This is something I am really bad at. I believe its called chasing the pain. Okay let me try to make some sense. When pain starts getting bad I normally take a few advil and try heat/ice, muscle cream etc to get it under control before bringing out the big guns. Sometimes it works but I have found more and more it doesn't do anything and by the time I take a vicodin it doesn't work as well as if I would have taken it sooner.
How do you ladies and gentleman decide when its time to take something for the pain? My doctor and fiancee both get on me about this and they both have a valid point of I have the medication so why suffer but my point is if I can control it with other means, why wouldn't I choose that method.
It's really dependent on how your pain medicine is prescribed...
Does the Dr. want you taking x amount of Vicodin per day, every day...the same dosage? Or do they give you a certain amount and expect that you aren't going to use it all in 30 days....
For me...I've been in PM for close to 8 years now and I take my long acting medication on a schedule. Every 8 hours without fail.
I have breakthrough medication that I take on an as needed basis...and yes...I have gotten to know when my pain is going to be higher so I take it right before this to stave off a big flare.
As in before grocery shopping, taking a shower, walking the dog, doing laundry...etc. These things I know will make my pain higher so I take my bt medicine.
In the beginning, I kept a pain journal which may be very helpful to you if you haven't quite figured out what causes more pain each time. And then be able to know, "when I do x, y, or z...my pain goes much higher" so you can take a Vicodin beforehand. Knowing that it hits the "max" at about 45 minutes in....and then slowly tapers down the next 4-6 hours.
And if I remember (sorry if I'm mixed up) but you aren't on any long acting meds...right?
And also sorry that my memory is bad....are you on any type of muscle relaxer? Would this be helpful at all?
What about other types of medication that is specific to your migraines? Things like Triptans (Imitrex, and all the "tran" ones), or how the Ergot ones are for migraines that last more than 48 hours....medicine like Migergot, Cafergot....they are combined with caffeine.
Anyway....as I mentioned...it's really about what your Dr. is wanting/expecting you to do. If you are allowed and supposed to take x amount per day...I would work them into your schedule and take them right before more active situations.
Obviously I do a lot more things to help my pain than just opiates...but for this conversation topic I am explaining my schedule of those
I do not take any long acting meds at this time and my vicodin is a take as needed (take 1 three times a day as needed) I have tried other medications for migraines although I have been doing some research on topomax which I want to discuss with my doctor at my next appointment. I also take soma as needed but they wipe me out so I can only take them at night. Migraine medications I have tried are maxalt, fioricet (and there's one like fiorcet that doesn't contain caffene), and there was one other med whose name I forgot. I also take magnesium, vitamin b complex, fish oil,d3 and savella during the day and savella, trazadone, and melatonin at night. I also take advil (800 mg as needed with doctors permission)
So do you get a prescription for 90 pills every 30 days? If so...then that would mean he is ok with you taking 3 a day, every day. But yes..it's best to make sure so that you are on the same page with the DR. as some of them write this on the prescription but then only expect "as needed" as it once in awhile and 90 pills to last a few months....
Thanks for giving more info...I figured since you have had migraines for so long that you had tried so many of the other types of medicine. My friend uses the Fiorcet once in awhile when she gets a migraine and that one knocks her out and does the job. I lived with her and her hubby/kids for 6 months when I got separated. (Now divorced)....And I would watch the kids for a few hours after she took this medicine.
If your Dr. prescribes Soma...than that is good and he believes in really helping with your pain levels as that med is now becoming scarce in use from a lot of Drs. as it has more addictive properties like opiates and unfortunately has become abused now
Which makes it harder on real chronic pain patients like us.
I have rotated with Flexeril, Robaxin, and Skelaxin...they all work well for me and I am back on Flexeril now. Because I've been in PM for so long....My Dr. rotates through medications every few years to keep tolerance from happening and having to increase dosages.
So...hopefully you are allowed to take the 3 a day...every day if this is what you truly need. And then it's more about finding the perfect schedule on when to take each one to help best with your pain.
Last edited by Ilovemycutedog; 07-25-2012 at 01:15 PM.
Some days I can get by with taking 0 to 2 but most days I need all three. If I do have any left over at the end of the day I just throw them back in the big bottle and just wait to fill my script. Normally a 90 ct will last me about 40 days. I was told because they aren't typical migraines (caused by trigger points in my neck that pinch the occipital nerve) so we haven't found a med yet that helps prevent/treat them. I think I will start keeping a pain journal not only for migraines but to figure out what may be causing fibro/mps pain, although most days its at its worst in the morning and at night. Today unfortunately is one of those days where I am counting the minutes until I can take another dose. We'll im going to attempt a shower and see if I can bribe my 7 year old to do some dusting.
Since I am also on a long acting med i take it like clock work. Every 8 hours. Now when I need my Opana IR for my break through pain I have learned that at the first sign of a twinge I take the break through pain. Also if I kow I am going to take the dog for a walk or vacum etc and i KNOW I will hurt after I take a BT pill before my activity
I too have been in PM for about 10 years and it's different when you are on a LA med as you will not usually spike so high and will have enough time to get to your breakthrough med before it gets too bad. Like Ilovemycutedog, I know to take my BT when I am going to be doing something like groceries or a shower. My BT is also very fast acting so those times I am out and end up with that writhing on the floor pain I know my meds will get to it quickly. I only do that on vacation with my hubby when I am pushing way past what I should so he has a good time.
Migraines are also difficult, my hubby gets those and usually lets them go to far before he takes his med, although it's still over the counter. He tried one of the ergotamines, the one you put under the tongue but then they discontinued that. He's tried the narcotics but he is allrgic to hydrocodone(throws up and the itchies which were hysterical to watch him, he is quite naive to all these meds so he gets really funny!) and oxy gives him weird dreams. Heck, if he takes a phenrgan he's knocked out for 6 hours!
But the pain diary is a great idea, gives you a better handle on how your pain behaves.
Hi there! I use my as needed meds the same as before I got long acting meds. I have a lot more untreated pain (I'm lucky to reach 50% relief) than I have ever had short acting meds. I have a certain level of pain spike where I feel its best to take a pill. So far that level of pain has occurred just often enough for me to have a few doses of meds left over each month (I get 15 doses every 28 days...this is the third doctor to give me that amount...they just continue it for whatever reason, even though I think more could be helpful). My pain has its ups and down regardless of my activity level (besides knowing that being at work makes me worse than being at home or out & about). If you know a certain activity makes you worse and you have enough meds, I'd take them.
For you, I'd figure out what that pain level is which you can treat without running out of meds, and not be afraid to use them. For me, I know Advil and such don't work. If you are getting to the point where alternative methods are only helping the pain less than 1/2 or 1/3 of the time, why not take the pain meds in addition to using those methods? If you are already taking all three allowed pills most days, and you are questioning if you are under treating your pain, it actually sounds like a long acting med could be warranted in addition to a short acting one. This might be a good discussion to have with your doctor, that you are having a tough time managing the pain with the methods you are currently using.
As for the migraines, I disagree with whomever said since yours appear to be triggered by a pinched occipital nerve, standard treatments won't help. I assume they have tried an occipital nerve block and trigger point injections? A lot of the meds commonly used as an adjunct to pain meds (or before them) as also often used to reduce migraines...anti depressants, anti seizure meds, beta blockers, etc. I question why your doctor hasn't thought to at least try you on a few of these (at different times, giving them a few months each).
I know you are not saying you are primarily on the Vicodin for migraines, but it sounds like its a significant amount of your pain (in addition to fibro/mps pain). Honestly you listing have tried very very few migraine treatments and I think if you have only seen one doctor for them and they stopped after a few abortive meds, you really need a new headache specialist. If migraines are more than a couple a week or don't respond to treatments, often a preventative should be tried. For abortives, there are six more triptans, several ergots, many more analgesics, etc. I think you would be likely to respond to something if you try enough...even if they weren't migraines. Best wishes.
I am not sure about LA meds. From what I have researched I don't think any would be equivalent to 7.5 hydrocodone (I believe they would be too strong) I also don't have prescription coverage so anything I do take needs to be relatively inexpensive. I also take a fairly large dose of anti depressants (savella and trazadone) I do get tpi done monthly and ready for this, insurance will not pay for a nerve block (nor will they pay for botox injections which my doctor thinks I would be a prime canidate for, and while we are at it they also will not pay for an MRI to confirm what my doctor believes is a herniated disc causing a significant amount of sciatic pain)
Vicodin is completely ineffective for my migraines and causes rebound headaches which is why I stick to the muscle relaxer/melatonin/ice combo. The tpi are normally helpful but for some reason have not done a thing this month.
I did see a neurologist for my migraines about a year ago. He put me on neurotin which I had horrible side effects with. When I asked him if we could try something else he told me "there are no side effects with neurotin, anything else I give you will make you fat" <- yes that was a true quote. Needless to say I was frustrated at that point which is when I switched to my current doctor.
The reason I have not tried anymore preventive medicine is, as I mentioned, the tpi are normally extremely helpful the first 3 weeks and normally I only get a migraine once or twice a month which IMO does not warrant taking another medication. I did start researching medications the past few weeks since they don't seem to be working this time (I got them done 2 weeks ago and have had 4 migraines since)
Im sorry if this post is a little scrambled, as usual I am slowly working on getting the coffee made
From what you have written...I don't see you moving up to a long acting med just yet either. We should always want to be on the lowest possible dosage of medication since this is going to be a life long journey for most of us. I haven't changed dosages in the last 3 years.
When I first started on medication, I was on Percocet for many years at only 2-3 a day.
It sounds like you are doing pretty much all you can and the main thing now will be journaling your pain to better be able to use the Vicodin and other meds to help your pain levels from getting too high. But like most of us...there will just be those days here and there that are the "bad" ones where we curl up and rest for the day.