the pain meds were helping the facial pain from Sinusitis, but now not working enough. He saw his ENT Doctor this week and they say he needs Sinus Surgery to shave bone and Sinus walls and has about 2 cups of Puss there and possible tumor. The ENT Doctor called his Primary and recommended Hubby be put on Oxycontin 40mg (he was on 20mg for 6 days in hopes to lessen the amount of oxycodone) and double the oxycodone to 240/month instead of 120/month until he has surgery and is healed. I am concerned that this is alot of narcotics? He will pick up Oxycontin tomorrow, due to MA Pharmacies having a 24 hour wait on filling Oxycontin. So ttomorrow will be the first day of taking 40mg 2x a day and Oxycodone 10mg 6-8 a day. Just wanted opinions if this is alot and will he have issue coming off Oxycontin after his sinus surgery? He will go back to 120 Oxycodone a month for his neck pain after sinus surgery.

Thanks,
Jen

 
Old 06-22-2012, 09:16 PM   #2
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Re: Concerned About Meds.

Hi there! The answer depends. While yes this is a higher dose of this medication, if someone is tolerant to it, it may not even make a dent in their pain. Is he confident in his prescribing doctor's abilities? If it was me, I would pursue treatment from a pain specialist, not a primary care doctor. They have the training and expertise to best treat chronic pain. Often primary care doctors may over or under prescribe narcotics as they just don't have that training and experience.

If its done right, he may be a bit uncomfortable tapering down on the Oxycontin after the surgery, but its definitely doable. Usually this means a slow taper with any adjunct meds like Clonidine if needed. Some folks believe in a faster taper if they are going to be miserable anyways. I have had to do this and although I was a bit anxious and such, I didn't have too much problem with it. I mostly was dealing with the uncontrolled pain as I was needing a higher dose, not the lower dose. Also keep in mind they may actually need to up his meds immediately after the surgery due to the surgical pain.

None of us taking these meds for chronic pain want to be on them, but we turn to them when nothing else has helped. I do hope he has exhausted all other options for the neck pain as well as the sinus pain, and that the sinus surgery helps. If he stays on these meds for the neck pain after the sinus surgery, also keep in mind his dose requirements will only increase over time as he builds tolerance. They can rotate meds and try adjunct meds and such, but as long as he is on them his body will become tolerant.

What many folks take for their chronic pain would kill someone who wasn't opiate tolerant, but most of us aren't impaired by our meds. Has he got a second opinion about the surgery? If I was to go under the knife, I'd want to be extra sure that its the best option and I have the best fit doctor for me doing it. also, it seems odd he is given as much immediate release meds (for breakthrough pain) as his total daily dose (80mg & 80mg).

Often this would indicate the long acting dose needs to be increased, but I think thats what they just did, so maybe he will not need as much of that now? Also, even if his doctors are offering this amount of meds, if he doesn't feel he needs that much, encourage him to speak up. Its best practice to take a minimum amount of meds such to minimize tolerance, side effects, etc.

A reasonable goal of pain management is 50% relief, but many cannot even obtain that. To try to take away nearly all the pain is unrealistic. Have you been involved in his medical appointments? It may be helpful to do this if you have concerns so you have the information to make an educated opinion. I agree that doubling both the long acting and short acting dose at one time seems like a lot, but I don't know if it is the right or wrong thing in this case.

My immediate advice would be to give the Oxycontin dose increase some time to build up before he starts taking the Oxycodone as he wouldn't want to have any issue with it being too much. Doubling a dose may cause some side effects such as sedation or even euphoria, but they are often very short term. Best wishes.
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Old 06-22-2012, 09:35 PM   #3
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Re: Concerned About Meds.

Hi Kate,

Yes, I do go to all of his appointments. This last appointment was his second opinion, and agreed with first ENT. His neck pain is due to 2 bulging discs and pinched nerve. He goes to PT for his neck. His Primary is the one giving him his meds. I have Chronic pain, and am on meds also..but not as much as him and mine are different. I take MS Contin 15mg 3x a day and Vicodin for breakthrough through my Primary who has a degree in PM.

I advised my Hubby not to take any Oxycodone before he picks up his Oxycontin tomorrow and takes his first dose, so he will be able to see how well it controls his pain. His ENT could not believe he tolerated this pain for so long, I think because he waited so long to do something about it, it just got out of control. My concern is him stopping the Oxycontin after surgery and going back to Oxycodone 120/month, just worried that after hime taking double his meds that going back to his original dose won't be enough? I was the one who spoke to his Doctor after the appointment, because the ENT gave him a script for 5/325 Percoset..and I called his Doctor asking why she would give him that script knowing he was already taking Oxycodone. After the phone call, I shredded the Percoset script.

Thanks For Helping!
Jen

 
Old 06-22-2012, 09:44 PM   #4
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Re: Concerned About Meds.

Yes if he is on this increased dose he will become tolerant and the 10mg at a time Oxycodone will likely not work as well for him. The transition from a long acting med to only a short acting med may also be tough, if he has been used to his neck pain also being treated more aggressively lately (due to the dose increase from the sinus pain).

That is something to be expected however, so I'd hope his doctor can work with him accordingly. Was the doctor specifically saying he would have to go back to that quantity and dose, or more of a general statement that this increased dose was for the short term until surgery? Its likely also too early to speak to what his dose requirements will be after surgery because this is assuming it will be a complete success.

Each person builds tolerance at different rates as well. If he is on a contract for the meds he needs to be especially careful about receiving any other meds from doctors. In that situation I would not have accepted that script (or returned it in person). Even though you shredded it, its in the file that he accepted it. Depending on your state you may not be able to prove it wasn't filled (some states have databases now to track a patient at any pharmacy and some don't).

Every once in awhile little things like that can turn into big problems and get a patient dropped from treatment. Don't want to freak you out, but thought I'd mention it. Yeah it makes no since the EN&T doctor gave him a script at the same time he called and recommended the primary doctor increase his meds. Best wishes.
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Old 06-22-2012, 09:59 PM   #5
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Re: Concerned About Meds.

Hi Kate,

No he doesn't have a Pain Contract or anything like that. I forgot to mention that he stopped taking his Oxycodone when he strted the 20mg Oxycontin cause he didn't realize he was supposed to take both! And when the ENT asked about what he was taking, he said he stopped the Oxycodone because he started the Oxycontin! That's when I called his Doctor and told him all this, and he said no, he should be taking both! I should have realized he was to take both, but have been sick with the Flu and Fibro-Fog. So, now yes he takes both. His Doctor is the who told me to shred the script, I asked if Hubby should bring it to him cause his office is down the street. I think he trusts him, Hubby has been his patient for 10 years and up til the Neck issue, has never needed to take Pain Meds. Hubby wants to be able to go back on the lower dose and hoping this surgery will take the extra intense pain away. The ENT did say that he might have to stay over night if they can't get the pain under control after surgery.

Thanks,
Jen

 
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